Patent Application: US-78047604-A

Abstract:
an apparatus to increase identification of cancer mass in subcutaneous tissue , by palpation by self examination , to accommodate disability , to increase therapy of medical and physical recovery and treatment , and method of using devices or compounds which reduce onset of symptoms of median nerve entrapment or carpal tunnel syndrome or repetitive stress syndrome , reduce tactile deficit of fingers , and as well as many other applications . this includes improving the efficiency of the movement of the fingers , reducing the inflammation in the carpal canal , reducing the tendon excursion in the carpal canal , reducing finger flexion , reducing loss of nerve sensation , reducing loss of tactile sensation , increasing tactile sensitivity of the fingers , increasing movement of the dorsal interossei muscles of the hand , increasing movement of the volar interossei palmar muscles of the hand , and increasing movement of the lumbrical muscles of fingers .

Description:
“ as in red hot ” is an anagram from the 10 most used letters in english . qwerty keyboard increases the symptoms of a medical disability termed “ carpal tunnel syndrome ,” which is also wrist injury . this invention tests whether flexion required by typing with the qwerty layout accelerates or aggravates the swelling of tendons and the entrapping of the median nerve . the purpose of the invention is to evaluate two keyboard layouts for carpal tunnel syndrome therapy , and to see if the efficient keyboard will be used as an adjunctive tool to other treatments or therapy for cts for typists . after evaluation of results from different sensory tests , questionnaires , and clinical examination , the final test invention consists of a medical history ,( 8c ) 2 simple tests describing the subjective assessment of pain by the subject ( visual analogue scale / verbal rating scale , and hand diagram ), diagnostic tests include 2 motor function tests , ( ability to turn door knob and turn key , and picking up small objects or coins that are dropped on the table ), 1 symptomatic question to add to the medical history ( paresthesia in the hand or fingers , especially at night ), and 1 clinical measurement ( nerve conduction velocity , median and ulnar nerve , and motor and sensory — orthodromic . ), 3 clinical measurements ( phalen &# 39 ; s test , tinel &# 39 ; s sign , water volume / caliper / tape measure ), 2 activity tests requiring the hand to transmit force to a tool ( typing on different keyboard layouts — qwerty and asinredhot ), and post activity tests measuring change in pain and swelling ( water volume , pain , and sensory ability ). each selected test has a history of evaluation . if a patient is without constant symptoms ( pain , swelling , tingling ), can a patient still have cts ? yes , because symptoms may require activity for the inflammation to occur . the subject need not be in constant pain , to either have cts or be selected for the typing test . the assumption is that if the subject has been diagnosed for cts , digit repetitive flexion ( i . e . typing ) will make the pain appear . the typing exercise is not known to be a finger exercise to relieve symptoms , such as the shaking of a hand is sometimes used to relieve symptoms . typing , even on an efficient keyboard , is not expected to be a treatment for cts to relieve symptoms ( i . e . if a little is good , a lot is better ). the invention uses of this efficient keyboard to prevent onset of swelling for a greater amount of hours during typing than typing on a qwerty layout keyboard . the medical history is used to take out subjects who have arthritis or current pregnancy from the typing exercise . this test invention , for carpal tunnel syndrome , will evaluate the following parameters : subjective opinion about pain and discomfort , objective sensory stability of the median nerve , and swelling of tissue after the typing activity , sensory stability of the ulnar nerve , and motor and sensory conditions . the medical literature ( 32 articles ) lists 67 tests that are suitable for the carpal tunnel syndrome part of the invention . in addition , words from typing lessons are included for the typing activity evaluation . ( 27 ) the test battery is performed with each subject in the subject group . nine diagnostic tests are selected . they are water displacement , caliper , tape measure for swelling ; phalen &# 39 ; s test , tinel &# 39 ; s sign for numbness and tingling ; self report analogue scale , self report hand diagram for subject &# 39 ; s pain perception ; dropping object , turn door knob and key for motor function ; nerve conduction velocity ( ncv ) tests for median and ulnar nerve abnormality and distal sensory latency , distal motor latency and conduction velocity . 58 other tests were evaluated but not selected . they are unnecessary in order to keep the evaluation manageable for subject and investigator . criterion for abandonment include tests that were invasive , and tests that focused on hand structures outside the carpal canal . d . the explanatory trial — activity ( asinredhot ) produces better results than activity ( qwerty ) all subjects will be asked to type until they feel pain , or for four hours . after typing , they will then report on the visual analogue scale and be measured by the water displacement test . before the interview and tests , the subjects will be requested to avoid , for twenty four hours prior to the test , any activity , especially typing , that requires substantial force from the hands , to avoid non - clinical inflammation or swelling . the subjects are also asked to avoid pain killers or medication before the typing test , as these may mask the pain from the median nerve entrapment , if any . in any case , the subjects will also be asked , as individuals , to follow the same daily routine and similar activities before each typing test . in each test , the subject , after first taking the medical history and sensory tests , will then be instructed to practice the typing test for 3 to 5 minutes , or such longer time , in order to become familiar with the testing system , and be able to type at similar speeds on both boards . then , under verbal encouragement , the test will be performed , and the result is recorded by the investigator . in this part of the study a typing test is administered . the subject is asked to type with 8 fingers and 2 thumbs as many times as possible ( maximal effort ) to measure the number of flexions it takes to cause discomfort , to fatigue the muscles and to swell ( 29 ) the hand and forearm . the subject is allowed to change positions , sit or stand , with arms in a comfortable position . in case of lost or mistaken words , the subject is to ignore the errors and to continue the performance . the number of words is measured by dividing keystrokes by 5 . the keystrokes are recorded with an electronic counting device ( computer program ). the fixed keyboard style demands from the fingers a minimum of ( ½ or ¾ inch ) of free movement between center of key caps . the test is performed analogically to normal typing conditions in order to measure the fatigue and swelling of the tissues . save the keystrokes to a file for later examination to compare speed and accuracy during the test . the beginning and ending time is recorded by the investigator , or by the computer program . time can by kept manually with a clock or stopwatch . in order to control for wrist angle , every typing subject will wear a wrist support or use a wrist pad . the subject will then be scheduled to return after any swelling has gone down to baseline . the invention will be repeated on a similar keyboard with only the letters rearranged . on the asinredhot keyboard , pressing the d and e requires minimal flexion , as pressing the middle and index finger on the home row communicates the letters . the ordinals letters ( a d e h i l n o r s t ) on asinredhot has 0 flexions . the four words “ as in red hot ” on asinredhot keyboard has 0 flexions of the fingers , and 2 abductions and 2 adductions , 1 each for left and right index fingers . the syndrome is more frequent in females ( 27 ) by a ratio of more than 2 to 1 , and half of the cases occur in subjects between 40 and 60 years of age . ( 23b ) the inclusion criteria for the invention are any adults who type , and who have carpal tunnel syndrome . subjects to exclude in various studies will be those who are unable or unwilling to have inflammation symptoms identified . usual symptoms are weakness or clumsiness in the hand , hypesthesia or paresthesia in the distribution of the median nerve , aggravation of the symptom when using hand ( especially typing ), numbness in the fingers after sleep , pain in the wrist or distal forearm , shoulder pain , upper arm pain . ( 23b ) carpal tunnel syndrome is classified into three groups according to the severity of the symptoms . early stage injury is defined as symptoms which appear only when provoked and related to specific activities . symptoms are mainly sensory without motor involvement . progressive stage injury is defined as symptoms which are more advanced , and which disturb daily functioning . motor weakness begins to occur in the affected hand . the subject awakens at night . this is usually when subjects seek medical assistance . late stage injury includes having symptoms for many years , with moderate muscle weakness including thenar muscle atrophy . subjects may report that intolerable conditions are somewhat better , not that the condition is improving , but that the permanent median nerve damage has resulted . subjects may become asymptomatic to pain and tingling , but persistent numbness indicates permanent nerve damage . ( 2 ) treatment for temporary early and progressive ( i . e . pregnancy cts ) stage cts is usually nonoperative . “ 25 percent of patients who are pregnant may have symptoms of ( cts ).” ( 18a ) subjects in the trial , will be under similar therapy , if any , in order to minimize confounding differences . exclusions : the invention tests typists that flex their fingers to type letters off of the home row . hunt and peck typists , who move their forearms and use only two or four fingers , do not sustain the digit flexion of the touch typist . therefore , subjects will be excluded who do not flex their fingers or use all eight fingers to press the keys , ( i . e . exclude people using only the index ii or index ii and middle iii fingers for typing ). as this invention tests the dosage of typing required to elicit a flare up of symptoms ( pain and swelling ) among different keyboard layouts , those who do not have carpel tunnel syndrome , will be tested separately . we test separately those who have carpel tunnel syndrome late stage , and whose median nerve is so damaged so that the fingers and hands are numb , without pain . all subjects not completing the study will be asked why they withdrew . all subjects can be tested on tactile sensation , and to discern whether further injury can result with digit flexion , when pain cannot signal termination of the activity . the endpoints , and what constitutes a success or failure , in a comparison study of qwerty to asinredhot keyboards are based on time , work , swelling , and feedback to pain . basic data on the subjects will be obtained from the medical history , or medical records . if available , nutrition history will be considered . base line — upon the subject &# 39 ; s return to any typing test session , the pain , water volume ( or thermography ) and environment of the study will be duplicated as closely as reasonable to the first session , so each test will be comparable , except for the keyboard layout and subject . h . statistics and assess the outcomes to establish which of the studied therapies does the greatest good . the data will be analyzed by calculations , including standard deviation , and a medical history . a limited medical history is used to identify level of therapy , general health , and reasons the person should not be tested . 1 . carpal tunnel syndrome , a practical review , katz il v49 : 6 american family physician may 1 &# 39 ; 94 p1371 ( 11 ) infotrac & amp ; library 2 . endoscopic carpal tunnel release by chow in arthroscopic surgery , the wrist , whipple ed . j . p . lippincott co . philadelphia , 157 et seq . 3 . cts : relief at hand , school of public health , vol . 11 : 4 , uc berkeley wellness letter , january 1995 , p . 7 . 5 . century of the typewriter , by beeching , director , british typewriter museum , st . martin &# 39 ; s press : new york , 1974 , 28 - 43 . 7 . sports - related extra articular wrist syndrome by wood and dobyns , in clinical orthopaedics and related research , by urist , number 202 , j . p . lippincott co . philadelphia , january 1986 , pp . 93 - 102 . 8a . upper extremity tendinitis and overuse syndromes in the athlete , by kiefhaber and stern , in injuries of the hand and wrist , in clinics in sports medicine , vol . 11 : 1 , january 1992 , saunders co . harcourt brace jovanovich , 39 et seq . 8c . the preparticipation fitness test , by van handel , in overuse injuries , clinics in sports medicine , vol . 10 : 1 , january 1991 , saunders co ., p . 3 et seq . 9a . introduction to overuse injuries , by herring and nilson , in clinics in sports medicine , vol . 6 : 2 , april 1987 , saunders co . harcourt brace jovanovich , p . 225 et seq . 12 . the hand , surgical and non - surgical treatment , by kilgore and graham , lea & amp ; febiger , philadelphia , 1977 . “ nerves ” pp . 211 et seq . 15 . carpal tunnel syndrome , the johns hopkins medical handbook , the 100 major medical disorders of people over the age of 50 , by margolis and moses , ed . the johns hopkins medical letter health after 50 , rebus , n . y ., 382 . 18a . neurology , medical library lawyers edition , by ausman and snyder , 6 : 105f , 1990 . 21a . “ tendon hypertrophy is associated with increased hydroxylation of nonhelical lysine residues in two specific cross - linking sites in type 1 collagen ” by gerriets and curwin , in i . biol chem ( united states ) dec . 5 , 1993 268 ( 34 ) p25553 - 60 . medline p . 2 . 21b . “ echographic assessment of the hand ” by bottinelli , et al , in radiol med ( torino , italy ), may 1993 , 85 ( 5 suppl 1 ) p227 - 36 , medline p . 3 . 21c . “ multiple ruptures of flexor tendons due to hypertrophic change at the distal radio - ulnar joint . a case report .” by minami , ogino and tohyama , in j . bone joint surg ( am ) ( united states ) february 1989 , 71 ( 2 ), p . 300 - 2 . 22 . comparative effects of querty ( sic ) and dvorak keyboards in the niosh health hazard evaluation at us west communications , by hales and sauter , niosh , cincinnati ohio , circa 1995 . 23b . entrapment and compression neuropathies , by eversmann , in operative hand surgery , by green editor , 3d edition , vol . 2 , churchill livingstone , new york , pp . 1346 et seq . 24a . clinical diagnosis of peripheral nerve compression in the upper extremity , by anto and aradhya , in the orthopedic clinics of north america peripheral nerve compressions of the upper extremity , george , ed . 27 : 2 : april 1996 , w . b . saunders , philadelphia , 227 et seq . 24b . carpal tunnel syndrome by kulick , in the orthopedic clinics of north america peripheral nerve compressions of the upper extremity , george , ed . 27 : 2 : april 1996 , w . b . saunders , philadelphia , 345 et seq . 24c . newer techniques of carpal tunnel release , by mirza and king , in the orthopedic clinics of north america peripheral nerve compressions of the upper extremity , george , ed . 27 : 2 : april 1996 , w . b . saunders , philadelphia , 355 et seq . tables 1 and 2 , at 363 and 365 . 24d . pitfalls of endoscopic carpal tunnel release by einhorn and leddy , in the orthopedic clinics of north america peripheral nerve compressions of the upper extremity , george , ed . 27 : 2 : april 1996 , w . b . saunders , philadelphia , 373 et seq . 26a . essential elements of an upper extremity assessment battery , by fess in rehabilitation of the hand surgery and therapy by hunter et al ed . 3d ed . 1990 , c . v . mosby , st . louis . 53 et seq . ( splint and rehab forms ) 26e . therapist &# 39 ; s management of carpal tunnel syndrome , by baxter - petralia , in rehabilitation of the hand surgery and therapy by hunter et al ed . 3d ed . 1990 , c . v . mosby , st . louis . 640 et seq . at 640 . 27 . carpal tunnel syndrome in complete guide to sports injuries by griffith , at 380 . 28 . surgical and diagnostic procedures : inappropriate procedures : 1991and 1992 , statistical record of health and medicine , by dorgan ed . gale research , international thomson publishing , new york , 1995 , p . 183 , table 239 . 29 . carpal tunnel syndrome , arm and leg surgery , the surgery book , 73 most common operations , by youngson , diagram group , st . martins press , 1993 , p . 176 et seq . 42 - 8 . lane , merritt , nathan : cts : the workup . patient care april 15 , 1993 , pp 97 - 108 , infotrac , management techniques , pp . 111 , morton l . kasdan , connie lane , wyndell h . merritt and peter a . nathan , infotrac 42 - 26 . when to suspect — and diagnosis . 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