Abstract:
A muscle strength testing method and apparatus allow an examiner to objectively evaluate the strength of a plurality of muscles of a patient. The apparatus includes an actuator member releasably connected to a controller device for supporting a weight thereon. The weight is either a patient entity including at least a selected segment of the patient or an examiner entity including at least a part of the examiner supporting the segment. The segment corresponds to the specific muscle(s) to be tested. The controller successively measures a first and second forces applied by the weight on the actuator. The first and second forces correspond to the weight with the specific muscle(s) in a relaxed state and in an active state respectively. The active state induces a substantially vertical pressure on the segment. The controller calculates a difference between the first and second forces which is the strength of the specific muscle(s). The apparatus also allows the examiner to simultaneously subjectively evaluate the strength of the specific muscle(s) of the patient under test.

Description:
FIELD OF THE INVENTION  
         [0001]    The present invention relates to the field of gauging devices and is more particularly concerned with a muscle strength testing method and apparatus.  
         BACKGROUND OF THE INVENTION  
         [0002]    Muscle strength can be defined as the ability of a muscle or a group of muscles to produce tension or exert force through the skeletal system. The generally accepted measurement criterion for the maximum tension which can be exerted by a muscle is the maximum amount of force a muscle can exert on a body part. In physiology, this is referred to as the maximum strength of the muscle and might be expressed, for example, in kilograms per square centimeter of muscular section. In day-to-day life with the patient, the strength is usually expressed in kilograms, Newtons, pounds or inch-pounds and Newton-meters.  
           [0003]    There are a plurality of situations wherein it is desirable to monitor or test different muscle strength of an individual. This type of examination is commonly used in diagnostic, therapeutic and prevention activities. The tests are typically used to determine difference in strength between individuals and/or to determine strength deficits in a given individual. In such a case, deficits are detected by the comparison of contralateral limb segments or muscle groups. The tests are also typically used to monitor a patient&#39;s progress during a period of recovery or rehabilitation. Muscle testing is also used in the design of rehabilitation programs for injured patients or individuals wanting to undertake activities for which they are not properly conditioned.  
           [0004]    Although the medical and therapeutic fields have evolved into high-tech sectors using state of the art technology, muscle strength testing which is part of most routine physical examination is still widely performed by a mere manual operation on behalf of an examiner. Muscle strength is typically tested by asking the patient or individual to move actively against the examiner&#39;s resistance or to resist against the movement of the examiner on a part of his/her body. While the patient is asked to maintain a specific posture, the examiner subjectively judges the patient&#39;s maximum force. Because of the sensitivity provided by the examiner, this method enables the examiner to qualitatively sense the weak muscular contraction such as slight shaking, saw-teeth type of effort or the like.  
           [0005]    The strength is typically subjectively quantified and graded on a conventional zero to five scale. Although there are no international established standards, the grading scale varies between no muscular contraction detected (0) and active movement against full resistance without evident fatigue corresponding to normal muscle strength (5). Many clinicians make further distinction by using plus or minus signs towards the stronger and weaker end of the scale respectively. Thus, a (4+) grade indicates good but not full strength while a (5−) grade means a trace of weakness.  
           [0006]    During the procedure, for purpose of comparison, the unaffected limb of the patient is typically similarly tested. From the hereinabove description, it is quite evident that the common manual method of muscle testing is opened to a large proportion of subjectivity.  
           [0007]    Not only is the evaluation potentially unreliable when performed by a same individual but also this problem is compounded in situations wherein different individuals may use different techniques to perform the same testing.  
           [0008]    Accordingly, several attempts to standardize manual testing procedures have been made and the prior art shows various devices adapted to measure muscle strength. For the most part, prior art devices suffer from a set of disadvantages including lack of ergonomical features, cumbersomeness, inability to test particular muscles or groups of muscles, complexity, lack of portability, expensiveness and so forth. One major drawback associated with some of the prior art devices is their inability to isolate specific muscles or muscle groups needing to be tested. Also, in the clinical context prior art testers have often proven to be difficult and time consuming to adjust to the specific ergonomical characteristics of the patient.  
           [0009]    In order to test various body parts the devices always need to be quickly repositioned, thus failing to provide a practical solution, as opposed to quick displacements of the examiner to support and test these various body parts. As a result, despite the obvious disadvantages of the subjective test of muscle strength, manual testing without instrumentation continues to be the predominant method used in the clinical setting. One of the predominant factors is the so far unequaled ergonomical support provided by the examiner&#39;s hands since prior art devices, especially the handheld devices (HHD), are often uncomfortable to the patient and unstable (as opposed to a stabilization provided by a hand-grip). To improve stability, most dynamometric apparatuses are provided with straps and the like that are time consuming.  
           [0010]    Accordingly, there exists a need for an improved objective muscle strength testing method and device that uses the comfort and the grip of the naked hand of the examiner as the only support and resistance.  
         OBJECTS OF THE INVENTION  
         [0011]    It is therefore a general object of the present invention to provide a muscle strength testing method and apparatus that obviates the above-noted disadvantages.  
           [0012]    Another object of the present invention is to provide a muscle strength testing method and apparatus that enables testing of most muscles and group of muscles of a human body.  
           [0013]    A further object of the present invention is to provide a muscle strength testing method and apparatus that provides sufficient sensitivity to objectively detect anything ranging from extremely small forces or muscle effort (even when the patient is unable to displace his/her body part against natural gravity) to normal large forces generated by limb muscles.  
           [0014]    Yet another object of the present invention is to provide a muscle strength testing method and apparatus that remains essentially manual in practice and enables simultaneous qualitative subjective and quantitative objective testing of muscles without interfering on or modifying the test itself.  
           [0015]    Advantages of the present invention include the fact that the present muscle strength testing method and apparatus is specifically configured so as to be easy to use in a manner closely akin to the testing that examiners such as physicians, therapists, athletic trainers, coaches and the like currently use.  
           [0016]    The muscle strength testing method and apparatus can be readily positioned so as to test various muscles or groups of muscles without the need for elaborate attachment to the patient and thus provides for a time efficient solution. Also, the present muscle strength testing method and apparatus affords accurate measurements and repeatability in its strength indication from one test to the next.  
           [0017]    The present muscle strength testing method and apparatus by allowing use of a method closely akin to the currently highly performed manual method allows the examiner to obtain both a conventional subjective evaluation of the muscle strength and a more objective dynamometric numerical value of the patient&#39;s muscle strength. By allowing the hand of the examiner to provide for resistive forces during the strength evaluation process the muscle strength testing method and apparatus eliminates the need for time consuming and sometimes complex set up procedures.  
           [0018]    Furthermore, the present muscle strength testing method and apparatus allows for the elimination of gravity induced biases and thus allows for the evaluation of even very weak muscles.  
           [0019]    The present muscle strength testing method and apparatus provides various options such as the display of strength versus time curves, the recall of previous test values, the storage of various test values in electronic memory, the electronic linkage to various computing means for processing of the information.  
           [0020]    Still further, the present muscle strength testing method and apparatus allows for measuring, recording and displaying of the strength of various muscles or groups of muscles and of strength peak values during effort.  
           [0021]    Other objects and advantages of the present invention will become apparent from a careful reading of the detailed description provided herein, within appropriate reference to the accompanying drawings.  
         SUMMARY OF THE INVENTION  
         [0022]    According to one aspect of the present invention, there is provided a muscle strength testing method for an examiner to objectively evaluate a strength of a plurality of muscles of a patient; said method comprises the following steps:  
           [0023]    a) providing an actuator device connected to a controller device;  
           [0024]    b) installing a weight on said actuator device, said weight being a patient entity including at least a selected segment of said patient and corresponding to a specific of said plurality of muscles being tested;  
           [0025]    c) measuring a first force value applied by said weight on said actuator device using said controller device; said first force value corresponding to said weight with said specific of said plurality of muscles being in a relaxed state;  
           [0026]    d) measuring a second force value applied by said weight on said actuator device using said controller device; said second force value corresponding to said weight with said specific of said plurality of muscles being in an active state, the latter inducing a substantially vertically oriented pressure on said segment;  
           [0027]    e) obtaining a difference value between said first and second force values from said controller device, said difference value being said strength of said specific of said plurality of muscles.  
           [0028]    Preferably, the examiner simultaneously subjectively evaluates said strength of said plurality of muscles of said patient; said method further comprises, after step b) the following step:  
           [0029]    b′) having said examiner supporting said segment of said patient;  
           [0030]    steps c) and d) further including subjectively measuring said first and second force values applied by said weight using said examiner respectively;  
           [0031]    step e) further including subjectively obtaining said difference value and said strength of said specific of said plurality of muscles from said examiner.  
           [0032]    Alternatively, the weight is an examiner entity including at least a part of said examiner supporting said segment of said patient.  
           [0033]    Alternatively, the examiner entity includes said examiner supporting said segment of said patient.  
           [0034]    Alternatively, the examiner entity includes an examiner structure supporting said examiner supporting said segment of said patient.  
           [0035]    Alternatively, the patient entity includes said patient.  
           [0036]    Alternatively, the patient entity includes a patient structure supporting said patient.  
           [0037]    Alternatively, the patient entity includes a patient structure supporting said segment of said patient.  
           [0038]    According to another aspect of the present invention, there is provided a muscle strength testing apparatus for an examiner to objectively evaluate a strength of a plurality of muscles of a patient, said apparatus comprises an actuator device releasably connected to a controller device for supporting a weight thereon, said weight being a patient entity including at least a selected segment of said patient and corresponding to a specific of said plurality of muscles being tested, said controller device successively measuring a first and a second force values applied by said weight on said actuator device, said first and second force values corresponding to said weight with said specific of said plurality of muscles being in a relaxed state and in an active state respectively, said active state inducing a substantially vertically oriented pressure on said segment; said controller device obtaining a difference value between said first and second force values being said strength of said specific of said plurality of muscles.  
           [0039]    Alternatively, the weight is an examiner entity including at least a part of said examiner supporting said segment of said patient.  
           [0040]    Preferably, the apparatus is further adapted for said examiner to simultaneously subjectively evaluate said strength of said plurality of muscles of said patient with said examiner supporting said segment of said patient, thereby simultaneously subjectively measuring said first and second force values applied by said weight and evaluating said difference value and said strength of said specific of said plurality of muscles.  
           [0041]    Preferably, the controller device includes a keypad member adapted for an operator to activate the same, and a display member for displaying said difference value obtained by the same.  
           [0042]    Preferably, the patient entity includes a patient structure supporting said patient, said actuator device including at least one actuator member located underneath said patient structure.  
           [0043]    Preferably, the examiner entity includes said examiner supporting said segment of said patient, said actuator device including at least one actuator member located underneath said examiner.  
           [0044]    Preferably, the actuator device includes at least one actuator member, said controller device including an electronic circuit member connected to said at least one actuator member, and a display member connected to said electronic circuit member for displaying said difference value.  
           [0045]    Preferably, the first force value being a time average of a first force profile over time, said second force value being a second force profile over time, and said difference value being a difference profile over time of said second force profile over said time average.  
           [0046]    Preferably, the electronic circuit member includes a storage memory for storing a plurality of said difference values.  
           [0047]    Preferably, the specific of said plurality of muscles and all said values are information, said apparatus further comprising a computer member for activating said controller device, recording and storing said information from the same and post-processing said information.  
           [0048]    Preferably, the controller device further includes a remote control for said examiner to remotely control the same.  
           [0049]    Preferably, the apparatus is adapted for being hand-carried by said examiner, whereby said apparatus is conveniently displaced to a patient residence by said examiner visiting said patient.  
           [0050]    Preferably, the controller device repeatedly successively measures said first and second force values applied by said weight on said actuator device, said controller device repeatedly obtaining a difference value from said first and second force values being said strength of said specific of said plurality of muscles.  
           [0051]    Preferably, the operator is said examiner.  
           [0052]    Preferably, the plurality of muscles of a patient are selectable from a database stored in said computer member, said database providing said segment for each of said plurality of said muscles of said patient being tested along with corresponding description of said examiner and patient entities, corresponding patient and examiner test positions and corresponding location of said at least one actuator member.  
           [0053]    Preferably, the first and second force profiles over time have a time duration of generally less than two and thirty seconds respectively, said difference profile over time having a time duration of generally less than thirty seconds.  
           [0054]    Preferably, the first and second force values are repeatedly measured by said controller device between five and one thousand times every second.  
           [0055]    Preferably, the actuator device has a measurement accuracy of less than forty grams and a measurement range from zero to three hundred kilograms. 
       
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0056]    In the annexed drawings, like reference characters indicate like elements throughout.  
         [0057]    [0057]FIG. 1 is a schematic diagram of an embodiment of a muscle strength testing apparatus according to the present invention, illustrating the interactions between the different components of the apparatus, the dashed lines indicating interactions with optional components;  
         [0058]    [0058]FIG. 2 is a schematic diagram of an embodiment of a muscle strength testing method according to the present invention, showing the sequential steps of the same;  
         [0059]    [0059]FIG. 3 is a schematic perspective view of the embodiment of FIG. 1, showing the apparatus being used for measuring the force of a patient resting on a table and vertically pushing his/her arm down or lifting it up against the resistance of an examiner standing nearby, as shown in solid and dashed lines respectively, actuator members being positioned underneath the table legs;  
         [0060]    [0060]FIG. 3 a  is a view similar to FIG. 3, showing the apparatus being used for measuring the force of a patient resting on a table and vertically lifting his/her arm up against the resistance of the examiner standing nearby, as shown by the arrow; in this case, the examiner of illustration of FIG. 3 had previously supported the arm in a relaxed state to obtain the reference value that takes the gravity into account;  
         [0061]    [0061]FIG. 4 is a schematic perspective view similar to FIG. 3, showing the apparatus being used for measuring the force of a patient resting on a table and vertically pushing his arm down or lifting it down against the opposition of an examiner standing nearby on an actuator member;  
         [0062]    [0062]FIG. 5 is a schematic perspective view similar to FIG. 3, showing the apparatus being used for measuring the downward, or upward (as shown in dashed lines), vertical force of a patient resting on a table and acting against an actuator member; and  
         [0063]    [0063]FIG. 6 is a diagram showing an example of a display of the computer showing illustrative pictorials of different selectable positions from a database to perform specific tests.  
     
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS  
       [0064]    With reference to the annexed drawings the preferred embodiments of the present invention will be herein described for indicative purpose and by no means as of limitation.  
         [0065]    Referring to FIG. 1, there is shown an embodiment  10  of a muscle strength testing apparatus according to the present invention. The apparatus  10  includes a force responsive actuator device  20 , preferably at least one actuator member  22 , such as load cell type force sensor or the like, adapted to be strategically positioned at various locations as will be hereinafter disclosed. The apparatus  10  also includes a controller device  30  connected to the actuator device  20  for electrically measuring forces applied to the actuator members  22 . The controller device  30  has a display member  32  for displaying any output information from the controller  30  and a keypad member  34  for activating/starting the controller  30  by an operator O entering input information.  
         [0066]    As schematically illustrated in FIG. 2, the present invention also relates to a method of testing and measuring muscle strength. This method is based on the premise that once gravitational forces have been taken into account, any modification to the vertical force value exerted on the force responsive actuator device  22  on selected activation of the patient&#39;s muscle will provide an accurate read out of the muscle strength of such muscle.  
         [0067]    The method thus consists in properly positioning a segment  42  of the patient body  44  related to the selected muscle(s) of which the force is being evaluated in a generally horizontal relationship relative to the line of gravity in such a manner as to allow the selected muscle(s) of the patient  44  to exert a force F in a generally vertical orientation on the segment  42 . A first force (or reference) value is established by measuring a weight applied to strategically installed or positioned actuator members  22  when the muscle is in a relaxed state. This step allows correction for the gravitational weight of the segment  42  being evaluated either in the positive or negative direction depending on the vertical direction of the movement relative to the gravitational force, by eliminating its effect. It provides the controller device  20  and the examiner  54  with a read out not only of the force exerted by the patient  44 , but also of the force required by the patient  44  to maintain the segment  42  against gravity, which will be subtracted later on. Once the reference value has been established the patient  44  is asked to exert a maximum force F in the vertical direction against a resistance provided by the examiner  54 , resulting in a pressure on the segment  42 .  
         [0068]    Modulations of the read outs by the actuators  22  being strategically positioned gives an accurate read out of the strength of the selected muscle(s).  
         [0069]    More specifically, the method consists in  
         [0070]    a) providing the actuator device connected to the controller device;  
         [0071]    b) installing a weight on the actuator device, the weight being a patient entity including at least a selected segment of the patient and corresponding to a specific of the plurality of muscles being tested;  
         [0072]    c) measuring a first force value applied by the weight on the actuator device using the controller device; the first force value corresponding to the weight with the specific of the plurality of muscles being in a relaxed state;  
         [0073]    d) measuring a second force value applied by the weight on the actuator device using the controller device; the second force value corresponding to the weight with the specific of the plurality of muscles being in an active state, the latter inducing a substantially vertically oriented pressure on the segment;  
         [0074]    e) obtaining a difference value between the first and second force values from the controller device, the difference value being the strength of the specific of the plurality of muscles.  
         [0075]    Simultaneously, a resistance offered by the examiner  54  provides for the qualitative subjective evaluation obtained through the conventional manual muscle strength testing method. The actuators  22  may be strategically positioned either directly in contact with the segment  42  being evaluated as shown in FIG. 5, in contact with the examiner  54  as shown in FIG. 4 or in contact with a patient support structure  46  on which the patient  44  is resting, as shown in FIG. 3.  
         [0076]    For example, in a situation such as the one schematically illustrated in FIGS. 3 and 3 a , a patient entity  40 , preferably the patient  44 , rests on a patient structure  46 , such as table or the like with his/her segment  42 , such as his/her arm positioned substantially horizontally. An examiner entity  50 , preferably the examiner  54  alone is positioned so as to provide opposition to the downward force F, or upward force F′, exerted by the patient  44  so as to measure the strength of the specified muscles of the latter, specifically the shoulder flexors or extensors in this case respectively (FIGS. 3 and 3 a ). Actuators  22  may be positioned either underneath the table legs  47  or directly underneath the examiner  54 , as shown in FIG. 4. Once zeroing (measurement of first force or reference or neutral zero value) has occurred (as illustrated in FIG. 3), a second force value measurement is performed by the controller  30  when the patient  44  exerts a downward force F, or upward F′, against the opposition of the examiner  54  (as illustrated in FIGS. 3 and 3 a ), providing a relative accurate difference value between the first and second force values, which is the muscle strength value of the patient&#39;s examined shoulder flexors or extensors respectively.  
         [0077]    In the above example, when the patient  44  exerts a first effort to put the muscle(s) in a relaxed state for the measurement of the first force value, the examiner  54  preferably supports the segment  42  from underneath at a determined location associated with a specific lever arm (see FIG. 3). Then, upon the upwardly oriented force F′ for the measurement of the second force value from the patient  44 , the examiner  54  obviously needs to provide a resistance leverage at a similar location above the segment  42  (see FIG. 3 a ).  
         [0078]    In situations illustrated in FIGS. 3 and 4, the examiner  54 , supporting the segment  42  under test, has the privilege of simultaneously performing a standard qualitative subjective evaluation of segment  42  with the quantitative objective testing described hereinabove.  
         [0079]    Similarly, the examiner  54  supporting the segment  42  of the patient  44  could be sitting on the table that would become the examiner structure  56 , with the patient  44  standing on the floor B, or being on another treatment table (not shown) or simply a chair or the like.  
         [0080]    In a preferred embodiment of the invention the actuators  22  take the form of modified electronic weighing machines such as those used for weighing parcels since they provide a high measurement accuracy of less than 40 grams (that could detect contraction of small muscles such as finger muscles and the like) and a wide measurement range from zero to over three hundred (300) kilograms. The fact that a difference value is calculated improves the accuracy of the apparatus, as opposed to an absolute value. As it would be obvious to anyone skilled in the art, actuators  22  along with their respective connection to the controller device  30  are specifically adapted to exclude parasites.  
         [0081]    As shown in FIG. 1, the controller  30  includes an electronic circuit member  36  connected to the actuators  22  and the keypad member  34  to receive input information from the operator O. The electronic circuit  36  is further connected to the display member  32  as an output channel. The electronic circuit  36  also includes a storage memory  38  to store the different output information for further downloading and post-processing, as hereinafter described. Obviously, the controller  30  also includes all required interfaces for all connections, as it is well known in the art.  
         [0082]    Typically, the controller  30  is so configured as to preferably read (5) actuators  22  although other configurations may be provided without departing from the scope of the present invention. Readings are performed simultaneously in order to provide for better accuracy. Obviously, first and second force values are preferably force profile over time. Accordingly, the actuators  22  are typically read at a rate of approximately one hundred (100) cycles per second per channel. The input rate could be higher up to one thousand (1000) cycles per second or more (or less) without departing from the scope of the present invention. The display member  32  typically takes the form of a liquid crystal type LCD display. Preferably, the display  32  provides information on the actual output information showing the peak strength value, prior test output values or any other suitable information. As is well known in the art, angulation and intensity of the LCD display may be adjusted through suitable adjustment means, if required.  
         [0083]    A power source is further provided for powering various parts, components of the apparatus  10 , as well known in the art. Typically, the power source includes re-chargeable batteries so as to provide for autonomy of the apparatus  10 .  
         [0084]    Accordingly, the apparatus  10  is adapted for being hand-carried by the examiner  54  in order to be conveniently displaced to a patient&#39;s residence by the examiner  54  visiting the handicapped or under-rehabilitation patient  44 . Therefore all test results are preferably stored in the apparatus memory  38  for further analysis by the examiner  54  at his/her office.  
         [0085]    When a connection is not being used on the controller  30 , the signal for the specific input is adequately being treated as to eliminate interferences. Within the keypad  34 , an activating switch is provided for initiating the test procedure. Optionally, the activating switch  70  may be actuated by the foot, the hands or any other suitable body part of the examiner  54  if remotely connected using a connecting wire  72  or simply be wireless as often used in similar applications. Preferably, the activating switch  70  is provided with a magnet so as to allow for the latter to be magnetically anchored to most metallic equipment.  
         [0086]    Additionally, a pair of selecting switches are provided for allowing selective display and browsing of prior test output results. A reset switch is also preferably provided for resetting the apparatus  10 . Audio display means may also optionally be provided to provide audio cues for enabling the examiner  54  to follow step procedures in synchronization with the controller  30 .  
         [0087]    The electronic circuit  36  preferably computes the output information emanating from the actuators  22  via the controller  30  and preferably coordinates the different sequences of testing operation.  
         [0088]    Once the apparatus  10  is activated, the electronic circuit  36  preferably initializes the input data, the LCD  32 , an all interfaces. The apparatus  10  then waits in a stand-by mode. Once the operator O or the examiner  54  activates the activating switch for a given test, the circuit  36  initiates the reading/recording process. Each reading sequence preferably includes a waiting time interval typically in the range of two (2) seconds prior to reading the reference (or first force) value on each actuator  22 . In order to read a reference value the circuit  36  communicates with actuators  22  which transmit the respective weight data. The circuit  36  reads approximately one hundred (100) reading cycles on each channel. An average value is computed every ten readings in order to preserve approximately ten (10) readings per second.  
         [0089]    Once the reference value has been computed, the circuit  36  preferably waits for an additional waiting period substantially in the range of two (2) cycles prior to performing the strength measurement, or second force value, readings for a typical period duration of less than thirty (30) seconds (longer periods could be considered for performing endurance tests of the muscle(s), or the like tests). The patient  44  is instructed to activate the selected segment  42  so as to create a vertical force F, either downwardly or upwardly oriented. The circuit  36  subtracts the respective reference value to each reading on each actuator  22  in order to obtain the difference value or the force F exerted by the patient  42 . The difference value is preferably computed immediately after each reading in order to enable real time output appearance on the display  36 .  
         [0090]    Once the test is finished for a given segment strength, the electronic circuit  36  computes the peak force on a predetermined peak force range typically in the range of half a second (0.5 s) and displays the latter on the LCD  32 . All of the readouts and computed values are then stored in the storage memory  38 . The apparatus  10  then returns to the stand-by mode. The circuit  36  of the controller  30  is also optionally connected to a computer member  60  to send all of the read, computed and stored values towards the same via a serial type interface so as to allow for proper transfer (or download). The computer  60 , preferably a PC (or Macintosh®) type computer with its own keyboard  62  for operator input may optionally initiate any step sequence, display the input and output computed values and store the computed and input values within its own memory  66 . A calibration ratio may also be transferred to the computer in order to allow the latter to perform its own computing sequence. The electronic circuit  36  and preferably the computer  60  may be used for further data post-processing such as mathematical statistics or pre-processing such as other modular treatment to the input values and to manipulate the latter so as to facilitate cognitive sequential treatment. Essentially, the computer  60  determines the proper sequence of performing a series of tests to minimize displacement efforts to the patient  44  as well as testing time. The computer  60  preferably includes a database  68 , in its memory  66 , providing, for each of the different possible muscle segments  42  to be tested (over one hundred (100) and even more), description of the required examiner  50  and patient  40  entities (presence or not of any specific respective structure  56 ,  46 ), as well as corresponding examiner  54  and patient  44  test positions, corresponding location of the actuator(s)  22 , and, preferably, a corresponding illustrative pictorials  64   a , as shown in FIG. 6. Also, the controller  30  provides capability for the operator O to calibrate the actuators  22  whenever required through a programmed calibration procedure.  
         [0091]    Optionally, in the case the location of the apparatus  10  remains permanent into a specific room, one could consider having the floor B of the room being subdivided in specific sections mounted on respective actuator members  22 . The latter would thereby be embedded therein and seem invisible to the examiner  54  and the patient  44  while still being connected to the apparatus  10 .  
         [0092]    Although the present muscle strength testing method and apparatus have been described with a certain degree of particularity it is to be understood that the disclosure has been made by way of example only and that the present invention is not limited to the features of the embodiments described and illustrated herein, but includes all variations and modifications within the scope and spirit of the invention as hereinafter claimed.