**1. Design of the associated measurement symmetry system**

The questions posed above express doubts and searches of many specialists in the field of biomechanics - anthropomotorics in particular. Initiation of the associated measurement symmetry system (AMSS) was an attempt not only to answer the above questions but also to draw attention of the medical and scientific community involved in the study of the musculoskeletal system, to the need to search for a universal standard (protocol) and a multiband system for evaluation of the structural and motor characteristics of the body. The analysis of the existing measuring instruments clearly indicates that in order to simultaneously use several measurement methods, each of which has originally different system of units (on an interval scale), we are not able to assess the interparametric relationships in real time, and possible relationships between parameter trends can be expressed with a long delay, by means of using statistical tests only. In this situation, a good and

**22**

1999. pp. 8-11

*Recent Advances in Biomechanics*

1980;**33**(8):1846-1851

**References**

[1] Hall C, Quigley O, Giles R, Sc M. Upper limb anthropometry: The value of measurement variance studies. The American Journal of Clinical Nutrition. www.noraxon.com/docs/education/abc-

[10] Tronstad C, Johnsen GK, Grimnes S, Martinsen ØG. A study on electrode gels for skin conductance measurements.

[9] Spach MS, Barr RC, Havstad JW, Long EC. Skin-electrode impedance and its effect on recording cardiac potentials.

Circulation. 1966;**34**(4):649-656

Physiological Measurement. 2010;**31**(10):1395-1410

[11] Pallás-Areny R, Webster JG. Common mode rejection ratio in differential amplifiers. IEEE Transactions on Instrumentation and Measurement. 1991;**40**(4):669-676

[12] Fuglevand AJ, Winter DA,

1992;**67**(2):143-153

Compartments. 2019

Patla AE, Stashuk D. Detection of motor unit action potentials with surface electrodes: Influence of electrode size and spacing. Biological Cybernetics.

[13] Winter D, Fuglevand AJ, Archer S. Crosstalk in surface electromyography: Theoretical and practical estimates. Journal of Electromyography and Kinesiology. 1994;**4**(1):15-26

[14] Chaudhry M, Arain A. Anatomy, Shoulder and Upper Limb, Forearm

of-emg.pdf

[2] McDowell MA, Fryar CD, Ogden CL, Flegal KM. Anthropometric reference data for children and adults: United States, 2003-2006. National Health Statistics Reports. 2008;**10**:2003-2006

[3] Greiner TM. Hand Anthropometry of U.S. Army Personell. Technical Report Natick. 1991;TR-92/011:434. Available from: http://oai.dtic. mil/oai/oai?verb=getRecord{&} metadataPrefix=html{&} identifier=ADA244533

[4] Muzumdar A. Powered Upper Limb Prostheses: Control, Implementation and Clinical Application; Verlag Berlin

Heidelberg: Springer; 2004

[5] Hermens HJ, Freriks B, Disselhorst-Klug C, Rau G.

pii/S105064110000027

Development of recommendations for SEMG sensors and sensor placement procedures. Journal of Electromyography and Kinesiology. 2000;**10**(5):361-374. Available from: http://linkinghub.elsevier.com/retrieve/

[6] Winter DA, Rau G, Kadefors R, Broman H, De Luca C. Units, Terms and Standards in the Rporting of EMG Research. Report by the Ad hoc Committee of the International Society of Electrophysiological Kinesiology; 1980

[7] Hermens HJ, Freriks B, Merletti R, Stegeman D, Blok J, Rau G, et al. European Recommendations for

Surface ElectroMyoGraphy. Netherland: Roessingh Research and Development;

[8] #Book\_Lib. The ABC of EMG. March; 2006. Available from: http:// expected solution would be to illustrate on one graph, calibrated with one time stamp (in a selected, universal frame of reference), a whole range of parameters, starting with the traditional vector features of motion, with attached, parallelly registered causative parameters of motion, e.g., rheological, impedance, and magnetic, as well as parameters of physical effects of motion on the ground (strain gauge measurements) and electrodiagnostic imaging and psychometrics. Reflecting on one correlated graph, the phenomena of parameter symmetry for parallelly used measurement techniques (or with a slight time shift) provide a unique opportunity to formulate static and dynamic motor standard of the body, containing the parameters of the specific psychometric and electrogalvanic predispositions, resulting in the creation of a time-space distribution of motion vectors and also the temporalspatial distribution of gravity vectors in the area of contact of the limbs with the ground [1–4].

The use of the quotient scale allows to incorporate into the system almost every research method, in a manner that refers to the symmetrical construction plan of the musculoskeletal system (and many internal organs) or, in other words, to measure the mirror areas of the left and right upper and lower limbs and trunk. The consequence of this action is determining the nondimensional representation (coefficient) for the symmetry of a measurement pair in the field of a specified physical quantity, presented as a symmetry, asymmetry, or lateralization indicator, whose value is in the range of 0–1.

The next part of the work presents the author's design of a device implementation, along with the base of a systemic software based on the quotient scale, where interactions between parameters derived from several concurrent measurement devices are easily visible on one graph in real time. It should be noted that the basic feature of the quotient scale—auto-calibration and the absolute zero associated with it—allows for a simple presentation of dynamic and structural symmetry (reflecting the state of balance) and asymmetry phenomena (reflecting the state of dysfunction). It is also worth to notice the advantages lying in the practical aspect, namely, great ease to compare or even convert data from measurement systems based on the interval scales. For this purpose, the system will be equipped with an interface, allowing for a systemic application of data from devices which show results in the interval scales. The adoption of a universal, multiparametric quotient scale to illustrate the results of instrumental research and to associate it with known, clinical criteria of a medical examination may be an introduction to the formulation of more strict definitions of the patient's condition at the stage of diagnosis, the subsequent stages of treatment, as well as the determination of the recovery criteria (in relation to the parameters of the group standard).

Another issue is the need to develop the technical standard of the device and the measuring points, lying on the body's subsequent levels in a standing position—for easier visualization, they were called transverse measurement planes (TMP), with a strict location for each type of measurement (like the location of the electrodes in the ECG). The output standard should contain a set of horizontal measurement planes and a scheme of their vertical correlations. The next part of the implementation is a standard procedure for testing medical devices, which involves, among others, developing a standard of population norms, in the first phase for healthy individuals (including sexual dimorphism and the process of involution in several standard age groups). In the second phase, after selecting diseases of the locomotor system with particularly specific criteria for the clinical diagnosis, they should be expanded by a formal description of symmetry in standard measurement planes of geometric, kinematic, rheological, thermal,

**25**

*Theoretical Biomechanics: Design of the Associated Measurement Symmetry System*

electrical, and magnetic features, whose classification (and then unification) will give the chance to formulate a concise statement setting out the state of parametric symmetry (or asymmetry) of patient's organism, as compared to the group norm, pathology pattern of a disease unit, or comparatively, between the initial state and the next stage of the therapy. Following the above in relation to disease units with specific diagnostic criteria, one can think of attributing sets of relevant coefficients of asymmetry to them, thus enriching the diagnostic criteria with a quantitative dimension. A desired, but still unsurpassed, standard to be followed by locomotor organ diagnosticians should be the topographic-parametric formula of registering in ECG, which FUNCTIONS OVER THE SYSTEM AND LANGUAGE

In experimental studies conducted among large groups of students and healthcare professionals, a repeatable and close relationship between structural symmetry coefficients and symmetry of marker dynamics was observed, and above all, with the coefficients of changes in tissue perfusion, their temperature, resistance, and magnetic induction. The high repetition of the symmetry trend observed in subsequent age groups and the diverse asymmetry in the population of patients raises the hope of creating reliable norm standards for involution phenomena and selected

Presentation of a global, multiparameter body description on a single graph, which allows simultaneous display of coexistence and correlations between the dominant parameters describing patient's condition, on the one hand requires focusing on the clinical phenomena, which are the most important in this case, and, on the other hand, converting all results registered in a variety of disease units—to

The measurement is a procedure of associating the features of the examined objects with numbers or other symbols according to specific rules for which (1) the relationship between the numbers and features subject to measurement must be exclusive, (2) the rules for assigning number features should be standardized and applied uniformly, and (3) these rules must not change in relation to the objects and time. The next step is scaling, i.e., creating a continuum on which numerically measured object features are placed. This enables measuring, i.e., assigning to each tested object a strictly defined number within the range of the scale used. Among the scaling techniques, there are (1) comparative scales that allow direct comparison of the features of the examined objects in relative categories and are ordinal or rank and (2) noncomparative scales, for which each object is scaled independently of the others in the examined set, while the results are interval or quotient. Despite the benefits of using comparative scales, such as a common reference point and the ease of detecting small differences between the tested objects and a small number of theoretical assumptions, they have significant disadvantages, which include the ordinal nature of the data and the resulting inability to approximate results outside

The quotient scale is the most versatile, because it has all the properties of a nominal, ordinal, and interval (fixed unit) scale, allowing for precise calculation of relationships between the scale values, for which all proportional transformations are permitted. The most important of its advantages, not occurring globally

**1.1 Searching for one scale for the symmetry phenomena**

*DOI: http://dx.doi.org/10.5772/intechopen.92758*

BARRIERS WORLDWIDE.

types of pathology.

one, universal scale.

**1.2 Measurement and measuring scales**

the population of the scaled test objects.

*Theoretical Biomechanics: Design of the Associated Measurement Symmetry System DOI: http://dx.doi.org/10.5772/intechopen.92758*

electrical, and magnetic features, whose classification (and then unification) will give the chance to formulate a concise statement setting out the state of parametric symmetry (or asymmetry) of patient's organism, as compared to the group norm, pathology pattern of a disease unit, or comparatively, between the initial state and the next stage of the therapy. Following the above in relation to disease units with specific diagnostic criteria, one can think of attributing sets of relevant coefficients of asymmetry to them, thus enriching the diagnostic criteria with a quantitative dimension. A desired, but still unsurpassed, standard to be followed by locomotor organ diagnosticians should be the topographic-parametric formula of registering in ECG, which FUNCTIONS OVER THE SYSTEM AND LANGUAGE BARRIERS WORLDWIDE.

In experimental studies conducted among large groups of students and healthcare professionals, a repeatable and close relationship between structural symmetry coefficients and symmetry of marker dynamics was observed, and above all, with the coefficients of changes in tissue perfusion, their temperature, resistance, and magnetic induction. The high repetition of the symmetry trend observed in subsequent age groups and the diverse asymmetry in the population of patients raises the hope of creating reliable norm standards for involution phenomena and selected types of pathology.

#### **1.1 Searching for one scale for the symmetry phenomena**

Presentation of a global, multiparameter body description on a single graph, which allows simultaneous display of coexistence and correlations between the dominant parameters describing patient's condition, on the one hand requires focusing on the clinical phenomena, which are the most important in this case, and, on the other hand, converting all results registered in a variety of disease units—to one, universal scale.

#### **1.2 Measurement and measuring scales**

The measurement is a procedure of associating the features of the examined objects with numbers or other symbols according to specific rules for which (1) the relationship between the numbers and features subject to measurement must be exclusive, (2) the rules for assigning number features should be standardized and applied uniformly, and (3) these rules must not change in relation to the objects and time. The next step is scaling, i.e., creating a continuum on which numerically measured object features are placed. This enables measuring, i.e., assigning to each tested object a strictly defined number within the range of the scale used. Among the scaling techniques, there are (1) comparative scales that allow direct comparison of the features of the examined objects in relative categories and are ordinal or rank and (2) noncomparative scales, for which each object is scaled independently of the others in the examined set, while the results are interval or quotient. Despite the benefits of using comparative scales, such as a common reference point and the ease of detecting small differences between the tested objects and a small number of theoretical assumptions, they have significant disadvantages, which include the ordinal nature of the data and the resulting inability to approximate results outside the population of the scaled test objects.

The quotient scale is the most versatile, because it has all the properties of a nominal, ordinal, and interval (fixed unit) scale, allowing for precise calculation of relationships between the scale values, for which all proportional transformations are permitted. The most important of its advantages, not occurring globally

*Recent Advances in Biomechanics*

ground [1–4].

value is in the range of 0–1.

of the group standard).

expected solution would be to illustrate on one graph, calibrated with one time stamp (in a selected, universal frame of reference), a whole range of parameters, starting with the traditional vector features of motion, with attached, parallelly registered causative parameters of motion, e.g., rheological, impedance, and magnetic, as well as parameters of physical effects of motion on the ground (strain gauge measurements) and electrodiagnostic imaging and psychometrics. Reflecting on one correlated graph, the phenomena of parameter symmetry for parallelly used measurement techniques (or with a slight time shift) provide a unique opportunity to formulate static and dynamic motor standard of the body, containing the parameters of the specific psychometric and electrogalvanic predispositions, resulting in the creation of a time-space distribution of motion vectors and also the temporalspatial distribution of gravity vectors in the area of contact of the limbs with the

The use of the quotient scale allows to incorporate into the system almost every research method, in a manner that refers to the symmetrical construction plan of the musculoskeletal system (and many internal organs) or, in other words, to measure the mirror areas of the left and right upper and lower limbs and trunk. The consequence of this action is determining the nondimensional representation (coefficient) for the symmetry of a measurement pair in the field of a specified physical quantity, presented as a symmetry, asymmetry, or lateralization indicator, whose

The next part of the work presents the author's design of a device implementation, along with the base of a systemic software based on the quotient scale, where interactions between parameters derived from several concurrent measurement devices are easily visible on one graph in real time. It should be noted that the basic feature of the quotient scale—auto-calibration and the absolute zero associated with it—allows for a simple presentation of dynamic and structural symmetry (reflecting the state of balance) and asymmetry phenomena (reflecting the state of dysfunction). It is also worth to notice the advantages lying in the practical aspect, namely, great ease to compare or even convert data from measurement systems based on the interval scales. For this purpose, the system will be equipped with an interface, allowing for a systemic application of data from devices which show results in the interval scales. The adoption of a universal, multiparametric quotient scale to illustrate the results of instrumental research and to associate it with known, clinical criteria of a medical examination may be an introduction to the formulation of more strict definitions of the patient's condition at the stage of diagnosis, the subsequent stages of treatment, as well as the determination of the recovery criteria (in relation to the parameters

Another issue is the need to develop the technical standard of the device and the measuring points, lying on the body's subsequent levels in a standing position—for easier visualization, they were called transverse measurement planes (TMP), with a strict location for each type of measurement (like the location of the electrodes in the ECG). The output standard should contain a set of horizontal measurement planes and a scheme of their vertical correlations. The next part of the implementation is a standard procedure for testing medical devices, which involves, among others, developing a standard of population norms, in the first phase for healthy individuals (including sexual dimorphism and the process of involution in several standard age groups). In the second phase, after selecting diseases of the locomotor system with particularly specific criteria for the clinical diagnosis, they should be expanded by a formal description of symmetry in standard measurement planes of geometric, kinematic, rheological, thermal,

**24**

in other scales is a non-arbitrary "0" point on the scale, is the so-called absolute zero, giving the possibility of estimating not only the symmetry of parameters measured by a common unit but primarily a comparison (on one frame of reference) of measurement trends, based on units that are significantly different in their specificity, and virtually using all statistical techniques. Quotient scale, as the most versatile, has all the properties of nominal, ordinal, and interval scale, enabling precise calculation of relationships between the scale values, for which all proportional transformations in the form of y = bx (where b is a positive number) are allowed.

Typization is the process of ranking elements of reality into certain types by referring to existing knowledge resources, preferably parametric (Schütz). A specific element of the surrounding space is treated as similar, provided that the construction and parametric criteria typical of the previously created and known set of features are met. This procedure is an expression of the use of economic simplifications in the classification of objects. Getting to know the surrounding space, you first perceive the general features typical of the class of the object and only then focus on the details. A certain analogy, in particular for the creative process, is standardization, i.e., the activity of analyzing and giving new procedures and innovative products' parametric repeatability to ensure compatibility and limit unnecessary diversity. Profiles of standardized products are made public in the form of standards, technical regulations, or recommended parametric standards (e.g., SI).

The idea of typing for a measuring system is reflected in **Figure 1**, where each of the measured parameters is presented as a plane built into the patient's standard silhouette, on which the lateralization coefficient is determined, which is a reflection of the local parametric symmetry determined on the basis of sensor indications applied at standard marker points. The quotient of these values gives a lateralization

#### **Figure 1.**

*The layout of marker symmetry on AMSS measurement planes according to the P402850 patent application in the Polish Patent Office, entitled "Method of formulating parametric, diagnostic-therapeutic criteria with an algorithm and device for its implementation".*

**27**

**Figure 2.**

*Theoretical Biomechanics: Design of the Associated Measurement Symmetry System*

coefficient, the value of which can depict the symmetry or asymmetry of a given parameter on a common quotient scale. Based on population surveys, mean and reference values as well as the range of standard deviation of results can be deter-

While developing the author's concept of anatomical-functional parameteriza-

1.Introduction of (employed by us) anatomical standard agreed on transverse measurement planes of the body A(1…n) (**Figure 2**) in order to determine symmetric left-hand MA(1…n)L(x1…n) and right-hand MA(1…n)P(y-…n) markers – their location quite naturally prompts a conversion of any interval parametric scale (exemplary units: V, mA, Ω, um, T) to symmetry and asymmetry indices on a quotient scale, which may reflect symmetry or asymmetry of both, selected features of static images (photography, radiography, and microdensitometry), anatomical structure of twin body organs (joints, bone parts, and points of silhouette contours), dynamic images (quadroscopy and X-ray seriography), and recordable spontaneous (thermography, magnetography, and electrography) and forced emission phenomena (scintigraphy, gammagraphy, and SPECT). It also applies to contact recording of dynamic (accelerometry, gyrometry, and tensometry), electrical (EMG, ENG, EEG, EOG, and PCP), and magnetic phenomena, as well as rheological parameters in symmetrical points of the vascular system (plethysmography, Doppler-USG, angio-CT,

*Exemplary construction of a measurement graph with indication of lateralisation direction (R/L), type of the test (STM—survey tests, MSPT—static planimetric tests, MDPT—dynamic planimetric tests, CTM—*

*biometric tests, ATM—biochemical tests) and sequence of time stamps.*

tion of symmetry, attention was drawn to the subsequent stages necessary for

*DOI: http://dx.doi.org/10.5772/intechopen.92758*

mined in subsequent age groups.

implementation [5]:

and angio-MR).

**1.3 A summary of the project features**

*Theoretical Biomechanics: Design of the Associated Measurement Symmetry System DOI: http://dx.doi.org/10.5772/intechopen.92758*

coefficient, the value of which can depict the symmetry or asymmetry of a given parameter on a common quotient scale. Based on population surveys, mean and reference values as well as the range of standard deviation of results can be determined in subsequent age groups.
