Patent Publication Number: US-2021169377-A1

Title: Device For Sensing Displacement During A Joint Mobilization Procedure And Method For Using Such A Device To Quantify Joint Mobilization And Detect Joint Laxity

Description:
BACKGROUND 
     The application relates generally to a device used to quantify grades of joint mobilization and detect joint laxity. More specifically, the application relates to a device used by a clinician that provides feedback indicative of the quantity or grade of joint displacement during joint mobilization and testing. 
     Joint mobilization is a technique routinely used by clinicians, such as physical therapists, to address pain and mobility limitations related to musculoskeletal injury. During joint mobilization, a joint of an injured area of the body is manually moved by the clinician. An exemplary joint mobilization technique involves the linear translation of one joint surface on another, as shown in  FIGS. 1A  and B. Joint mobilization is typically classified into one of four (4) grades of mobilization. Criteria for each four (4) grades of joint mobilization (I-IV) are clearly defined  FIG. 2 . As shown, the grades in this example are defined by the degree of applied force and displacement, as a percentage of total range of motion. In practice, the grades of joint mobilization can be challenging to identify accurately, and as a result, the clinical application of these techniques has been reported to be quite variable. This lack of consistency can have a significant effect on patient outcomes. Furthermore, previous methods of measuring joint mobility were expensive, with large equipment that was not easily portable, adaptable to different sized patients or joints, and/or required the clinician to lose visual or touch contact with the patient during use. 
     A need therefore exists, to accurately identify the grade of joint mobilization undergone during treatment. 
     SUMMARY OF THE EMBODIMENTS 
     A medical device to communicate a grade of joint mobilization during a mobilization procedure on a joint, includes a main base body portion; a proximal body portion engaged to the main base body portion through rollers and slots such that the main base body portion and proximal body portion move relative to one another; a mechanical measurement gearing that moves a measurement spool when the base body portion and proximal body portion move with respect to one another; and a measurement tape that moves when the mechanical measurement gearing moves and indicates a measure of movement of the main base body portion and proximal body portion to one another. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIGS. 1A-B  are cross sectional views showing a joint in two positions during a joint mobilization procedure. 
         FIG. 2  is a graph of force/linear displacement applied to a joint against percentage of full range of motion, during each of four grades of joint mobilization. 
         FIG. 3  is a perspective view of a glove according to the invention, as worn on a clinician&#39;s hand during a joint mobilization procedure. 
         FIG. 4  is a top plan view of the glove of  FIG. 3 . 
         FIG. 5  is a bottom plan view of the glove of  FIG. 3 . 
         FIG. 6  is a schematic illustration of a sensor according to an embodiment of the invention. 
         FIG. 7  is a schematic illustration of a display according to an embodiment of the invention. 
         FIG. 8  is an exploded perspective view of a sensor enclosed in a sensor housing according to an embodiment of the invention. 
         FIGS. 9 and 10  show isometric views of a device for measuring joint displacement. 
         FIGS. 11A-D  show an alternate embodiment of a distal portion of the device. 
         FIGS. 12-16  show exploded interior views within the device. 
         FIG. 17  shows an exploded view of the device. 
         FIG. 18  shows an illustration of one embodiment of the device. 
         FIG. 19  shows an example of a base lid on the device. 
         FIG. 20  shows an example of a base on the device. 
         FIG. 21  shows an example of an adapter block for the device. 
         FIG. 22  shows an example of a potentiometer hold down on the device. 
         FIG. 23  shows an example of a potentiometer adapter on the device. 
         FIG. 24  shows an example of a track capture on the device. 
         FIG. 25  shows an example of roller mount on the device. 
         FIG. 26  shows an example of a distal base. 
         FIG. 27  shows an example of a contoured attachment for a wrist. 
         FIG. 28  shows an example of a contoured attachment for a knee. 
         FIG. 29  shows an example of a contoured attachment for an ankle. 
         FIG. 30  shows an example of a contoured attachment for a shoulder. 
         FIG. 31  shows an example of a contoured attachment for an elbow. 
         FIG. 32  shows an example of a small distal base attachment. 
         FIG. 33  shows an example of a large distal base attachment. 
         FIG. 34  shows an example of a large veterinary attachment. 
         FIG. 35  shows an example of a small veterinary attachment. 
         FIGS. 36, 37A, and 37B  show exploded and assembled views of the mechanical device. 
         FIGS. 38, 38A, and 38B  show the mechanical device with cross sections in the up/zero measurement position. 
         FIGS. 39, 39C, and 39D  show the mechanical device with cross sections in the down/14 mm measurement position. 
     
    
    
     DETAILED DESCRIPTION OF THE EMBODIMENTS 
     Certain terminology is used in the foregoing description for convenience and is not intended to be limiting. Words such as “front,” “back,” “top,” and “bottom” designate directions in the drawings to which reference is made. This terminology includes the words specifically noted above, derivatives thereof, and words of similar import. Additionally, the words “a” and “one” are defined as including one or more of the referenced item unless specifically noted. The phrase “at least one of” followed by a list of two or more items, such as “A, B or C,” means any individual one of A, B or C, as well as any combination thereof. 
       FIGS. 1A and 1B  show a joint  10  connecting two bones  12 ,  14  of a human body during a joint mobilization procedure. The joint  10  illustrated is intended to be exemplary and could be any joint that connects two bones, such as an elbow, knee, hip, shoulder, etc. Furthermore, the joint need not be in a human, but could be in an animal. As shown, the joint  10  comprises a stabilized bone  12  and a mobile bone  14 . During a joint mobilization procedure, the stabilized bone  12  is retained in a fixed position by a clinician performing the procedure, while the mobile bone  14  is displaced with respect to the stabilized bone  12 , by translating in the illustrated embodiment.  FIG. 1A  shows the joint  10  in a first stage of such a joint mobilization procedure, in which the stabilized bone  12  and the mobile bone  14  are in linear alignment.  FIG. 1B  shows the joint in a second stage of the joint mobilization procedure, in which the mobile bone  14  has been translated with respect to the stabilized bone  12 . As shown in the figures, the direction of mobilizing forces changes when the joint is moved out of neutral position. The dotted line in figures represents the treatment plane. 
       FIG. 2  is a graph showing four exemplary grades of mobilization which may be used as a reference during joint mobilization. As shown, a patient&#39;s full range of motion of a mobile bone  14  with respect to a stabilized bone  12  is taken into consideration in determining the four grades of mobilization specific to that patient. Each of the grades, I-IV are determined as a function of position, taken with respect to the patient&#39;s full range of motion, versus intensity of the force applied to place the mobile bone in such a position. Different grades of joint mobilization may be applied during treatment based on the desired outcome and stage of treatment. In another embodiment, the grades of mobilization are simply determined by dividing the full range of motion of the mobile bone  14  with respect to the stabilized bone  12  by four. In addition, the grades of mobilization reflect the magnitude of the oscillations within the defined quartile of available motion, i.e. Grade I is in the first quartile of motion and are small oscillations of movement, Grade II is into the second quartile and utilizes larger amplitudes of oscillations, Grade III is in the third quartile with similar amplitudes as Grade II, and finally Grade IV is at the end of the available range/fourth quartile with small amplitude oscillations (similar to Grade I). 
       FIGS. 3-5  show an exemplary embodiment of a glove  20  according to the invention. As shown, the glove  20  comprises a dorsal side  22  that comes in contact with the outer, or dorsal side of a wearer&#39;s hand, and a palm side  24  that comes in contact with the palm of a user&#39;s hand. The dorsal side  22  and the palm side  24  are joined at opposite edges  26 ,  28 , to form a glove body, which is configured as a closed loop of fabric that surrounds the clinician&#39;s hand during wear. A first edge  26  joins the dorsal side  22  and the palm side  24  and is oriented on the outer edge, or pinky side edge, of a wearer&#39;s hand, while a second edge  28  joins the dorsal side  22  and the palm side and is oriented on the inner edge, or thumb side edge, of a wearer&#39;s hand. 
     The glove  20  further comprises a lower edge  30  defining a wrist opening  32  through which a wearer&#39;s wrist passes during wear. An upper edge  34  is located opposite the lower edge  30 . Five finger portions  36 ,  38 ,  40 ,  42 ,  44  extend outward from the upper edge  34  and are configured for receiving a wearer&#39;s fingers during wear, a first finger portion  36  being configured to receive the wearer&#39;s thumb, a second finger  38  portion being configured to receive the wearer&#39;s index finger, a third finger portion  40  being configured to receive the wearer&#39;s middle finger, a fourth finger portion  42  being configured to receive the wearer&#39;s ring finger, and a fifth finger portion  44  being configured to receive the wearer&#39;s pinky finger. As shown, each finger portion is formed as a tube configured to receive the associated finger. Preferably, as shown in  FIGS. 3-5 , the finger portions are truncated, such that each comprises an opening  46 ,  48 ,  50 ,  52 ,  54  that allows the outer portion of the associated finger to pass therethrough, exposing the outer portions and tips of the wearer&#39;s fingers. Such a configuration allows the outer portions of the clinician&#39;s fingers, including fingertips, to come in contact with a joint undergoing mobilization, as described in detail below. 
     As shown in  FIGS. 3 and 4 , the glove  20  further comprises a sensor  60 . The sensor  60  detects position and motion of the glove  20 , and in use during a joint mobilization procedure, position and motion of the mobile bone  14 , as described in detail below. As shown, the sensor  60  is positioned on the dorsal  22  side of the glove body. In use, the palm side  24  of the glove body will likely come into contact with the patient. Placement of the sensor  60  on the dorsal side of the glove body avoids the sensor  60  coming into contact with the patient&#39;s body, which could result in discomfort to the patient, interference with the joint mobilization procedure and/or damage to the sensor  60 . 
       FIG. 6  shows an embodiment of the sensor  60  in detail. As shown, the sensor  60  may comprise an accelerometer  62 , gyroscope  64 , a microprocessor  66 , a sensor display  68 , and a battery  70 . The sensor  60  is powered by the battery  70 , which may be a rechargeable battery. In some embodiments, the sensor  60  may comprise a port  72  that connects the display to an electrical power source for recharging the battery  70 , and optionally, as an alternate power source. The accelerometer  62  measures a rate of acceleration of the glove  20 . The accelerometer  62  is preferably, multi-axis accelerometer, which may be, for example a three-axis accelerometer that measures the rate of acceleration of the glove  20  in three dimensions. The gyroscope  64  measures an angular orientation of the glove  20 . The gyroscope  64  is preferably a three-axis gyroscope that measures angular orientation of the glove  20  in three dimensions. In some embodiments, an accelerometer  62  may be provided without a gyroscope  64 . In other embodiments, a gyroscope  64  may be provided without an accelerometer  62 . In other embodiments, other types of motion sensors known in the art could be employed in addition to or as an alternative to an accelerometer  62  or gyroscope  64 . 
     The sensor  60  may be enclosed in a sensor housing  100 , such as that illustrated in  FIG. 8 . As shown, the housing  100  includes an enclosure  102  that fully or partially encloses the sensor  60 . The enclosure may be formed of any suitable material, such as a polymeric material. In one embodiment, the enclosure  102  is formed of Acrylonitrile Butadiene Styrene (ABS). As shown, the sensor display  68  is viewable through the enclosure  102 . As shown, the port  72  is formed in the sensor housing to facilitate recharging of the battery  70 . In one embodiment, the port  72  is a USB port. The enclosure  102  is configured to detachably affix to a receptacle  108 . In an embodiment, the enclosure  102  affixes to the receptacle in a snapping engagement, though other means of detachably affixing the enclosure  102  to the receptacle  108  could be employed as well. The receptacle  108  affixes to the glove body. The enclosure  102  may further include terminals  106  and the receptacle  108  may include corresponding contact pads. When the enclosure  102  is affixed to the receptacle  108 , the terminals  106  come into contact with the contact pads  106 , forming a first end  92  of the connection  90  between the sensor  60  and display  80 , as described below. 
     In use, the accelerometer  62  communicates the acceleration to the microprocessor  66  and the gyroscope  64  communicates the angular position to the microprocessor  66 . The microprocessor  66  processes the acceleration and the angular position to determine the position of the glove and optionally the force applied to the mobile bone  14 . The microprocessor  66  may optionally also process the angular position to determine an orientation of the glove  20 . In some embodiments, the sensor  60  may be provided with a sensor display  68  that displays the position of the glove  20 , the orientation of the glove  20 , the force being applied to the mobile bone  14 , or any combination thereof. In some embodiments, the sensor display  68  is a low power LED display, though other types of displays known in the art could be employed as well. 
     The sensor  60  may be secured to the glove  20  by any means known in the art, such as adhesives, stitched thread, hook and loop fasteners such as those sold under the trade name VELCRO®, buttons, snaps, and other fasteners known in the art. In some embodiments, the sensor  60  is permanently secured to the glove  20 , such as by stitched thread or adhesives. In other embodiments, the sensor  60  is detachably secured to the glove  20 , such as by buttons, snaps or hook and loop fasteners. In the embodiment shown in  FIG. 8 , the sensor  60  is enclosed within a housing  100  that detachably engages snappingly with a receptacle  108  affixed to the glove body. Embodiments in which the sensor  60  is detachably secured to the glove  20  have the advantage of allowing the sensor  60  to be removed during maintenance and/or laundering of the glove  20 , avoiding potential damage to the sensor  60  during such processes. 
     The glove  20  further comprises a display  80  which is in communication with the sensor  60 . The display  80  is preferably an LED display, but can also be any type of display known in the art which is capable of providing visual feedback regarding the displacement of the glove  20 , as described herein. 
     An embodiment of the display  80  is shown in detail in  FIG. 7 . The display  80  of the illustrated embodiment comprises four indicators  82 ,  84 ,  86 ,  88 , each is which configured to illuminate in a selected color when displacement of the glove  20  is within a selected range. In one embodiment, the display  80  illuminates in each of the four different colors when the displacement of the glove is within an associated one of four different grades of mobilization. For example, the display  80  may include a first indicator  82 , which is configured to illuminate in blue when displacement is within a first grade of mobilization, a second indicator  84 , which is configured to illuminate in green when the displacement is within a second grade of mobilization, a third indicator  86 , which is configured to illuminated in yellow when displacement is within a third grade of mobilization, and a fourth indicator  88 , which is configured to illuminate in red when displacement is within fourth grade of mobilization. 
     In another embodiment, the display could include fewer or more indicators that illuminate in different colors, to indicate when displacement is within fewer or more than four grades of mobilization. 
     In another embodiment, the display  80  could include a single indicator that is configured to illuminate in multiple colors, each color being associated with a selected grade of mobilization as described above. 
     As shown, the display  80  is positioned on the dorsal side  22  of the glove body. In use, the palm side  24  of the glove body will likely come into contact with the patient. Placement of the display  80  on the dorsal side of the glove body avoids the display  80  coming into contact with the patient&#39;s body, which could result in discomfort to the patient, interference with the joint mobilization procedure and/or damage to the display  80 . In the illustrated embodiment, the display  80  is located between the second edge  28  and the sensor  60  on the dorsal side  22  of the glove body. Such placement of the display  80  makes it easily viewable to a clinician during joint mobilization, during which the thumb side of the hand is often located facing the clinician, and therefore most easily viewable. In other embodiments, the display  80  may be located on other areas of the glove body. In other embodiments, the display  80  may be attachable at different areas of the glove body. In yet other embodiments, the display  80  could be detached from the glove body and optionally affixed to a separate structure. 
     The display  80  may be secured to the glove  20  by any means known in the art, such as adhesives, stitched thread, hook and loop fasteners such as those sold under the trade name VELCRO®, buttons, snaps, and other fasteners known in the art. In some embodiments, the display  80  is permanently secured to the glove  20 , such as by stitched thread or adhesives. In other embodiments, the display  80  is detachably secured to the glove  20 , such as by buttons, snaps or hook and loop fasteners. Embodiments in which the display  80  is detachably secured to the glove  20  have the advantage of allowing the display to be removed during maintenance and/or laundering of the glove  20 , avoiding potential damage to the display  80  during such processes. 
     The sensor  60  communicates the position of the glove  20  to the display  80  via a connection  90 . In the illustrated embodiment, the connection  90  is a wired connection through which the sensor  60  transmits at least one signal indicative of the grade of mobilization. In other embodiments the connection  90  could be a wireless connection. 
     In some embodiments, the microprocessor  66  generates a position signal, indicative of the position of the glove  20  and transmits the signal to the display  80  via the connection  90 . In some embodiments, the display  80  illuminates in a selected color, as described above, indicative of the grade of mobilization, wherein the grade of mobilization is determined according to the position, or degree of displacement of the glove, and in turn the mobile bone  14 . The display  80  may then illuminate in blue during Grade I mobilization, in green during Grade II mobilization, in yellow during Grade III mobilization and in red during Grade IV mobilization, wherein Grade I mobilization is a first displacement range, Grade II is a second displacement range greater than the first displacement range, Grade III is a third displacement range greater than the second displacement range, and Grade IV is a fourth displacement range greater than the third displacement range. 
     The microprocessor  66  may optionally also process the force applied to the mobile bone  14 , in order to determine the grade of mobilization in accordance with the chart of  FIG. 2 . In such embodiments, the microprocessor  66  processes the position of the glove  20  and the force being applied, as described below, to generate a mobilization signal, indicative of the grade of mobilization, as determined according to the chart of  FIG. 2 , i.e., taking force and displacement into account, and transmits the mobilization signal to the display  80 . The display  80  may then illuminate in a selected color, as described above, indicative of the grade of mobilization, i.e., the display  80  illuminates in blue during Grade I mobilization, in green during Grade II mobilization, in yellow during Grade III mobilization and in red during Grade IV mobilization. 
     In one embodiment, the microprocessor  66  generates an orientation signal, indicative of orientation of the glove  20 , and transmits the orientation signal to the display  80  via the connection  90 . In such an embodiment, the orientation of the glove  20  could be determined by a gyroscope  64  comprised in the sensor  60 , as described above. The display  80  may indicate the orientation of the glove  20  or may provide a user with a visual or other warning when the angular orientation of the glove  20  is outside of a desired range. 
     A method for using a glove  20  according to the invention is as follows. A user or clinician places the glove  20  on the hand expected to contact a patient&#39;s mobile bone  14  during a joint mobilization procedure. The clinician uses the opposite hand to stabilize the adjacent bone, referred to herein as the stabilized bone  12 . The clinician then performs a test mobilization to determine the full range of motion of the mobile bone  14  with respect to the stabilized bone  12 . In one embodiment, the sensor  60  may be provided with means to communicate with the microprocessor  66  that the mobilization is being performed is a test mobilization, such as a button or switch  74 , in which depressing the button or toggling the switch communicates that the mobilization is a test mobilization. The accelerometer  62  senses and communicates to the microprocessor  66  the displacement of the glove  20 , and in turn, the mobile bone  14  during the test mobilization. The microprocessor  66  divides the displacement into a selected number of segments, the selected number being four in the exemplary embodiment, though it should be understood that fewer or more segments could be calculated. In one embodiment, each for the segments is equal in length. For example, in such an embodiment, if the full range of motion of the joint is determined to be 10 mm, each segment will extend for 2.5 mm. Each segment will be considered to be an individual grade of mobilization, which may be referred to as Grades I-IV described above. 
     During subsequent mobilizations executed as a means of treatment (“treatment mobilizations”) the clinician will stabilize the adjacent, or stabilized bone  12  using the ungloved hand, and displace the mobile bone  14  using the gloved hand in the manner described above. The microprocessor  66  will transmit a signal indicative of the segment in which the mobile bone  14  is currently located, and the display  80  will display information indicative of the grade of mobilization, for example by illuminating a real-time linear value and/or a selected color to indicate each Grade of mobilization, such as blue for Grade I, green for Grade II, yellow for Grade III, and red for Grade IV. 
     In embodiments in which the microprocessor processes the force applied in order to determine the grade of mobilization, the display may display information indicative of the grade of mobilization as determined according to the chart of  FIG. 2 . 
     In embodiments in which the microprocessor transmits an angular orientation signal to the display, the display may display information indicative of the angular orientation of the glove  20 . For example, the display may display a numeric value that quantifies the angular orientation of the glove  20 , or may simply communicate a warning when the angular orientation is outside of a predetermined range, which may be an auditory warning, visual warning, tactile warning, or any other type of warning known in the art. 
     The glove  20  according to the invention may be provided in different sizes and configurations to accommodate different hand sizes. Additionally, the glove could be configured to be worn on the right or left hand. In some embodiments, the sensor  60  and/or display  80  are configured to be attachable to opposite sides of the glove  20  so that it can be worn on either the left or right hand, with the sensor  60  and display  80  being located on the dorsal  22  side thereof. In other embodiments, a pair of gloves  20  according to the invention and configured to accommodate a user&#39;s right and left hand could be provided. 
       FIGS. 9-16  show an alternate embodiment of a mobilization measurement device  900  for measuring joint mobilization and/or linear translation. The mobilization measurement device  900  includes two portions, a stable base component portion  910 , and a distal base component portion  920 . The distal stable portion  920  moves linearly with respect to the stable distal portion  910  along a joint or seam in the device and measures movement by means of a linear potentiometer, as can be seen comparing the distal portion  920 &#39;s position between  FIGS. 9 and 10 . 
     The distal portion  920  may include an adjustable fin  929  that rotates about an axis  929 . The adjustable fin  929  allows the device  900  to be used on different sized and contoured patients and at also different joints. The adjustable fin  929  may be of different sizes and shapes to accommodate different joints and types of patients. 
       FIGS. 11A-11D  show views of another variation of the distal portion. An alternative distal portion  1120  includes a tab  1122  with an upturned flange  1124 . In use, this tab  1122  and upturned flange  1124  may help a clinician hold the alternative distal portion  1120  against a patient during translation. Although not shown, this alternative embodiment of an alternative distal portion  1120  may also be rotatable about an axis similar to the axis  929 . 
     As seen in  FIG. 12 , in use, a clinician aligns the stable portion  910  with a patient&#39;s stabilized bone  12  and the distal portion  920  with the mobile bone  14 . The clinician aligns the patent&#39;s joint  10  with the device joint or seam  930 . The clinician may also align a fin  929  or other specialized attachment to engage the contours of the patient&#39;s relevant body part more accurately. 
     With the device  900  properly aligned on a patient, the clinician ensures that the distal portion  920  engages the patient either through hand pressure or through a strap (perhaps VELCRO™ or other similar fasteners known in the art may be used with both portions on both sides of the joint) or other attachment means and then translates the patient&#39;s mobile bone  14  using some form of manual or machine mobilization. Movement of the mobile bone  14  with respect to the stabilized bone  12  results in corresponding movement of the distal portion  920  to the stable portion  910  along the seam  930  of the device  900 . The device  900  processes and records the portion  910  and  920 s&#39; relative movement to one another and displays a measurement of this movement on the display or screen  940 , which may be attached or detached or detachable from the device  900 . This measurement may be in units of distance, grades, or other measures as required, but in any event corresponds to the distance that the distal portion  920  moves with respect to the stable portion  910 . Measured linear distance could be between  0 . 0  and  20  millimeters. This measurement may by recorded and saved and then tracked in subsequent mobilizations. 
       FIGS. 12-16  show interior and exploded views of certain components within the device  900 . As best seen in the interior exploded view of  FIG. 13 , the device  900  includes a power switch  1310  to engage power from a battery  1320  to the power-driven components such as the linear potentiometer assembly  1330  (see  FIG. 15 ), potentiometer  1340 , and display  1360 . 
     The potentiometer  1340  includes a roller mount  1342 , linear potentiometer  1350  and potentiometer capture  1356 . A return spring  1343  extending from the roller mount  1342  engages a housing block  1380  to ensure the distal portion  920  returns to the same level as the stable portion  910  after each translation. 
     A roller mount bolt  1344  (shown as a knurled mounting hardware  1344   a  in  FIG. 16 ) extends from the roller mount  1342 , which is within the stable portion  910  and engages to the distal portion  920 . Because of this engagement, the roller mount  1342  moves through the engagement of the roller mount rollers  1345  to posts (or other means) within the stable portion  910  when the distal portion  920  moves relative to the stable portion  910 . 
     As the roller mount  1342  moves linearly, the linear potentiometer  1350  also moves due to its engagement to the roller mount  1342  through an adaptor  1351  and slider  1352 . The linear potentiometer  1350  is engaged to the potentiometer capture  1356  through rollers  1357 , and together, motion of one relative to the other is measured within the potentiometer and that measurement or other data is processed and/or transmitted to the screen  1360 . 
       FIGS. 17-18  show alternate embodiments of a mobilization measurement device  900 .  FIG. 17  is the assembly image of the components of the device in an exploded view, and  FIG. 18  is a perspective view of the same. As seen in  FIGS. 17-26 , the device comprises at least the following: self-clinching nut(s)  901 , charger  902 , charger adapter block  903 , fastener  904 , battery  905 , LCD display  906 , switch lock  907 , microprocessor  908 , potentiometer hold down  909 , linear potentiometer base  910 , linear potentiometer arm  911 , potentiometer adapter  912 , socket head screw(s)  913  and  923 , base  914 , knob  915 , roller mount  916 , distal vertical portion  917 , track roller  918 , distal base optional attachment component  919 , track capture  921 , compression spring  922 , spring plunger  924 , attachment for supine knee  925  and base lid  926 . The device  900  may be portable, lightweight (weighing under one pound), handheld and adjustable to sit flush against a patient&#39;s body regardless of the joint movement being measured. The device  900  allows measurement of linear translation while at the same time keeping physical and visual contact with the soft tissue around the joint, allowing soft tissue feedback. 
       FIG. 19  includes the details of the base lid  926 . This custom molded component may comprise an on/off switch for the device  926 A, a USB port  926 B for the display or LCD, a frame for the display  926 C, the adapter block  903 , a battery, which may be a lithium battery  905 , a micro-processor  908 , a linear potentiometer hold down  909 , base  910 , arm  911 , and an adapter  912 . In one embodiment, the housing is made of plastic and/or nylon material. 
       FIG. 20  includes the details of the central base  914  between the base lid  926  and the distal vertical portion  917 . The central base  914  connects to the base lid  926  on one side with all of the above referenced components enclosed between them. 
       FIG. 21  shows one embodiment of the charger adapter block  903 , which is found within the base lid  926  and serves as a mounting surface for the USB charger  902 . The charger adapter block  903  may also be attached to a battery, which could be a Li-Ion battery  905 , and a micro-processor  908 . 
       FIG. 22  shows one embodiment of the potentiometer hold down  909 . The potentiometer hold down  909  secures the potentiometer base  910 , which then secures a potentiometer arm  911  and adapter in place  912 . The potentiometer hold down  909  may have fastener holes to be used with screws or similar fastening methods known in the art to be fastened to the above components. 
       FIG. 23  shows one embodiment of the potentiometer adapter  912 , which is situated between the potentiometer base  910  and the potentiometer arm  911 , as shown in  FIG. 17 . 
       FIG. 24  shows one embodiment of the track capture  921 . The track capture  921  may be attached to the central base  914 , and may be attached by socket head screws  923 . The roller mount  916  may be positioned between the track capture  921  and the central base  914 . A compression spring hole  921 B may hold a compression spring in place between the track capture  921  and the roller mount  916 . The track capture  921  may include a dovetail receptacle of the track capture  921 A to accommodate the attachment of the various components for the joints on which the device will be used, as will be discussed herein and shown in  FIGS. 27-31 . 
       FIG. 25  shows one embodiment of a roller mount  916 . It is housed between the central base and the track capture. The roller mount  916  may have at least three holes  918 A and  915 A, these holes to be used to connect both the track rollers  918  and the knob  915  that passes through the distal vertical portion  917  to the roller mount  916 . Two of the holes  918 A are for the track rollers  918 . One of the holes  915 A is for the knob  915  that passes through the distal vertical portion  917 . 
       FIG. 26  shows one embodiment of the distal vertical portion  917 . Positioned between the central base  914  and the distal vertical portion  917  is the roller mount  916 , the track roller  918 , and the track capture  921 . The distal vertical portion  917  includes at least one hole  917 A for the base adjusting knob  915  and a dovetail receptacle  924 B for the attachment of various components that can be added to and used with the device to stabilize the joint in the use of the device, as discussed herein and shown in  FIGS. 27-35 . 
     The device battery  905 , display  906  and microprocessor  908  of the device  900  include all of the features previously described for the battery  70 , display  68  and microprocessor  66  of the glove  20 , which descriptions are incorporated herein by reference. 
     Thus, as one method of use, pressure on the distal vertical portion  917  moves the distal vertical portion  917  down via the roller mechanism. In all of the herein described embodiments, this invention has the advantage that the user is in contact with the patient while performing the mobilization or linear translation. The user can see the patient&#39;s face and also feel the relevant soft tissue, thus, able to receive qualitative soft tissue feedback all while measuring the joint movement. The user never loses visual or touch contract with the patient during the mobilization. 
     The microprocessor, which could be an Arduino board, sends a small current to the linear potentiometer and measures the resistance, which changes depending upon the vertical position of the rollers. The corresponding voltage drop recorded is indexed against a distance range prescribed, in this case, anywhere from 0.0 to 20 mm. Data processing and storage is accomplished via an Arduino board. The results could be outputted and displayed to an LCD screen on the external housing. The device could also include an auditory mechanism, to alert the user of the range of movement. In a further embodiment of the device  900 , there are wireless capabilities, the data could be transmitted and stored by a computer application, which results could also be transmitted to the patient so that the clinician and/or patient could view any test results or progress and/or could see goals or treatments plans for the patient. The treatment sessions could also be connected to a billing application. The device could also include special attachments or embodiments that are configured to measure joint movement for specific body parts and types. For example,  FIG. 27  shows one embodiment of a wrist component  320  that could be used with the device  900 , which is designed to more conveniently and accurately measure joint movement in a wrist. The wrist component  320  is specially contoured such that it more readily and easily can be placed flush to the upper side or underside of a patient&#39;s wrist, and then used similar to the devices described herein with the same features and functionality. The wrist component  320  includes a dovetail flange  320 A to snap into a dovetail receptacle  924 B of the distal vertical portion  917 . A spring plunger receptacle  320 B helps secure the wrist component  320  once it is in place. 
       FIG. 28  shows one embodiment of a knee component  330  that could be used with the device  900 , which is designed to more conveniently and accurately measure joint movement in a knee. The knee component  330  is specially contoured such that it more readily and easily can be placed flush to a patient&#39;s knee, and then used similar to the devices described herein with the same features and functionality. It includes a dovetail flange  330 A to snap into the dovetail receptacle  924 B of the distal vertical portion  917 . The spring plunger receptacle  330 B helps secure the knee component  330  once it is in place. 
       FIG. 29  shows one embodiment of an ankle component  340  that could be used with the device  900 , which is designed to more conveniently and accurately measure joint movement in an ankle. The ankle component  340  is specially contoured such that it more readily and easily can be placed flush to a patient&#39;s ankle, and then used similar to the devices described herein with the same features and functionality. It includes a dovetail flange  340 A to snap into the dovetail receptacle  924 B of the distal vertical portion  917 . The spring plunger receptacle  340 B helps secure the ankle component  340  once it is in place. 
       FIG. 30  shows one embodiment of a shoulder component  350  that could be used with the device, which is designed to more conveniently and accurately measure joint movement in a shoulder. The shoulder component  350  is specially contoured such that it more readily and easily can be placed flush to a patient&#39;s shoulder, and then used similar to the devices described herein with the same features and functionality. It includes a dovetail flange  350 A to snap into the dovetail receptacle  924 B of the distal vertical portion  917 . The spring plunger receptacle  350 B helps secure the shoulder component  350  once it is in place. 
       FIG. 31  shows one embodiment of an elbow component  360  that could be used with the device  900 , which is designed to more conveniently and accurately measure joint movement in an elbow. The elbow component  360  is specially contoured such that it more readily and easily can be placed flush to a patient&#39;s elbow, and then used similar to the devices described herein with the same features and functionality. It includes a dovetail flange  360 A to snap into the dovetail receptacle of the distal vertical portion  917 . The spring plunger receptacle  360 B helps secure the elbow component  360  once it is in place. 
     As one skilled in the art would appreciate, other components could also be used to more conveniently and accurately measure joint movement in other joints. Furthermore, these components could be sized to better fit adult or pediatric or animal patients. 
     The device  900  may also have separate, specially sized distal base attachments for use with the device.  FIGS. 32 and 33  show two separate embodiments of a contoured distal base attachment, one of smaller scale  370  ( FIG. 32 ), and one of larger scale  380  ( FIG. 33 ). In  FIG. 32 , the contoured distal base attachment  370  has a dovetail contour  370 A used to accommodate the dovetail receptacle  924 B on the distal vertical portion  917 . This serves as the attachment of the various components used to stabilize the joint in the use of the device  900 . Like the dovetail on the track capture  921 D, there is a spring plunger hole  924 A on the distal base and a spring plunger receptacle  370 B to help secure this component to the device  900 . In  FIG. 33 , the larger scale contoured distal base attachment  380  for use with the device  900  may have a similar dovetail contour  380 A used to accommodate the dovetail receptacle  924 B on the distal vertical portion  917 . This dovetail receptacle  924 B may serve as one means to attach various specialized components used to stabilize the joint in the use of the device  900 . It also may include a spring plunger receptacle  380 B to help secure the component on the device. In another embodiment, the specialized attachments may be adjustable or may be able to expand or contract to better fit the joint and patient. 
     The device  900  may also include specially sized and shaped or contoured attachments such that the device could be used to measure joint movement on animals.  FIG. 34  shows one example of the larger of two contoured distal base attachments  300  for veterinary use on this device  900 . It has a dovetail contour  300 A used to accommodate the dovetail receptacle  924 B on the distal vertical portion  917 . This serves as the mechanism for attachment of the various components used to stabilize the joint in the use of the device. 
       FIG. 35  shows one example of a smaller version of a contoured distal base attachment  310  for veterinary use. It has a dove tail contour  310 A used to accommodate the dovetail receptacle  924 B on the distal base. This serves as the mechanism for attachment of the various components used to stabilize the joint in the use of the device. There is a spring plunger hole  310 B on the distal vertical portion  917 . 
     The described embodiments have the advantage of being lightweight, with the housing along with the components being portable and weighing less than 1 pound. The device is fully portable and can be used be a single practitioner. 
       FIGS. 36, 37A, 37B, 38, 38A, 38B, 39, 39C, and 39D  show another embodiment of the invention that is a mechanical device  3600 . Operators or companies may gamma radiate or otherwise subject the mechanical device  3600  to sterilization techniques that might harm sensitive electronics inside the device  900  above, and it may also meet the market need for an economical single use device. 
     Like the electronic device  900 , the mechanical device  3600  measures linear translation of a joint, i.e. arthrokinematics gliding, with a preferred measurement being millimeters. This is different than angular measures (in degrees) of joint osteokinematics, i.e. flexion, extension, rotation. The measurement excursion may be 15 mm, which is sufficient for the assessment of all joints of the body. 
       FIGS. 36, 37A, and 37B  show exploded and assembled views of the mechanical device  3600 . Assembled as shown in  FIGS. 37A and 37B , the device includes a main base body portion  3700  (comprising two halves  3701 ,  3707 ) joined together and housing multiple parts discussed hereafter including a support plate  3790  that supports the measurement spools and other parts as shown. The main base body  3700  is engaged to a proximal body portion  3800  via engagement of rollers  3820  within slot  3825 . The main base body portion  3700  and proximal body portion  3800  include attachments  3610 ,  3810  respectively removeable from their body portions and may conform to other joints or sizes of joints. The attachments  3610 ,  3810  may include strap slots  3615 ,  3815  that allow for engagement of the attachments to a patient. 
       FIGS. 38, 38A, and 38B  show the mechanical device  3600  in its zero-measurement position, ready to measure, and  FIGS. 39, 39A, and 39B  show it in its maximum 14 mm measurement position. Moving between these positions, the following occurs. 
     At first, a technician aligns the mechanical device  3600  on a patient, with its seam  3630  between the distal base  3700  and proximal portion  3800  aligned on a joint as discussed above. The technician then pulls the distal base portion  3700  relative to the proximal portion  3800  (while maintaining contact with the joint) as the proximal base portion rollers  3820  roll within a roller receiving slot  3825  within the distal base  3700  against a rolling surface  3703  thereof. A proximal gear rack  3830  is attached to and moves with the proximal portion  3800 , and when the proximal portion  3800  moves, the proximal gear rack  3830  has teeth  3835  engaged pinion gear teeth  3735  on the pinion gear  3730 . The pinion gear  3730 &#39;s rotation also rotates the measurement tape spool  3740  through a a ring and sun gear engagement between the spool gear  3742  with teeth  3745  and pinion gear teeth  3734 . 
     As the measurement spool  3740  rotates, it pulls the measurement tape  3750  and wraps the measurement tape  3750  around the measurement tape spool  3740 . As the measurement tape  3740  moves, the measurement marking  3785   3755  advances beneath the measurement scale  3760  that is printed on a transparent medium (and base housing scale area  3705 , which is also transparent), indicating the displacement measurement in 0.5 and 1.0 mm on the right scale  3764  and 0.25 and 1.0 mm on the left scale  3762 . 
     The pin drive-max measurement assembly  3770  is keyed to the output shaft  3747  of the measurement tape spool  3740  and rotates therewith. As the pin drive output shaft  3747  rotates, it drives the measurement spool-max  3755  to rotate with it. The max measurement release pawl  3758  is biased such that its engagement portion  3758  engages the gear teeth  3757   3755  and slides over those teeth when rotating clockwise and otherwise locks the measurement max tape  3780  in place for reading on the right side  3764  of scale  3760  using indicator  3785 . 
     When the distal side  3610  and base  3700  is released and allowed to come back to its zero position, the release pawl  3758  prevents the measurement spool-max  3755  from returning to its zero position, effectively holding the maximum measurement for the therapist. The release pawl  3758  can be actuated at any point by toggling the release button  3759  to allow the measurement spool-max  3755  to return to its zero position under its own bias. 
     The gearing within the main housing may be considered to be a mechanical measurement gearing and obviate the need for electronic sensors. 
     The mechanical device  3600  is capable of providing two measurements of displacement of a joint. A “live” measurement is constantly measured based on the position of the distal/base side of the device  3600  relative to the proximal base side  3800  and a “max” measurement that is the maximum displacement measured over multiple measurements until the maximum measurement release pawl  3770  is activated to zero the maximum measurement. 
     While the invention has been described with reference to the embodiments above, a person of ordinary skill in the art would understand that various changes or modifications may be made thereto without departing from the scope of the claims.