**9. Medical examination**

*Recent Advances in Biomechanics*

symmetry.

hazardous (e.g., deposits of toxic substances).

**8.1 Elements of the movement metrology**

the cerebrum created the seeds of abstract thinking, tend to quickly expand the strategy of survival in the environment by joining simple unconditional reflexes complex sequences of behavior aimed at classifying the environment into neutral, health-promoting areas (vegetation, water reservoirs, mineral deposits) and clearly

The symmetry of the structure and function of the basic elements of the human body remains in a close cause-and-effect relationship with the symmetry of the structure of the nervous system, treated as a control system, as well as the vascular system, which is in fact a supply and control system for the cellular stroma. Therefore, it can be assumed that each of the organ pairs existing in the living organism, despite the high level of structural separation, functions in an information-coupled manner by means of mirror elements of the nervous system, as well as in hormonal-distribution couplings implemented through the vascular system. The balance of the neural network conducted in subsequent integrators of the spinal cord and hypothalamus, in terms of controlling the distribution of signal and nutrients, including the mechanical and energetic loading of pairs of twin organs, allows their maintenance in a state of functional and anatomical

The macroscopic effects of maintained symmetries (especially in the geometrical range) currently belong to the basic criteria for assessing the condition of the musculoskeletal system. However, using the bioengineering assessment of the disease, which occurs with one limb dysfunction, it can be presented as asymmetries of individual parameters or parametric sets, not only regarding the location of markers of body movement in 3D space but also muscle strength, blood supply, resistance, temperature, and skin sensitivity to stimuli, while the numerical determinant of these asymmetries decreases from unity to 0, as the dysfunction increases in the course of the disease and increases again (to values close to unity), in a manner proportional to the disappearance of the symptoms of the disease [92, 93].

In this context, it is worth paying attention to the need for a reliable, parametric and quantitative estimation (that corresponds with the degree of biomechanical dysfunction of the musculoskeletal system) of a greater number of internal body parameters, whose mutual relationships shape the causative dimension of the noticeable biomechanical asymmetries, as well as the disease-related feelings of the patient. It is worth to note that it is difficult to talk about a proper estimation of the current state, prognosis, and treatment effects, without a reliable estimation of the quantitative parameter. Therefore, methods for objective monitoring of disease parameters are actively searched for. Great importance is attached to diagnostic imaging, pathology, and electrodiagnostics. The criterion systems existing in modern medicine give high sensitivity and specificity of qualitative diagnoses, in particular for diseases with a well-recognized etiology and mechanisms of action. An experienced doctor examining a patient is able to see in his body many deviations, such as compensatory movement profile asymmetries, static kinetic reflex disturbances in the Romberg test, temperature and humidity asymmetry of limbs, difference in skin sensitivity to pain and touch, and asymmetry of limb mobility and reflexes; however, he has a difficulty in parametric and numerical estimation of the characteristics of his observations. Estimated methods still exist in the practically used scope of locomotor system assessment, based on interactive, subjective relations between the patient and the doctor, such as the older Lovett scale, visual analog scale (VAS), or newer quality

**60**

of life scales [94, 95].

The metrological dimension of daily medical examinations of the musculoskeletal system is usually limited to the use of simple measurement techniques and tools, due to the difficult access to expensive, advanced measuring technology. In addition, although there are many sites with advanced quadroscopic and strain gauges for assessing and recording biomechanical parameters, their presentation and data collection systems are usually incompatible on an inter-center scale.

The first element of this procedure, an interview, organizes knowledge on the subjective symptoms of the patient. The study design is layered, because it begins with a general health assessment, and delves into the area of details that are specific for certain organs, so it is relatively easy to reduce it to a survey test, allowing for an approximate quantitative assessment. The quality of life rating scales, anatomicalfunctional syndrome assessment scales, and pain assessment scales have gained in importance here. The credibility of this information depends on:


The doctor's education, clinical internship, and experience as well as his condition on the day of the examination determine whether the collected information will be used as an inspiration for a series of diagnostic associations.

The physical examination is an assessment of the patient's state of health with the use of the telereceptors (eyesight, hearing, smell) and extroceptors (touch, heat, cold, movement) in palpation. The next stage of the study is the use of minimally invasive stimulations in the form of tactile and tactile stimuli, provocative tests, or simple measurement tools. Subsequently, tests are carried out using a goniometer, plurimeter, plumb line, and linear bearing, which allow simple numerical approximations, unfortunately often unrepeatable, due to the fact that every physician introduces some alterations (based on his/her own experience) into the measurement standards. In practice, it translates into introducing one's own interpretations or minor methodological mistakes, specific for one's habits referring to measurement position and the method of the measurement tool's application. These phenomena, provided that patients are examined by the same physician, generate a uniform and distinctive profile of system errors that are fairly easy to eliminate, but when these patients deal with other doctors, they are confronted with a different interpretation profile of the measurement principles (system errors). The overlapping of different approaches to accomplish the same measurement task often leads to the interpretation differences, not only in terms of quantitative assessments but even of the qualitative criteria [61].
