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P‐4508 as of July 2014 iii

Section 1: Introduction to the Technology Description 1

Section 2: Set‐Up Software Installation 2 Hardware Set‐Up 2

myoPRESSURE Device Configuration Settings 4

Section 3: Software Navigation Overview Main Navigation Bar 7 Main Operation and Instruction Bar 7 Tool Bar 8 Local Menu Element Controls 8

Section 4: Home Tab Introduction 9 Select a Module 9 Select or Create a Subject 10

Select or Create a Configuration 10 Right Side Tool Bar 10

Section 5: Create a New myoPRESSURE Measurement Configuration Introduction 11 Create or Edit a Measurement Configuration 12 Measurement Options 13

Section 6: Measure Menu Introduction 14 Preview Screen 14 Recording Measurements 15 Screen Layouts 15 Measure Menu Functions 19

Section 7: Database Menu Introduction 21 Right Tool Bar 23

View Records 28

Section 8: Viewer Menu Introduction 29

Signal Processing 33 Video Analysis and Video Options 33 Marker Menu 33 Edit Menu 34 Edit Channel Properties 40 Signal Bars 41

Section 9: Report Menu

Table of Contents


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Introduction 42 myoPRESSURE Reporting System 42 Gait and Running Analysis Report 47 Report Period Definition Step 47 Report Preview and Editing 56

Appendix A: Report Descriptions 64

Appendix B: Multi‐Device Configurations and Master Sync System 74

Appendix C: Master Sync and Connect Schemes for myoPRESSURE Treadmills 75

Appendix D: Master Sync and Connect Schemes for myoPRESSURE Insoles 77


P‐4508 As of July 2014 1

Description Noraxon‘s myoPRESSURE module operates with different pressure distribution devices:

The instrumented treadmill system – myoPRESSURE‐T

The portable insole system – myoPRESSURE‐S

The pressure plate – myoPRESSURE‐P (coming Q4 2013) The data acquisition and analysis using the different pressure devices is very similar, only some hardware setup and sync settings differ. myoPRESSURE presents the user with both 2‐D and 3‐D animated pressure prints of each detected foot step during both the recording and replay. In the report, the user is also given: the vertical ground reaction force curve of each foot, a comprehensive analysis of standard gait parameters, center point of pressure (COP) related analysis and associated averaged curves.

Section 1: Introduction to Technology


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Software Installation

Before you start the MR3 software please connect all devices to your PC that you plan to use with the software. Insert the installation USB card or use the MR3 download file and start the installation with Noraxon.mr.3.x.x.exe (x is the latest version release number). Follow the steps in the Installation Wizard menu and click Finish to close the Installation Wizard routine. A new Icon will appear on your desk top:

Double click on the icon to start the MR3 software.

Hardware Setup At the very first program start, MR3 will operate an automatic hardware detection run by prompting this screen:

Make sure that all purchased devices are connected to the PC via USB and properly installed in the Windows operating system. Click OK to run the hardware detection. You can manually repeat this hardware detection and hardware setup routine at any time.

After starting the program click on (upper right corner) in the green command line to open the right side tool bar.

Section 2: Set‐Up


P‐4508 as of July 2014 3

In the newly opened tool bar click on to open up the Hardware Device setup menu. The Hardware Setup menu will automatically insert any devices connected to the computer, including any webcams that may be part of the computer. Click on

if you would like to remove any inserted devices from your configuration. The Hardware Setup menu may also show some “Player” devices which are virtual demonstration drivers to simulate an EMG, myoMOTION or pressure plate recording

without connected hardware. Click on to remove it from your configuration.

Click to integrate the devices you plan to use with the MR3 modules. The next screen shows a list of all selectable devices or preconfigured devices. Please note that only connected devices (recognized by Windows operating system) will be listed here:

Select your auto‐detected pressure device, operate its device specific settings and click OK.


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If you plan to use myoPRESSURE together with other devices like 3D kinematic system (myoMOTION) or EMG (myoMUSCLE), the sync mode needs to be activated. Please refer to Appendix B, the hardware installation menu and the hardware manual for more details on “multi‐device” setups.

Note: To operate multi‐device setups Noraxon’s MyoSync device is strongly recommended. More information on the Master Sync concept can be found in Appendix B.

Confirm by pressing OK. This will bring the user back to the Hardware Setup menu. Review everything and press OK to return to the Home screen. Many MR3 interface functions are shared between editions and devices. Some major interface elements are introduced in the next chapter.

myoPRESSURE Device Configuration Settings Once the myoPRESSURE device has been selected and the OK button has been hit a Settings Menu will pop up. Different pressure systems will have different setups. Please see the hardware manual for your specific pressure system setup. Once the device settings are correct, the user should press OK. This will return the user to the Hardware Setup menu. Now, the Noraxon pressure system’s icon should be present. If there is ever a need to change the device settings, the settings box can be reached by highlighting the device and clicking the Configure Device button in the Hardware Setup menu.


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Hardware Profiles It is possible to save various hardware profiles. This allows the user to have specific hardware setups and device configurations saved. This is especially useful if myoMOTION is used and the user does not have a full body, 16 sensor system. The hardware profile allows the user to save different device configurations such as upper body, lower body, etc. To save a hardware profile first open the Hardware Setup as described above. The Hardware profile will automatically open in the Default profile. The default profile cannot be saved and will change as devices are inserted and deleted. Click on the New button in the upper right corner to create a new savable hardware profile, or click on the drop down arrow to select a previously saved hardware profile.


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Selecting the New button will open the New Profile dialogue box where the user can create a profile name to save the hardware profile. Selecting Clone Settings allows the user to copy the devices and device configurations currently in the Default hardware profile.

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Introduction The Home screen menu consists of 3 sub steps that allow you to select a measurement module (in this case myoPRESSURE), and select or create a subject and measurement configuration. To do this, simply perform steps 1 through 3 on the Home screen:

Select a Module MR3 is multi‐functional software that can operate numerous sensors and devices. Each of these can function as a stand‐alone device or module or be used in combination with each other. Step 1 allows you to select the module you would like to use for the measurement. Modules include; myoMUSCLE for EMG recording, myoMOTION for 3D motion analysis, myoPRESSURE for integrated foot pressure analysis and myoVIDEO for 2D motion capture. Modules become available once they are purchased and unlocked by the user.

Section 4: Home Menu


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For this section select myoPRESSURE as the measurement module.

Select or Create a Subject Each record will be saved under the subject. There are an unlimited number of subjects that may be saved to the MR3 database. Subjects may be selected from the drop down menu in step 2. Next to the drop down menu is also the button to create a new subject.

Note: Subjects are saved under Projects. Projects can only be changed or selected under the Database menu.

Select or Create a Configuration Next the user will select, edit, or create a new configuration. Please see the next section for details on Measurement Configurations.

Right Side Tool Bar Each tab will have different tools available in the tool bar. For the Home tab, the tools are described below.

Actions Setup – This takes the user into the hardware setup. The hardware setup screen is described in the hardware manual. Update License – Allows the user to update their software in case they purchase additional modules or features.

Configurations Rename – Allows the user to rename the highlighted software configuration. Delete – This will delete the highlighted configuration.

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P‐4508 as of July 2014 13

MyoPressure‐S (Medilogic) has no other setup requirements.

MyoPressure‐T (Instrumented Treadmill) allows you to select between:

Gait mode for bilateral gait and running analysis on instrumented treadmills

Stance mode for Bilateral Stance analysis on instrumented treadmills and floor plates

You are now ready to continue to the measurement screen.

Note: If MyoPressure‐T treadmill/platform is being used make sure the plate is unloaded (nothing/ no one standing on it) and ready for an initial calibration that will occur immediately after the Start Measure button is pressed.

If Medilogic insoles are used, this unloading is not needed and subjects may be standing on the insoles at the beginning of the measurement.

Measurement Options

In the right side tool bar are the Measurement Options including: Recording Options, Feedback Options, and Online Processing. These options are meant for use with myoMOTION and myoMUSCLE but do not apply to myoPRESSURE.


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Introduction

After selecting an existing configuration or creating a new configuration continue to the measurement screen by clicking the Start Measure button in the green operation line:

Note: Immediately after clicking this button, a short treadmill plate calibration is performed where users should be OFF the treadmill, but this calibration is not needed for the Medilogic insoles.

Preview Screen

The system is now ready to take measurements; the incoming pressure data will be visualized on the screen by a 3‐D isobar graph:

This view of visual animation can be changed using the various mouse buttons. The animation can be rotated by clicking and holding the left or right mouse button. The mouse wheel zooms in and out on the 3D visualization, and if you press and hold the mouse wheel button you can move the animation up and down, left and right within the video animation screen.

Section 6: Measure Menu


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Recording Measurements The system is now ready to take measurements. Any movement made by the test subject will be animated by the 3‐D isobar graphs in real time.

To start a recording press Record, perform the desired activity and press Stop:

The Save Data dialog will appear and a Name can be entered in first line:

The second line Subjects allows the user to change, create or confirm the previously selected subject name. After pressing Ok the record can be reviewed in the record Viewer. To perform the next measurement with the same subject just click the Measure tab in the top navigation bar again. Make sure that the pressure platform is unloaded at the start of each Measure.

Screen Layouts

If the only device in the configuration is the myoRESSURE device, the 3‐D isobar graph will be the only thing visible during the measurement. In the case of multi‐device setups, e.g. myoPRESSURE with myoMUSCLE (EMG and mobile sensor recording), myoVIDEO (2 camera video recording) or myoMOTION (3D motion analysis of angles) it may be helpful to use the customizable screen layout system of the Measure menu. Generally, each device will have its own specific register tab:


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In the above example, pressure data are shown in the Video/Animation tab while EMG from the myoMUSCLE Module is shown in the EMG Device tab:

This separation is helpful to manage the many signal windows created by the use of full body or multi‐device measurements (e.g. 16 EMG channels are added). Any signal from any signal tab section can be clicked and dragged into the new user view tab labeled with +. For example, the signals from a specific muscle can be moved into a new user tab. Once a signal is present, the New User View tab will automatically be renamed Tab 1. Right click using the mouse allows the user to rename the view. A Rename card dialog box will appear:

This screen layout system allows the user to create as many signal selections or new user views as needed. A similar system is available for the Video/Animation window:


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Double clicking on a given signal name moves this signal into a pop‐up window:

The small red X button in the upper right corner of the window title line will close the pop‐up window and move back the signal to its original tab location. If you hold the CTRL key and click on a second channel title from the source tab you can insert more channels to the pop‐up window:


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If you click on the channel name and drag it over another channel, they are shown in an overlay mode:

This and other pop‐up Signal/Animation windows can be moved to a second monitor, if one is available. Whenever a certain screen/window layout arrangement is established you can Save it in the Screen Layouts section of the right tool bar. Click on Save and enter a suitable name for your channel layout configuration and it will appear in the upper list section:

In case you want to use a user defined layout double click on its name in this selection list.


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Other default options in Screen Layouts are these buttons: All in one tab – all signals from one tab will be shown (again) on one shared screen Show by group – each device and signal category is shown in separated tabs (this is the default) Delete – will delete a screen layout configuration from the selection box

Note: The channel layout which was setup in the Measurement menu will be the same in the Viewer menu. However, all layout and channel arrangement functions are still available in the Viewer menu as well.

Measure Menu Functions

Local Amplitude Zoom Function

During measurement and recording the given amplitude (Y‐axis) scaling can be changed by using the local red zoom plus/minus buttons:

The timeline (X‐axis) also has local scaling options. The plus and minus will increase or decrease the length of time displayed in the signals window while the equal sign returns the window to a 10 second time display.

Actions Tool Bar The right tool bar of the Measurement menu includes a section titled Actions. This tool section is only meant to be used for myoMOTION and myoMUSCLE signal screens and is not active (or needed) for pressure distribution animation in myoPRESSURE or video analysis in myoVIDEO.


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Measurement Setup – directly goes back to measurement setup/configuration screen. Please see below for more details about this setup and options.

Calibrate Baselines – this option is only needed if EMG and other biomechanical sensors from the Telemyo G2 or DTS system are included in the recording. For such signals it may be required to correct zero line offset shifts via recalibration Record – same function as the green Record button on top left position

Marker Menu

With this menu you can create marker names and manually mark or comment events in

your recording. Once recording has started, clicking the button, under the Markers tool bar, will place a marker in the record (displayed in the Viewer menu) as well as provide an audio cue. The default marker name is Marker. If you want to create a new marker name, double click on the Marker name entry box and overwrite the existing one, click the green check mark button, and this new marker name will be inserted to the list of available marker labels:

To use a marker name from the list double click on it (don’t use the green check mark button). A successfully placed marker is indicated by a short tone. To delete a marker from the marker label list, click on the red X right side to each marker name.


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Introduction

As indicated by its name the Database tab manages all functions around data file management, like selection, editing, exporting and importing.

1) Lists Project’s Subjects 2) Lists Subject’s Records 3) Local List Functions 4) Right Tool Bar Menu 1 & 2 – List sections The screen is split into two sections, reflecting the organization of records into Subjects (left list section) and Records (right list section) stored under a given subject name: 3 – Local List Functions Below each list you find a set of list functions:

Section 7: Database Menu

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Edit/Rename Here you can change the subject name and add additional information associated to your subject such as subject properties, comments or pictures.

Delete Here you can delete your subject and all records stored under this subject Note: deleted subject data and records cannot be restored.

Quick Search If you have a very large database it may be helpful to use a search function to quickly find a certain subject

Sort This entry allows you to sort your database by first or last name in ascending or descending order

Info If this button is pressed/box is checked, the subject properties window with Basic info, Subject form, Comments and associated pictures is permanently visible

The same set of list functions is available for the records list screen as well. The record

Info button shows important record property details:

Basic A summary of basic record properties like file name (editable), size, date, duration etc.

Muscles/Devices Only for EMG and sensor records, shows a list of selected sensors

Comments Each record can receive a record specific comment which can be created or reviewed here

Picture/Video This info tab is very helpful if you have recorded data together with video. The first picture of the video is shown here to help you find and identify a record

Meas. Options Not activated yet

Processing History In case any signal processing was applied to your original record, all processing steps are documented here


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4 ‐ Right Tool Bar Menu

If you click the button on the right side of the green instruction bar, the

Database Tool bar will show up. To remove the tool bar, click . Besides the Subjects Database there is another database section called Normative Database

It contains all normative data records that were compiled via the “Add to Normative” function within the Report Menu (see chapter 9: Report Menu). All database functions described below are also available for normative records.

Note: The normative sample file “Natural floor gait reference curve” is not meant to be used for any medical diagnosis or similar purposes. It only serves as an educational example on how to use or operate normative data.

Right Tool Bar

Projects and Data Hierarchy MR3’s database system is organized in hierarchy levels:

Projects

Subjects

Records

Project is the highest database level. Projects can include an unlimited number of Subjects, which can include an unlimited number of records.

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Import Records

You can import myoPRESSURE records from external locations such as a previous version on your PC, backup data from external hard drives or network folders:

To import myoPRESSURE or multi‐device records select Import, then

and set a path to the external directory (e.g. a net drive or external hard disk directory).

Other import options include:


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Import from external location

Import entire MR3 projects, subjects or records saved to an external location Note: It is possible to import into the directory the records were originally saved in, or into the currently opened project

Import video file Externally recorded video files in avi format can be imported

Import MRXP data Import of records from the former MyoResearch XP version

Import record from text file

Imports Ascii or txt formatted records. Attention, only MR3s ascii data or similar arrangements are supported (see export file to ascii)

Import of C3D file C3D format used by most Motion capture companies is supported and allows for import of kinematic, force and EMG data recorded there

Import record from Noraxon Datalogger (*.tm2)

Data logged files from the Telemyo G2 and Telemyo DTS belt receiver can be imported here

Import Zebris16 Data Imports pressure data recorded with Zebris old 16Bit systems (FDM, FDMT)

Import MyoPressure data

Data recorded with the myoPRESSURE Software from Zebris can be imported here

Import record from MyoMotion Datalogger (*.mml)

Imports data recorded with myoMOTION inertial sensor data logger

Export Records You can export myoPRESSURE records to external locations, the records of another subject, to a text file, and to an excel file:

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Introduction

Each successfully stored recording will automatically be loaded to the record Viewer. Data will be presented in the same channel layout scheme that was used for recording. The main goal of the Viewer menu is to inspect the quality and details of a record, apply signal processing, place markers (for analysis period definition) and prepare the record for further analysis (=> Report). As an overview the following menu elements are available:

1. Channels and view functions 2. Time line 3. Playback controls 4. Tool bar menus

Note: MR3 automatically calculates the resulting ground reaction force curve from the pressure data for the left and right sides. They are shown as a signal to the left of the pressure animation screen. With multi‐device setups the record Viewer can show signals from all measured devices plus video, pressure and motion animation avatars. The addition of multi‐device modules also adds functions to the right side tool bar, e.g. myoVIDEO based video recording adds two more sub menus; Video analysis and Video Options.

Section 8: Viewer Menu

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1) Channel View and Functions The Viewer menu presents all recorded data exactly in the same screen layout arrangements as they were measured. Because of the multi‐device nature of MR3, numerous signal, animation video and biofeedback screens can occur which require a sophisticated screen element management. As described in the measurement menu/section screen layouts, in the case of multi‐device setups each device will be shown in its own tab section. The following channel display, zoom and overlay functions are available:

Local X and Y axis +/‐ buttons allow for zooming operations of amplitude and time

Double click on channel name maximizes a channel to a pop‐up window

CTRL – Double click adds a second or third (….) channel to the pop‐up window

Pop‐Up windows can be moved to a second monitor

Left mouse drag of the channel name to another signal creates an overlay of both signals

Any amount of signals can be mouse dragged to a new tab

Any given screen layout arrangement can be stored as a configuration available in the right tool bar

(See the Measurement chapter for more detailed descriptions and examples)

2) Time Line The time line indicates the cursor and marker time positions, marker labels and the location of the analysis periods (see the Report chapter for details).

3) Video/Avatar Play/Replay Controls

Play Plays all visible videos on the screen at the same time

1x Plus and minus signs control the play speed, 1x means the original speed, + increases, ‐ decreases the play speed

Arrows Their function follows standard video control functions: Go to the beginning of the video clip, go one picture back, one picture forward or go to the end of the video clip

Play to Video File This is MR3s video/screen recorder function and allows you to record any video, screen animation, time synchronized measurement signals, etc. (e.g. EMG, auto‐tracked angles) to an .avi file. A small menu dialog allows you to define file destination directory, video size, frame rate and compression factor:

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Video Options (optional) Consists of a set of video adjustment tools Marker Menu (optional) Several modes for marker labeling and auto marker settings for trigger and angle channels. Note: Markers can be manually set in the signals by double clicking the left mouse button.

Signal Processing

Typically not needed for Pressure distribution recordings! The signal processing menu is nearly identical to the Online processing menu of the measurement menu. It has some additional processing options, but the main operation of functions is similar. Signal processing is a collection of commonly used processing modes for biomedical signals. These processing options are most commonly applied to raw EMG signals.

Video Analysis and Video Options (optional) These options are only displayed if you have purchased the myoVIDEO module and recorded a video. A more comprehensive description of functions is given in the myoVIDEO Manual or online help function.

Marker Menu Typically not needed for Pressure distribution recordings!

The marker menu manages all operations to place labeled markers in your recording. The main purpose of markers is to define analysis periods for reports. Markers can be placed by three major actions:


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in real time, by pressing the Mark button while recording

in the Record Viewer by double clicking a signal portion (left mouse button)

by using the auto‐marker algorithms presented in this menu The markers and periods system is needed to fulfill the complex task of analyzing selected signal portions, TTL triggered periods, timing related onsets, or sub phases in gait analysis, just to name some examples. MR3 offers four auto marker methods to place markers in a record:

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Edit Menu

Unlike Signal Processing, all Edit operations physically change the record data set and the original recording cannot be restored. Therefore, it is generally recommended to first make a backup or a copy of your data. Alternatively, save any changes done in Edit mode with the option Save as...., which allows you to create a new record file (including all your edit changes) while keeping the source record in its original status.


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At the top of the Channel Tools box there are 3 iconized View Modes of the signals:

Raw – show the original unprocessed signal (signal processing is removed)

Processed – show the signal only in its processed version (signal processing included)

Both – show an overlay of both raw and processed

Depending on the selection done here, any channel tool operation refers to this selection. For example, to copy a raw channel to clipboard and paste it to another location the Raw signals mode must be used.

New channel(s) This function allows you to create new channel lines at any location in your record.


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Place After – can be used to define a certain location for the insertion in the channel order. Name – edits the name of the channels. Color – loads a color palette to define a trace color for this channel. Channel type – offers a pull down list of all available channel types to be selected for the new channel. Raw Signal –organizes the amplitude scaling settings for the new channel.

Units – define the physical channel unit. # of digits – is the decimal value when showing the actual amplitude value. Bottom value/ Top value – the lowest (Bottom) and highest (Top) amplitude scaling value for the Y‐axis.

Delete, Copy and Paste Channels

All three options have the same functionality. The selection for the given operation is done via the Select By section of this sub menu. By default all recorded channels are selected if there is no Select By method chosen.

To select a channel for the given Edit operation you can use these selection modes: Select by:

Channel type select channels by type, e.g. EMG, force, etc.

By body side select left or right side labeled channels Channel number: select by the channel list number


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Note: All 3 modes can be combined with each other.

Delete – physically erases a channel

Note: after the confirmation, which appears when leaving the record viewer menu, this channel cannot be restored!

Copy channels – copies the selected channel data to the clipboard Paste values – fills channel data coming from the clipboard to the selected target channel

Paste channels – pastes channels copied to the clipboard below the last channel

Fill Channels

The Fill Channel function is an editor for amplitude values. Based on a mouse mark signal portion, any amplitude value can be entered and will overwrite the existing values. For example, this function can be used to manually eliminate artifact spikes or other invalid data portions within a channel.

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Signal Bars

This button adds a new screen window showing the amplitude data at the cursor position as a bar graph:

Show channels with unit < > – allows the user to select what type of signal/channel will be displayed as a bar graph Smoothing – the value entered here defines a smoothing interval based on the mean value of this selected interval


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Introduction

Whenever the myoPRESSURE insole or pressure plate/instrumented treadmill system are used in recording it is recommended that users analyze the data (typically standing, walking or running activities) with myoPRESSURE’s Bilateral Gait Report or Stance Analysis Report. The Bilateral Gait Report is configured so that the resulting ground reaction force curves are used to determine the “heel strike” and “toe off” of each foot which are used to define the gait cycle. The Stance Analysis Report is designed to analyze the pressure distribution of two feet standing side‐by‐side. Reports can only be started if a recording was taken in Measure and followed immediately by selecting a Report, or a report was selected in Database and loaded to the Viewer menu (see work flow from left to right in the main navigation bar). Staying in the Viewer menu, click on the Report button in the top navigation bar or green Report button in the main action bar:

myoPRESSURE Reporting System

All myoPRESSURE gait recordings can be analyzed with a standardized default report called MyoPressure Bilateral Gait report; it does not matter if the recording was treadmill/platform based or insole based. Simultaneously recorded data from other modules, like EMG channels (myoMUSCLE module) or 3D angles (myoMOTION module) are automatically included in the analysis. There are numerous possibilities to edit, modify or even create self‐defined new reports. Stance records can be analyzed with the MyoPressure Stance/Balance Report. When done, the Select Report menu is opened. Dependent on the amount of installed modules, a selection of ready to go analysis reports are displayed.

Section 9: Report Menu


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1. Report selection organized in module tab system 2. Channel selection section 3. Report info section with report preview 4. Report Options

1) Report Selection Reports are sorted in four major tab sections. The accessibility of these tabs is dependent upon the equipment and modules installed.

MyoMuscle (Application, Clinical, Standard) – for all myoMUSCLE EMG and sensor records

MyoMotion – for all myoMOTION based 3D kinematic records

MyoPressure – for all pressure related records

MyoVideo – for myoVIDEO 1 and 2 video camera records The list of available default reports may grow with new program updates.

2) Channel Selection By default all channels of a given record are selected for the report analysis and listed in the section Selected channels:

1

2

3

4


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If analysis should be restricted to certain channels, three filter options are offered:

Channel type e.g. select all EMG, force or angle channels

By body side select left or right side labeled channels

Channel number: select by the channel list number

3) Report Info with Report Preview Here you can find a short description of the selected report addressing its main purpose, the way analysis periods are defined (Period Definition), analysis elements and typical signal processing steps (if needed, e.g. EMG).

The right side shows a static picture to preview the typical contents of the selected report


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4) Report Options

New Specialists can create their own reports by selecting a report class and manually choosing analysis, layout and info elements. A description of this Report Generator module is given in an additional document. Edit – Basic Settings If needed a report’s title, tab sections, description text and preview window can be changed with this edit menu:

Edit – Report Class The report class editor is meant to be used for experienced report designers only. Reports can vary in complexity in terms of periods and phase definition. For example, some reports do not require any period or phase definition because usually the whole record or a mouse marked area is analyzed (e.g. Clinical coordination report or Spectrum report). Other reports, like Unilateral Gait in the MyoMuscle Application Reports, need a foot switch triggered period definition with 2 phases (stance and swing phase) to properly analyze the gait cycle. Even more complex are the Bilateral gait setups which add more sub phases to the gait cycle. The current MR3 version offers six levels of complexity to manage these differing tasks:


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Selection / Whole record – The whole record or the mouse marked area will be analyzed. Point of Interest – Only single points of interest, marked with the button Add to Report in Viewer menu, will be included in the report (designed for Video Analysis). One‐phase periods – A sequence of markers or event based (defined by trigger channels) periods without additional sub phases will be analyzed. Two‐phase periods – A sequence of periods with two sub phases will be analyzed (e.g. extension/flexion, stance/swing phase, etc.). You can freely name the first and second phase (default names are Pre and Post event). Bilateral analysis – This class is mainly designed for left to right comparison analysis in bilateral gait measurements and splits the period definition into left and right side periods. Bilateral Gait analysis – A sub version of Bilateral analysis and needed for myoPRESSURE recordings.

Delete This function will delete a report without a possibility of restoring it. Carefully use this option and consider first making a backup to an external location using the Export function.

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Period Definition for Treadmill or Floor plate data For treadmill/pressure plate recordings the period definition routine automatically identifies the gait events and visualizes them with red (left side) or green (right side) bars just below the force curve signals:

The dark shades indicate the subject is in stance phase, while the lighter color indicates swing phase. Using the mouse, if you highlight a signal area (in light blue) on the force traces screen, only the steps inside this selection will be analyzed:


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When all the analysis periods have been set correctly, click on to start the report:

Period Definition for Insole data The period definition (step detection for gait/running activities) is operated in 2 steps:

First the left side gait events, heel strike and toe off, are automatically detected by using the period definition mode Rise/Fall by trigger channel and Rise to rise with event. The algorithm is automatically looking for the left side force curve and identifies the rise and fall of the force curve from zero, up, and back to zero. The rise occurs during the heel strike and beginning of stand phase while the fall consists of the end of stance phase and beginning of swing phase. Click on Set to use this algorithm for period definition:

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Note: It is recommend choosing the basic settings pre‐configured for this report and only entering the period definition tool bar menu if experiencing problems, such as noisy signals. A wrongly selected and operated period definition will result in an inaccurate analysis of the default MyoPressure report. MR3 supports 4 major period definition methods

By Markers This is the default mode for most reports. Markers are set by left mouse double click or by using the Marker Menu in the Viewer menu. The default name for these is Marker, but the marker menu allows you to create other marker names. Individual marker names can be used with the second method By markers labels. If the report class is a One Phase (e.g. Standard Amplitude) or Two Phase (e.g. Average Activation) report, a set of sub modes are presented in the vertical sub mode column: One phase reports: Two phase reports:


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The result of any auto period definition routine is visualized by horizontal periods bar just below the signal screen: One phase reports: Two phase reports:

Selected sub mode: ‐ Every other interval ‐ Every interval with event Check if one of the offered sub modes is more suitable to your task and select it by confirming OK. Pressing the Preview button allows the user to see the periods in the signal window before selecting OK.

By Marker Labels Markers can freely be named by any label (see Viewer, Marker Menu). If special marker names were used in record viewer or in imported files (C3D gait event markers) the period definition can specifically use these marker labels for period definition. For example, all “Heel strike” markers can be used for the beginning of a 2 phase cycle (step), and all “Toe” markers as “event marker”.


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Choose the marker type in the pull down list Marker name Offsets from markers will add a pre‐marker period, a setting that is helpful for event markers in jump testing (pre‐activation period before hitting the ground). Skip one marker is needed in case there are desired interruptions within un‐interrupted motion cycles (e.g. gait).

Min/Max by trigger channel This period definition type is designed for angle curves and similar signals that should be used as a motion trigger signal. It detects local Min and Max values in the selected trigger channel. If the report class is a One Phase (e.g. Standard Amplitude) or Two Phase (e.g. Average Activation) report, a set of sub modes are presented in the vertical sub mode column: One phase reports: Two phase reports:

Channel – select the trigger channel to be used for the auto‐period detection Threshold – regular angle signals can be analyzed by the Auto mode. In special cases it may be required to select a Manual mode. Here you need to enter a suitable value that defines the minimum range that has to be found between Max and Min angle value to accept it as a local event.


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Check if one of the offered sub modes is more suitable to your task and select it by confirming OK.

Rise/Fall by trigger channel The Rise/Fall auto detection is designed for classical TTL styled signals and foot switch on/off signals with a sharp rising edge going to high TTL and sharp falling edge going back to low. If the report class is a One Phase (e.g. Standard Amplitude) or Two Phase (e.g. Average Activation) report, a set of sub modes are presented in the vertical sub mode column: One phase reports: Two phase reports:

Set period by Channel – select the trigger channel to be used for the auto‐period detection. Only once for each activity – designed for multi‐activity recordings which interrupt a recording via a pausing period.


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Threshold Relative tries to automatically detect every Rise and Fall of the trigger signal by checking the TTL range and placing markers at the 50% position between the rise and fall level. This location can be customized by the controls Rise at and Fall at between low and high (TTL level). Absolute takes the amplitude values entered in Rise at and Fall at as threshold lines and uses it for the period definition; each time the TTL signal passes the defined threshold line, it is assumed that this event can be used to define a period.

Minimum (anti‐rattle) duration defines the minimum duration a TTL event has to last to be recognized by the algorithm. This switch can help avoid wrong selections caused by artifact spikes (typically very short spikes).

Note: For very short trigger events like jump ground contacts, this anti‐rattle duration needs to be adjusted to lower values!

Check if one of the offered sub modes is more suitable to your task and select it by confirming OK.

Note: we recommend choosing the basic settings pre‐configured for the report and only entering the period definition tool bar menu if experiencing problems, such as noisy signals. A wrongly selected and operated period definition will result in an inaccurate analysis of the default myoPRESSURE report.

Report Preview and Editing

Once a report is chosen and the analysis periods have been set, a preview of the report will be generated. At this point, there is also the option for printing, exporting, or further editing and analysis.

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View Signal – the user can view the signals of a selected element. Clicking on this will display the selected element in the window. To return to the report preview, hit the back arrow button or click on the Report tab.

Analysis Options

Reanalyze – will take the user back to the Viewer menu to change the period definition.

Compare – default is set to none, but the user can choose to compare sides (right vs. left), compare to other records in the database, compare to the normative records in the database, or compare selected channels.

Add To Normative – adds to normatives in the database, or creates and adds to new normatives in the database.


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Note: The only normative included with the MR3 software is the Natural Floor Gait Reference Curves. All other normative data must be created and saved by the user. Only the time normalized averaged curves are stored to the given normative file.

Add to normative

MR3 has a powerful normative data generator. It is designed for records analyzed with averaged curves reports such as Gait, Average Activation, Isokinetics, etc. All these records have a time normalized ensemble average curve with plus/minus 1 SD. The time normalization in cycle from 0 to 100% enables a standardized format for comparison files of different phase duration.

Any successfully created averaged curve can create a New normative file or it can be added (Add) to an existing one:

All normative files are listed in the Normative Data base section of the Database menu. They are also available as normative comparison files in the report Comparison option described above.

Compare Click on Compare in the right tool bar menu to start the Comparison Menu. MR3 supports four major comparison routines for report data:

Compare sides

Compare to other records

Compare to normative (if available)

Compare channels (within the same record) Compare sides In records measuring both sides of a muscle group/channel, the Measurement Setup Menu allows each muscle group a side indicator (LT and RT, see Measurement Setup Menu). If this comparison mode is chosen, muscles/channels of the same name but with differing side indicator RT and LT are automatically compared. This function works independently of the channel numbers and arrangements, all channels of the same channel name but with LT and RT indicator are automatically compared!


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Compare to other records Compares the record to another record previously stored in the database and analyzed in the Report menu.

Note: In order to compare records, the records must have generated the same exact report at some point. Only 2 reports should be compared in one comparison run.

After confirming the record selection with , both record data will be shown side by side or as an overlaid signal in each report element:


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Compare to normative (curves) MR3’s unique normative data system can be used to compare a current record to a normative record. Normative records are usually time normalized averaged curves of single healthy subjects performing a repetitive sequence of the analyzed activity. To create a normative curve, first the single subject performs a repetitive sequence, and then each repetition period in this sequence is averaged in time normalized cycles. Finally 10 or more of these individual time normalized records are averaged again in MR3’s normative database in a group or normative curve. Once done and available in the normative database, a current patient curve can be compared to this group curve to show differences, such as differences in the EMG pattern.

Note: Only records of the same type and analyzed with the same report settings can be compared.

The selection box Normative has a pull‐down list of all available normative curves available in the current project. Choose a suitable normative record from this list. All normative files that were created with the right tool bar function “Add to normative” are listed here.

MR3 is equipped with one sample normative file for floor walking.

Scale normative – If normative data were not amplitude normalized via Signal processing in the Viewer menu, the amplitude data may heavily vary. This function allows users to amplitude normalize both the selected patient record as well as the

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Appendix A: Report Descriptions

MyoPressure Bilateral Gait Report With the exception of a couple of analysis parameters both MyoPressure‐T treadmill and MyoPressure‐S insole records will result in the same analysis report. The report consists of 3 pages unless there is additional data from a multi‐device setup:

If a multi‐device setup was used with EMG, Motion data and/or video the report can grow up to 7 – 8 pages.

MyoPressure Report Page 1

Report header

This header box is repeated on each report page. Users can change pictures (e.g. add a company logo), title text, selection of patient or record property items by double clicking on the element to be changed.


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Pressure Prints

This report element shows the average and maximum pressure data of all detected steps in a color coded isobar graph. The migration of the center point of pressure (COP) is shown as a grey line, known as the gait line.

COP Diagram (or Cyclogram) The COP diagram consists of three graphs:

Left (red) and right (green) gait lines from each stride plus a butterfly diagram in the middle. The butterfly diagram is meant to analyze the pattern characteristics of COP migration from back to forefoot roll up phase and then turn transversion to the other side. To do this both feet are artificially placed side by side to visualize the motion pattern within. It is a very sensitive tool to identify asymmetries and abnormalities in gait and running activities.


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COP Parameters The COP parameters are a set of numerical values describing gait line and butterfly related characteristics:

Gait Line Length The Length of Gait Line is the length of the line that describes the course of the pressure center, with only the individual ground contacts on one side of the body are taken into consideration. This parameter comprises the course of the MPP for all the steps recorded for one side of the body. Single Support Line The Single Support Line is equivalent to the average length of the lines that describe the course of the pressure center, when all the ground contacts are taken into consideration. Anterior / Posterior Position This parameter takes all the user’s steps into consideration to describe the shift forwards / backwards, of the intersection point of the course of the CoP in the cyclogram display. The zero position is the heel strike. Lateral Symmetry This parameter takes all the user’s steps into consideration to describe the shift to the left / right of the intersection point of the course of the CoP in the cyclogram. A negative value indicates a shift to the left side, and a positive value a shift to the right side. The zero position is the center of the presentation.


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MyoPressure Report Page 2 Page two refers to the classical gait parameters describing phase related, temporal and spatial aspects of the gait performance related to gait events and gait sub phases. MR3 is using the gait phase definition established by J. Perry:

Gait Phase Parameters

Phase in % cycle DescriptionStance Phase

Describes the period within a gait cycle during which the foot has contact with the ground

Load Response

Describes the Load Response period within a gait cycle

Mid Stance

Describes the period within a gait cycle during which the contralateral foot has no contact with the ground

Pre-swing

Describes the pre-swing period within a gait cycle

Swing Phase Describes the period within a gait cycle during which the foot has no contact with the ground

Double Stance Describes the period within a gait cycle where both feet have ground contact


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Spatial Gait Parameters

Spatial Parameter DescriptionFoot rotation (deg)

Angle between longitudinal foot axis and walking direction (plus = outside, minus = inside) Not calculated for Insole measurements !

Step Length (cm)

Shows the distance between the heel contact of one side of the body and the heel contact of the contralateral side

Stride Length (cm)

Shows the distance between two heel contacts on the same side of the body

Step width (cm)

Distance between left and right heel

Spatial Parameter DescriptionStep Time (sec)

Describes the period within a gait cycle between the heel contact on one side of the body and the heel contact on the contralateral side

Stride time (sec)

Shows the distance between two heel contacts on the same side of the body

Cadence (steps/min)

Shows the parameter steps/minutes and is calculated from the reciprocal of the Stride Time

Velocity

Average walking velocity over all strides


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Averaged Force Curves and Force Parameters The resulting ground reaction force is calculated from the sum of all pressure cell data and shown as a time normalized averaged curve + /‐ 1 standard deviation range:

Standard Amplitude parameters are listed in a table presenting Min, Max and Range value. If EMG or 3D motion signals were recorded together with pressure data, they will be automatically added to the averaged curve analysis element:

=> Force => Knee Angle => Hip Rotation Angle => EMG Tib Ant. => EMG Gastroc.


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MyoPressure Stance/Balance Report As indicated by the name this report is meant to used for static posture and balance activities only. This typically happens in an un‐interrupted measurement interval between 30 and 60 seconds. A period definition (to e.g. identify gait events and steps) is not needed. The previous chapter for the MyoPressure Bilateral Gait Report explains most of the report selection and final report options, so that in this chapter only the report elements specific to the Stance analysis report are explained.

Report header

This header box is repeated on each report page. Users can change pictures (e.g. add a company logo), title text, selection of patient or record property items by double clicking on the element to be changed.

Average Stance Pressure Print

In this diagram the average load distribution under the feet is displayed in color. The color scale enables the load distribution to be quantified. The central circled line shows the centers of pressure (COP) migration over the time (sway).


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Center Point of Pressure parameters

Analysis Time Duration of analyzed interval in sec 95% confidence ellipse area COP path lenth Traveled distance of COP in mm COP average velocity Mean velocity of COP movement in mm/s

Advanced Parameters The list of advanced parameters describes the ellipse around COP with a set of specific parameters.

The parameters are best explained with this diagram:


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Weight distribution: Based on the average force, the weight distribution is calculated between fore and backfoot and left / right foot:


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Left and right force curve The four channel curves show the left and right side fore and back foot force curves over time in N:


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Appendix B: Multi‐Device Configurations and Master Sync System

Whenever myoPRESSURE is used with other Noraxon devices like myoMOTION, myoMUSCLE EMG telemetry or myoVIDEO camera recording, it is recommended that the Master Sync System be purchased and activated.

The Master Sync is a special sync device with 5 output ports and 1 input port. It needs to be inserted as a device in the device setup menu: Make sure that the Master Sync device is connected to your PC prior to opening the Insert Devices menu:

Once the Master Sync is inserted as a device, it will automatically send a synchronization pulse to all other Noraxon devices. This pulse is generated and sent 1 second after start of recording. For setup with multiple devices for master sync mode please refer to Appendix C and the instructions in the hardware manual of the other devices.


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Appendix C: Master Sync and Connection Schemes for myoPRESSURE Treadmills and Platforms

Requires:

Noraxon Master Sync device

Sync cable for Pressure distribution plates and treadmills 1) Connect the Master Sync device to your PC via USB cable 2) Start the Device Setup menu by clicking on Setup in Home screen (right tool bar) 3) Click Insert Device and select the Noraxon Master Sync as a device to be added 4) Confirm with OK and make sure that the Noraxon Master Sync device is shown in the Selected Devices section:

5) When done click on the myoPRESSURE Force plate symbol and hit Configure Device‐ 6) Select Noraxon Master Sync (Sync In) for the Hardware Synchronization selection line:


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Go back to home screen when done by confirming all menu screens with OK. 7) Connect the treadmill sync cable (may require a special purchase order) in one of the Master Sync’s output ports and treadmill sync’s input port 8) When done perform a test recording. If the Master Sync signal is not seen by the treadmill there will be an automatic error message in the storing dialog right after finishing a recording.


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Appendix D: Master Sync and Connection Schemes for myoPRESSURE Medilogic Insoles

Requires:

Noraxon Master Sync device with wireless sync accessory

WST Sync receiver model G1 or G2, dependent on EMG device

Medilogic Sync cable to connect WST sync receiver to Medilogic transmitter 1) Connect the Master Sync device to your PC via USB cable 2) Start the Device Setup menu by clicking on Setup in Home screen (right tool bar) 3) Click Insert Device and select the Noraxon Sync Master as a device to be added 4) Confirm with OK and make sure that the Noraxon Sync master device is shown in the Selected Devices section:

5) When done click on the MyoPressure Medilogic Insole symbol and hit Configure Device 6) Select Sync in the Hardware Synchronization selection line:


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Go back to the home screen when done by confirming all menu screens with OK. 7) Connect the WST Sync receiver to Medilogic by using the Medilogic sync cable. 8) When done perform a test recording. If the Master Sync signal is not seen by the Medilogic Insole system there will be an automatic error message in the storing dialog right after finishing a recording.

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