| Research backgroundManipulation is a old external therapy of traditional Chinese medicine (TCM) in clinical disciplines, on which clinical workers are increasingly attracted attention at home and abroad for its unique efficacy and specialty of simplicity, comfort, effectiveness, safety. With the characteristics of dredging meridians, accelerating circulation of qi and blood, restoration of muscle, lubricating joints, adjusting internal organs function, enhancing disease resistance and so on, manipulation is widely applied in clinical disease such as orthopedic, internal medicine, gynecology, surgery, pediatrics, neurology and other subjects. As a natural therapy without drug side effects and invasiveness, it can emerge some abnormalities when there are operation mistake or patients are in inappropriate posture. And then these accidents can minor interference the effective of manipulation, or serious harm the human body or even threaten patients’life. So advancing the correctness and security is a key for teaching and clinical practice of manipulation. Experimental study has been very lagging behind in this field. Since1980s, the massage science got faster growth with the cross and penetration between the basic crossing subjects and it. And the study scope was expanded from human trials to animal experiments, from the clinical curative effect to the function mechanism of manipulation.Rolling manipulation was created by Ding Ji-feng who inherited the basis of pushing manipulation with one finger, which inherited the softness and increased the advantages of large treatment area and strong stimulation. Rolling manipulation is to roll and rotate on operation place using ulnaris flank of palm back and back protuberance of metacarpophalangeal joints. And it is mainly used in the treatment of sports system and peripheral nervous system diseases.For many years because of lack of research on dose-response relationship of manipulation and lack of objective quantification research for operating standards for guidance, the pattern of rolling manipulation presented diversity and clinical using exsisted blindness and arbitrariness. Even the most basic characteristics were lacking of creditable objective quantitative research. That doctor estimated the quantity and time of manipulation by patients’reaction and their clinical experiences has seriously impeded understanding and applying of the technique and has hampered further improveing of the curative effect. It is common to augmenting manipulation strength and prolonging treatment time blindly to enhance the curative effect. Revealing the essence and characteristics, analysing it qualitatively and quantitatively, surveying the characteristics of changing of physical quantity in operation, to establish the quantizing and normalized experiment research on manipulation, has proved to be an important issue that should be resolved immediately by massage/manipulation discipline of traditional Chinese medicine (TCM).Novel pliance mobile system (NPMS) was manufactured by NOVELgmbh of Munich of Germany, which was dynamic stress test system of capacitative sensors. The pliance mobile is a dynamic pressure distribution measuring system for capacitative sensors. The system is designed for a variety of testing use including medical, ergonomics and biomechanics applications. NPMS was one of the three system (pliance, pedar emed) that was developed to measure the contact pressure of multiple ensemble surface.(1)Structure and working principle Novel was based upon calibration, accurate and reliable capacitive sensor. Every sensor was elastic and was arranged according to matrix, that can attached to the three-dimensional surface. Sensor array was connect to the Novel pliance electronic devices.(2)Analysis of data acquisition and processing Measurement and real-time display of dynamic stress can be synchronized. These data of stress, contact area and time can be displayed on the screen at the same comparison after data acquisition. Process includes the calculation of center of pressure, force and area of the curve derivation and so on. Stress analysis can be online or off offline by a computer or handheld computer to complete.(3)Applied range This system is used in recommended temperature0-40°C, humidity20-80%. Novel system can measure the relatively soft surface pressure mainly in these field such as aircraft and car seats, office chairs and wheelchairs. We used the pliance-M expert S2020, and introduced it to massage pressure measurements and found it was an ideal tool for rolling manipulation.ObjectiveTo introduce Novel pliance mobile system to research rolling manipulation to clarify the characteristics of the image and area of rolling manipulation. And to compare the similarities and differences of the image and area of different operators. To provide a quantitative standardized and objective-oriented basis for clinical doctors and beginners to learn rolling manipulation.MethodsMedical students and physicians who had received formal training in manipulation of TCM were divided into3groups by learning and work experience of manipulation. Group A, the juniors, who are beginners of massage students, study and apply the rolling manipulation less than3years and grasp the rolling manipulation generally and inferiorly. Group B, the intermediates, who study and apply the rolling manipulation from3to8years, grasp the rolling manipulation well and superiorly. Group C, the seniors, who study and apply the rolling manipulation more than8years, grasp the rolling manipulation superiorly and were teachers who had been engaging in clinical manipulation physician and teaching massage for many years. There were20,10and5participants separately in group A, B and C, a total of35participants.And then connected the ports of NPMS closely, turned on the software of Novel, adjusted and corrected the pressure sensors. The software of Novel should be adjusted before data collectiog every time. Parts of the setup were as follows. Scanning Rate was38.000frames/sec, Baud Rate was115200Baud, CUT-OFF/COLOR COPE was≥0.200N/cm, X-edge was1.250, Y-edge was1.250, Area was1.563cm2, Time/frame was13.333ms。Manipulators who did not exercise strenuously and drink heavily within two days before experiment should have30-minute break before data collectiog. Their informations were collected when they were at rest by checksheet. Every manipulators, who then firstly were familiar with essentials again, manipulated tentatively on the mat for1minute which was on desk flatwise, and then manipulated for2minutes. The manipulating was in strict accordance with requirements on massage monograph. The maximum compression pressure, contact area and other informations for each operator were real-time display in computer. The collected data were processed and analysed by intrinsic software and SPSS13.0.Results1. Fundamental informations about manipulators Manipulators of group A were all graduate students in school, who were major in traditional Chinese medicine and systematically studied the regular massage from undergraduate school. They were22-26years old, averaging24.08years old,162-180cm height, averaging169.75cm, 50-70kg weight, averaging59.58kg, who had been studying and applying the rolling manipulation less than3years, averaging2.58years.Manipulators of group B were all graduate students in school and clinical manipulation and rehabilitation physicians or teachers, who were major in traditional Chinese medicine and systematically studied the regular massage from undergraduate school. They were23-29years old, averaging25.33years old,165-182cm height, averaging171.50cm,61-70kg weight, averaging66.33kg, who had been studying and applying the rolling manipulation from3to8years, averaging4.33years.And group C were all teachers who had been engaging in clinical manipulation physician and teaching massage from12to25years, averaging18.5years.. They were31-47years old, averaging39.5years old,167-178cm height, averaging171.75cm,70-78kg weight, averaging73.25kg.2. Area of rolling manipulation The result of average total area was group B>group C>group A, the difference between the maximum and minimum area was group B>group A>group C, the average maximum area was group B>group C> group A, the average minimum area was group C>group A>group B. Minimum of area in group A and B was0, which meant there existed jump when they were manipulating.3. The whole image of rolling manipulating The whole image was the overall image of the operation for2minutes, that was classified according to three kinds of methods:①the pressure uniformity,②the overall image morphology and③pressure image patterns over3N/cm2. Images can be classified to4types according to the pressure uniformity:the type I of very uneven pressure, the type II of uneven pressure, the type III of lack of uneven pressure, the type Ⅳ of even pressure.Images also can be classified to5types according to the overall image morphology:the type I of squareness, the type II of triangle, the type III of shape of q, the type IV of strip and the type V of irregular.Images can be classified to5 types according to pressure image patterns over3N/cm2:the type Ⅰ of a big monoblock, the type Ⅱ of a small monoblock, the type Ⅲ of2roughly equal block, the type Ⅳ of2unequal block and the type Ⅴ of multi-block. Ratio of the type Ⅰ of very uneven pressure, the type Ⅱ of uneven pressure were40%、70%and100%seperately in group A, B and C according to①the pressure uniformity. Majority was the type Ⅲ of shape of q in group A, the type Ⅰ of squareness and the type Ⅱ of triangle in group B, the type Ⅲ of shape of q and the type Ⅰ of squareness in group C seperately according to②the overall image morphology. Majority was the type Ⅰ of a big monoblock all in the3group according to pressure image patterns over3N/cm2that was40%、30%、60%in group A, B and C seperately.4. The images of each stages of rolling manipulation The images of each stages of rolling manipulation was the pressure image collected by pressure sensors at intervals of every0.04seconds (adjustable), and these images composed a continuous rolling screen when playing. NPMS can instantly display dynamically the changes of the pressure and image of rolling manipulation. That richness of images transformation of group A was less than group B and C meant that action was blunt and lack of alternating in group A. Transformations of image, area and pressure in group B were bigger than in group A and C. Numerical value transformations of area and pressure were moderate in group C.ConclusionNovel system provided an ideal quantifying basis and testing tool to research rolling manipulation which can wonderfully display the characteristics of images and area of rolling manipulation. This experiment provided scientific basis for the visual displaying and standardization and quantification of rolling manipulation. The result of average total area was group B>group C>group A. The difference between the maximum and minimum area was group B> group A> group C. In a cycle the average maximum area was group B>group C>group A, the average minimum area was group C>group A>group B. But it can not concluded that the biger or the smaller was better as to average total area because of. multitudinous factors that can inflect the average total area. That minimum of area in group A and B was0, which meant there existed jump when they were manipulating, was a objectiveevidence that manipulaters in group A and B did not grasp manipulation masterly. NPMS can instantly display dynamically the images changes of rolling manipulation. Ratio of the type I of very uneven pressure, the type Ⅱ of uneven pressure were40%,70%and100%seperately in group A, B and C according to①the pressure uniformity. Majority was the type III of shape of q in group A, the type I of squareness and the type II of triangle in group B, the type III of shape of q and the type I of squareness in group C seperately according to②the overall image morphology. Majority was the type I of a big monoblock all in the3group according to pressure image patterns over3N/cm2that was40%、30%、60%in group A, B and C seperately. All of these meant that group A was worse than group B, and group B was worse than group C as to the proficiency and fluency of manipulation. The images in manipulating were different forms so all the images can be classified capitally. That richness of images transformation of group A was less than group B and C meant that action was blunt and lack of alternating in group A as to the images of each stages of rolling manipulation. Transformations of image, area and pressure in group B were bigger than in group A and C. Numerical value transformations of area and pressure were moderate in group C,which meant the manipulation in group C was better than in group B and C. |
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