IndexContentsBackgroundMethodsTensile force and angular displacement feedback systemSoftwareSkills assessmentResultsWorking principlesSoftware interfaceDiscussionConclusionsBackgroundPhysiotherapists receive detailed, long-term training to develop their skills in cervical spine manipulation methods treatment of cervical musculoskeletal impairments. The most important reasons for the long training period are the presence of vital organs in the region and the widespread use of manual therapy (MT) techniques in the cervical spine. MT interventions include externally applied passive movements for facet joint alignment and soft tissue mobilization. The goal of these interventions is to achieve a clinically significant decrease in neck pain and an increase in neck mobility. Low-velocity passive movements are called mobilization techniques. Mobilization techniques are usually easier to learn and do not present major risks of complications. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an original essay Interventions applied to adjust the affected cervical segment, with a single thrust at high velocity and low amplitude are known as manipulation techniques. Cervical spine manipulation (MCS) has advantages over conventional physical therapy modalities in immediate increase in range of motion and decrease in symptoms (headache, stiffness) despite the risk of complications across a broad spectrum, from simple spasms on arterial dissection (may cause quadriplegia or death). The presence of serious risks, increases the duration of the course of manipulation techniques compared to other techniques. During the long training period, physiotherapy students deepen each safety component (extrinsic factor) of their manipulation skills; the appropriate pre-manipulative position of the patient's head and cervical spine, the angular displacement of the head and each cervical segment during manipulation, and the appropriate thrust speed. If there is a mismatch between extrinsic factors and the patient's condition, MCS may cause adverse effects or complications instead of the desired results. In classical MT training, students can only have subjective feedback; manual or verbal instructions from experienced professionals on their practices. The numerical magnitude of the extrinsic parameters is unknown. This is the main limitation of the classic training model and there is a need to measure, demonstrate and verify extrinsic parameters objectively. Physical therapist students also develop their mutual manipulation skills before actual patient experience. Even if they are healthy and classmates, the first experience of manipulation on humans can exaggerate students' unrealistic perception of risk factors; unfounded negative feedback from their classmates can sometimes contribute to self-distrust. This way of thinking can lead to physical therapist students avoiding developing each other's manual skills. Patient simulators are commonly used in medicine and nursing for demonstration of normal physiological functions, pathological conditions, and skill training prior to actual patient experience. However, only experimental simulator designs for MT training exist in the literature. There is a need for fully functional systems for school environments that can help physiotherapy students gain experience before performing techniques on volunteershealthy, simulators or real patients. In Turkish physiotherapy practice, Orthopedic Manual Medicine is the most common and conventional MT method, first introduced by Dr. James Cyriax in 1954. All of Dr. Cyriax's MCS techniques can be reduced to different variations of two skill components which can be measured using transducers. These two parameters are the tensile force and the angular displacement of the head and neck which should remain within physiological limits for patient safety. Excessive tensile force or excessive angular displacement of the spinal segments in one or more directions can cause complications. Analyzing the raw data to determine whether or not limits are exceeded can provide objective feedback on the safety of the manipulation. The aim of this study is to design and produce an objective skill assessment simulator for training cervical spine manipulation skills according to Cyriax. Methods Tensile force and angular displacement feedback system A tensile force and angular displacement feedback system suitable for Dr. Cyriax's manipulation method is configured as a classical biophysical signal acquisition and processing system consisting of a tensile force transducer; a traction force amplifier; an angular displacement transducer, a data acquisition device and a data processing device. Dr. Cyriax graded spinal traction force magnitude subjectively (grade A, B, C) and there is insufficient data in the literature for magnitude equivalence. Mechanical traction systems are alternative methods to manual traction and 10% - 15% of the patient's body weight or traction forces between 2.27-8. In clinical practice, 14 Kgf (5-40 lbs) is used. S-type load cells are suitable for mounting on a rotating surface and can measure tensile force. A 500N HC-C3 type S load cell (Zemic, Etten-Leur/The Netherlands) is used as the force transducer. The transducer range is selected in the clinical range (200 N) for simulations of excessive tensile forces. A bar graph threshold option is included in the software for normal traction range guidance. The load cell signal is amplified by an instrumentation amplifier (LT1167) with 500x regulated gain. The load cell calibration is performed using a set of class M2 reference masses. Dr. Cyriax described the range of angular displacement relative to the physiological barrier which is a subjective range between the anatomical barrier and joint dislocation. In an electrogoniometric measurement study the physiological range of cervical rotation is reported between 70° and 90°. This range will need to be validated in the future using a motion capture system on real patients for an alternative manual manipulation technique. A 5 V/360° single-turn analog encoder, Opkon MRV-50 (Opkon Electronics Istanbul/Türkiye), is used to measure the angular displacement. The transducer range is selected in the clinical range for simulating excessive rotational displacement. Furthermore, a physiological limit guide is provided by the adjustment screws which can limit the rotation in the reported range for both sides. The USB-1608FS DAQ board (Measurement Computing (MCC), Norton/USA) is used to acquire traction force and angular displacement data. The device was built using separate CNC machine elements (ball bearing, bearing housing, connector shell and shafts), a head model (Enas CPR Prompt, Wisconsin/USA) and cervical vertebra models (3B ScientificA72, Budapest/Hungary). All elements are mounted on a stainless steel base. Two adjustment screws with rubber pads were placed on the proximal side of the base to limit rotation as in the physiological range. Software The software is developed in C# using the MCC universal library for users who are not familiar with technical computing. The A/D input channels are read by the AIn function, and the returned 16-bit integer count values ​​are converted to an equivalent single-precision voltage value by the ToEngUnits function. The sampling rate was set to 1KS/sec. Raw voltage measurements are converted to force and angular position data using calibration equations. The final data is presented as an xy line graph or bar graph. The XY line graph format is suggested for demonstration and general analysis of skill models. The bar graph format is specially designed for training sessions with physiological limits. Graphic saving, data saving and report generation functions for archiving are included. The software is tested with Tracer DAQ 2. 3. 0 (MCC USA) reference software for reference weights and angular positions until the same results are achieved.AssessmentSoftware supports peak measurement results, generates a report with graphical values ​​and peak for the evaluation of fundamental skills. Additionally, maximum traction zone, rotation zone, and intersection zone indicators are used for a brief visual definition of skill deficits. The zone of maximum traction is a horizontal rectangle at the level where the traction force peaks and remains constant. The rotation zone is a vertical rectangle that represents the duration of the rotation. The intersection of both zones identifies the critical zone where any errors can cause complications. Results Force calibration was performed between 0 and 50 Kgf using the M2 class reference mass set. All data were analyzed using linear regression. The linearity of the force transducer is R=0. 995 and SEE=0. 910 is in the range. The angular position sensor has a factory calibration. It has 10-bit, 5V/360° resolution. Operating principles The tensile force on the head activates the load cell, the output signal increases in relation to the tensile force. Then the poor output signal is amplified 500 times and acquired by the DAQ card. The center of mass places the warhead in a natural 90° position (1.25 V). The baseline can be adjusted by the software. At the end of the traction, the rotation of the head activates the rotary encoder. The output voltage increases for the right side and decreases for the left side. The output signal has an adequate amplitude and is acquired directly from the DAQ-Card. Software interface The software interface consists of two group boxes and a graphics area. DAQ-Card, acquisition and evaluation operations can be performed using the controls in the group boxes. The peak value and current value are indicated by legends. The desired point values ​​can be accessed with a mouse click. Skills reporting, data export and graphical export functions are included. Controls and graphic presentations; (a) xy pilot line for assessing general abilities (b) bar graph for identifying physiological threshold. The red line/bar represents force and the blue line/bar represents angular displacement. MCS performance data in normal physiological ranges and skill deficit samples are presented in Figure 5. The ideal magnitudes of the maximum traction zone, the.