This application claims priority of U.S. provisional application No. 61/344,893 filed on Nov. 5, 2010, the entire contents of which are incorporated by reference herein.
TECHNICAL FIELDThe present disclosure relates to a system and a device for measuring a surface electromyography (EMG) signal, a gyroscopic motion sensor signal and a signal from a strain gauge testing apparatus to evaluate muscle functions of a patient. Previously filed applications generally describe an EMG measuring system (e.g., U.S. patent application Ser. Nos. 10/504,031 and 11/914,385, the entire contents of which are incorporated by reference herein).
The present disclosure relates to a dynamic muscle function monitoring and evaluating system. A number of sensors are attached to various parts of the subject's body (i.e., patient's body) for data collection. The sensor data are then directly fed into a point of detection (POD) device for conditioning, acquiring, and transmitting the sensor data. The sensors include, for example, but are not limited to, a surface EMG (sEMG) sensor, a motion detection sensor, and a muscle strength measurement sensor. The POD device acquires continuous analog signals and then digitizes these signals by sampling at a rate of, for example, 2 kHz. These digital data are then transferred wirelessly to a computer system for processing using software.
The system can monitor and record the data measured by the sEMG sensors attached to various muscle groups in the human body. While acquiring the sEMG signals, the system can simultaneously acquire a motion sensor signal responsive to the body motion and/or a signal responsive to muscle strength.
The system in the present disclosure is used for muscular testing by acquiring muscle contraction patterns and /or testing range-of-motion and functional capacity using surface EMG electrodes. The system can be specialized to test, for example, cervical, thoracic and lumbar spines as well as upper and lower extremities. The system can collect and display muscle function data and characteristics including tone, fatigue, as well as other activities that take place in the muscle. This system can be used in a number of arenas such as occupational and sports medicine, and rehabilitation clinics.
The present system uses a range of motion (ROM) device in combination with functional capacity evaluation devices and surface EMG electrodes to monitor muscle functions. Gyroscopic sensors are utilized to detect motion. A new functional capacity evaluation (FCE) device is also employed (the details of the functional capacity evaluation device are described in copending application filed on dd/mm/yyyy concurrently with this application (FUNCTIONAL CAPACITY EVALUATOR, the Attorney's Docket No. 085232-0030), the entire contents of which are incorporated by reference herein).
The signal conditioning in the present system takes place in two stages, one outside the POD device and close to the sEMG sensor leads, and the other inside the POD device itself. The POD device is small and thin, and is battery powered rather than AC powered. Accordingly the POD device can be portable and wearable by the patient. The POD device transmits all data wirelessly via an ad-hoc wireless network.
The present system also includes a program which will be executed by a processor in a computer to control the overall system, present instructions to the patient, manage patient information and record the measured data.
SUMMARYThe present disclosure provides a comprehensive muscular function monitoring and evaluating system and devices used in the system.
In one example, a system includes a processor, a wireless interface coupled to the processor, a display coupled to the processor, a non-transit storage device coupled to the processor which stores a muscular function monitoring and evaluating program and sets of test procedures, a signal collection device wirelessly coupled to the processor via the wireless interface and a sensor connected to the signal collection device. The program, when executed by the processor, causes the system to perform the following functions. The processor displays a patient information screen on the display for an operator to input patient's data for a patient to be tested. The processor receives the patient's data input through the patient information screen. The processor displays, on the display in accordance with one of the sets of test procedures, a muscle map indicating a place on a body to which the sensor is to be attached. The processor instructs the patient in accordance with the one of the sets of test procedures, through at least one of instruction language displayed on the display, an animation or video image displayed on the display, and an audible instruction. The processor receives a signal measured by the sensor, and records the signal into the storage device or transmits the signal to an outside server. The storage device may be located in a local computer or in a server system or “cloud” accessible from the computer through a network.
Optionally, in the above system, the storage device may store a patient database, and the program further causes the processor to obtain patient information by searching the patient database according to the input patient's data. The processor selects one of the sets of test procedures in accordance with the obtained patient information.
Optionally, in any of the above systems, one of the sets of test procedures is selected by an input by the operator.
Optionally, in any of the above systems, the program further causes the processor to display on the display a test procedure selection screen displaying a list of the sets of test procedures. The processor receives a selection of one of the sets of test procedures. The muscle map is displayed on the display in accordance with the selected one of the sets of test procedures.
Any of the above systems optionally includes a camera, and the program further causes the processor to record a video image of the patient acquired by the camera and to display the video image on the display.
Optionally, in any of the above systems, the program further causes the processor to display the received sensor signal on the display.
Optionally, in any of the above systems, the sensor includes one or more surface electromyography (sEMG) sensors. The muscle map indicates a place on a patient's body to which the one or more sEMG sensors are to be attached by different colors or numbers.
Optionally, in any of the above systems, the sensor includes one or more motion sensors utilizing one or more gyroscopes.
Optionally, in any of the above systems, the sensor includes a functional capacity sensor including a lift portion, a pinch portion and a grip portion.
Optionally, in any of the above systems, the program further causes the processor to display an error message when the system detects a sensor error. The sensor error is detected by the signal collection device or by the processor.
Optionally, in any of the above systems, the program further causes the processor to calibrate the sensor.
In another example, a non-transit recording medium stores a program which, when executed by a computer, causes the computer to perform the functions of displaying a patient information screen on a display coupled to the computer for an operator to input patient's data of a patient to be tested, receiving the patient's data input through the patient information screen, displaying, on the display in accordance with one of a plurality of sets of test procedures, a muscle map indicating a place on a patient's body to which a sensor is to be attached, instructing the patient in accordance with the one of the sets of test procedures, through at least one of instruction language displayed on the display, an animation or video image displayed on the display, and an audible instruction, receiving a signal measured by the sensor, and recording the signal into a storage device coupled to the computer or transmitting the signal to an outside server.
The non-transit recording medium is, for example, an optical disk such as CD-ROM, CD-RW, DVD-ROM, DVD-RW, DVD-R, DVD-RAM or Blu-Ray Disk, an EEPROM such as a flash memory or a hard disk drive.
The system and methods of the present disclosure, together with further objects and advantages, are better understood by references to the following detailed description and the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGSFIG. 1 shows an exemplary schematic overall view of the muscular function evaluating and monitoring system of the present disclosure.
FIG. 2 shows an exemplary block diagram of a computer used in the system ofFIG. 1.
FIG. 3 shown an exemplary block diagram of a POD device used in the system of FIG.1.
FIG. 4 shows an exemplary schematic view of an ROM sensor.
FIG. 5 shows an exemplary view of an sEMG sensor.
FIG. 6 shows an exemplary view of an FCE sensor.
FIG. 7 shows an exemplary operations flow chart within thecomputer20 and thePOD device10.
FIG. 8 shows an exemplary flow chart for measuring muscular function data through sEMG sensors, a ROM sensor and/or an FCE sensor.
FIG. 9 shows an exemplary screen view of a testing protocol selection screen.
FIG. 10 shows an exemplary patient information screen view.
FIG. 11 shows an exemplary main menu screen view.
FIG. 12 shows an exemplary muscle map view.
FIG. 13 shows an exemplary main menu screen view during a test.
FIG. 14 shows another exemplary flow chart for measuring muscular function data
DETAILED DESCRIPTIONIn the following detailed description, numerous specific details are set forth by way of examples in order to provide a thorough understanding of the relevant teachings. However, it should be apparent to those skilled in the art that the present teachings may be practiced without such details. In other instances, well known methods, procedures, components, and/or materials have been described at a relatively high-level, without detail, in order to avoid unnecessarily obscuring aspects of the present teachings.
FIG. 1 shows one exemplary schematic view of an overall muscular function monitoring and evaluating system according to the present disclosure. The system includes aPOD device10 and acomputer20. ThePOD10 is wirelessly connected to thecomputer20. Known wireless communication methods may be utilized. As shown inFIG. 2, thecomputer20 includes aprocessor201, an I/O interface202 including a wireless network interface and a local area network (LAN) interface coupled to the processor (for example, via a bus line203), anon-transitory storage device204 such as a hard disk drive (HDD),memories205 such as a ROM and a RAM and adisplay206. Thecomputer20 can further include a optical disk drive and a printer. Thedisplay206 is optionally a touch sensitive display (i.e., a touch panel display). Thecomputer20 optionally further includes acamera207 and amicrophone208 for capturing real-time video clips of patient activities and for recording audio during testing.
In certain embodiments, thecomputer20 communicates with a server or anothercomputer60 via anetwork70 including an intranet and/or the Internet. TheHDD204 stores a comprehensive muscular activity profiler (CMAP) program for controlling the overall system, presenting instructions to the patient, managing patient information and recording the measured data. Sensors include surface EMG (sEMG)sensors30, range-of-motion (ROM)sensors40 and a functional capacity evaluation (FCE)sensor50, all of which are connected to thePOD device10.
FIG. 3 shows an exemplary block diagram of thePOD device10. ThePOD device10 is a portable, wearable and non-invasive device that receives sEMG signals from thesEMG sensors30, the range-of-motion (ROM) signals from range ofmotion sensors40 and the functional capacity evaluation signals from theFCE sensor50. The signals from these sensors work in conjunction with one another to obtain a set of output signals, which relay information relating to the functional capability and characteristics of muscle groups and surrounding tissues.
The signals from all sensors are sent to thePOD device10 to be conditioned and, if necessary, A-D converted by circuitry in thePOD device10 and then transferred wirelessly over, for example, an ad hoc wireless network to thecomputer20. For example, the signals from the ROM sensors (i.e., digital signals) are received by a serial-peripheral interface (SPI)101 and transferred to aprocessor102. The signals from the ROM sensors may be digital signals. The signals from the sEMG sensors are input to a multistage filter andamplifier circuit106 and A-D converted by an AD-converter103 after multiplexed by ananalog multiplexer105. Theprocessor102 processes the digital data and transmits the processed data to thecomputer20 wirelessly via awireless interface104.
In the present example, thePOD device10 can connect threesEMG sensors30, twoROM sensors40 and oneFCE sensor50. Each sEMG sensor can monitor eight sEMG signals (i.e., eight channels), and each ROM sensor outputs three signals (three channels) corresponding to three degrees of freedom. Therefore, thePOD device10 can simultaneously monitor up to 24 channels of sEMG signals, six (6) channels of ROM signals, and one (1) channel of FCE signal. ThePOD device10 may be powered by an internal rechargeable battery such as a polymer Lithium-ion battery. ThePOD device10 includes connectors for three sEMG sensors, two ROM sensors and one FCE sensor. Each of the connectors for the sEMG sensor, the ROM sensor and the FCE sensor has a different size and/or shape so that the operator does not insert a sensor to a wrong connector. It is noted that since the FCE sensor of the present application is one integrated FCE sensor, thePOD device10 may have only one input port for the integrated FCE sensor.
FIG. 4 shows a schematic diagram of aROM sensor40. TheROM sensor40 utilizes a combination ofgyroscopic sensors401x,401yand401zto detect motion of the subject. TheROM sensor40 can detect and measure an angular rate of the subject (e.g., a head of the patient), e.g., how quickly the object rotates. TheROM sensor40 contains threegyroscopes401x,401yand401zfor measuring three degrees of freedom (i.e., x, y and z directions). For example, iSensor® gyroscopes (ADIS16260/ADIS16265) made by Analog Devices can be used for the gyroscopes, which outputs digital sensor signals. The threegyroscopes401x,401yand401zare mounted orthogonally to one another inside a plastic enclosure.
In the present example, up to two ROM sensors can be connected to thePOD device10. In most testing protocols, one ROM sensor is used at a time. However, there are a couple of testing protocols that require two ROM sensors, called a “dual inclinometer arrangement.” This arrangement allows for more accurate ROM data in an area like the lumbar spine where upper vertebrae move relative to the lower vertebrae. In this arrangement, both ROM sensors are read, and then one sensor's motion is subtracted from the other sensor's motion, which isolates one particular movement of the body. The ROM sensor may be attached to the patient with a plastic and lycra harness, placed over the patient's clothing for most testing protocols.
FIG. 5 shows an exemplary schematic view ofsEMG sensor30. ThesEMG sensor30 is a one-piece reusable cable/lead assembly. ThesEMG sensor30 is directly connected to thePOD device10 via aconnector301, for example, manufactured by Hirose Corporation. ThesEMG sensor30 includes a small printed circuit board (PCB)302 that includes an amplifier circuit for the first amplification stage of the signal conditioning. ThePCB302 is encapsulated in abase portion303 of thesEMG sensor30. From thebase portion303, nine flexible leads extend, one of which is a ground lead. The other eight leads are paired and color-coded electrode leads, respectively. The eight leads have different colors, for example, yellow, green, purple, orange, blue, white, red and brown. Black may be used for the ground line. Each of the eight leads is to be affixed to a pair of FDA-approvedsurface electrodes304. The signals detected by thesEMG sensors30 are sent to thePOD device10 for the second stage amplification.
FIG. 6 shows an exemplary perspective view of a functional capacity evaluation (FCE)sensor50. To measure isometric functional test (IFT), pinch strength, and grip strength, the present system utilizes an integrated measurement tool as shown inFIG. 6. TheFCE sensor50 is a combination of three different sensors. This combined sensor allows for the isometric functional dead-lift, pinch strength, and grip strength measurements with alift portion501, apinch portion502 and agrip portion503, respectively, which are integrated in one device.
TheFCE sensor50 utilizes a single full bridge strain gauge mounted to allow accurate readings from all three exercises without sacrificing resolution between measurements of differing force levels. The grip test allows adjustments to grip span with a finer resolution and wider and smaller span than a conventional device (e.g., a Jamar Grip). The pinch test allows measurements to be made in a fashion similar to a load cell and can also be adjusted to different pinch spans. The isometric function test measures, for example, asymmetric performance in one-tenth pound increments against an immovable footplate.
Software or a program to control the overall system is stored in a storage device such asHDD204 of thecomputer20. The software, when executed by theCPU201, causes the CPU to perform at least two functions, i.e data acquisition and data management. The executed software has no direct control over the hardware, but interacts with the hardware to read the conditioned data signals located in thePOD device10.
Thecomputer20 on which the software runs is operated by trained technicians in the field. The software presents a series of screen prompts which guide the technicians through the necessary steps to complete each step in the chosen protocol. In this disclosure, a “screen” generally refers to an image displayed on thedisplay206 including a “window” displayed on the display. These steps are defined by text, audio and/or video instructions in order to provide the clearest possible explanation. A video of the test will also be recorded in order to ensure proper test administration and compliance.
Thecomputer20 on which the software runs, through thePOD device10 and the sensors, collects the necessary data from the different sensor channels as set forth above. Thecomputer20 can collect the data simultaneously on a timing interval. Thecomputer20 may stream the data to theoutside server60 during the measurement. The data is also transferred in real-time to thecomputer20 during a step from thePOD device10 so that the operator can monitor the quality of the data being acquired.
Thecomputer20 optionally detects sensor failures, such as a sensor not being connected, a sensor lead falling off or a sensor lead experiencing an inconsistent connection. The sensor failures may be detected by thePOD device10 and sent to thecomputer20. If a sensor failure is detected, thecomputer20 notifies the operator through a sensor failure screen, while suspending any data acquisition activity. Once the failed sensor is corrected, the test can be resumed or redone.
To ensure data integrity, all data can be encrypted upon recording to thecomputer20. The data will remain encrypted until it is transferred to theoutside server60 for further processing of the data. The data may be recorded to multiple files due to the different file types. Each file may be encrypted and will remain encrypted until, for example, transfer to anoutside server60 for further data processing, archival, and analysis.
FIG. 7 shows an exemplary operations flow chart within thecomputer20 and thePOD device10.FIG. 8 shows an exemplary flow chart for measuring muscular function data through sEMG sensors, ROM sensors and/or an FCE sensor.
An operator who wishes to run a specific testing protocol to measure muscular functions will first turn oncomputer20 and execute the program. Usually, the operator is required to log-in to operate the program (Step5801) so that only a certified operator accesses the system and data. Thecomputer20 on which the program is now running displays a testing protocol selection screen ondisplay device206, for example, an LCD touch panel screen (Step S802). One example of the testing protocol selection screen is shown inFIG. 9.
In the example shown inFIG. 9, eight (8) testing protocols are available, which include a Cervical Protocol, a Thoracic Protocol, a Carpal Tunnel & Epicondyle Protocol, a Shoulder & Epicondyle Protocol, a Lumbar Protocol, a Lower Extremities Protocol, a Hip/Groin Protocol, and a Custom Ankle Protocol. Of course, other testing protocols can be employed. Further, the testing protocols may include one or more subsets of the protocols. The protocols may be provided as a pull-down menu.
If the operator chooses the Carpal Tunnel & Epicondyle Protocol by, for example, clicking the carpal tunnel portion of the illustrated body as shown inFIG. 9 (Step S803), thecomputer20 next shows a patient information screen as shown inFIG. 10 on the LCD display206 (Step S804).
The patient information screen provides information to match “subjective” complaints of the patient with “objective” findings of the test. The patient information screen prompts the operator to input, for example, but not limited to, the patient's personal information, physician's information, insurance information, test indication, etc.
When the operator inputs the required information and hits a proceed button (Step S805), thecomputer20 displays a main testing protocol menu for the selected testing protocol, i.e., a menu for the Carpal Tunnel & Epicondyle Protocol, as shown inFIG. 11 (Step S806).
When the operator touches amuscle map icon1101, the menu screen shows amuscle map1102 illustrating positions of an sEMG sensor and a ROM sensor in ascreen area1103.FIG. 12 shows an enlarged view of themuscle map1102.
In the Carpal Tunnel & Epicondyle Protocol, three sEMG cable assemblies and two ROM sensor are utilized. More specifically,8 leads each on three sEMG sensors are utilized in this protocol. Themuscle map1102 shows three sEMG sensors by number (1-3) and two ROM sensor by a “MT” image. As set forth above, each of the sEMG sensors has eight leads with different colors. Themuscle map1102 shows each position of a sensor head (a pair of sensors) by color and the number so that the operator can place the sensor heads on appropriate portions of the patient's body.
According to the instruction shown in thearea1103 of the screen, the operator attaches the respective sensors to the patient's body. Of course, the operator is requested to connect the respective sensors to thePOD device10.
For the ROM sensors, the operator is instructed to calibrate the ROM sensors. The operator is instructed to place the ROM sensors on a flat surface and to connect cables of the ROM sensors into thePOD device10. When the operator touches a “Proceed” button, initialization (calibration) begins. If re-calibration is necessary, the operator can repeat the calibration by touching a “Repeat” button. If the ROM sensors are calibrated correctly, the operator touches an “OK” button. Then, the ROM sensors are attached to designated places of the patient body by, for example, attachment pockets.
If the FCE sensor is also used in the test, the FCE sensor is also calibrated. The operator is instructed to place the FCE sensor on a flat surface and to connect a cable into the POD device. Then, the operator touches a “Proceed” button to begin initialization. If re-calibration is necessary, the operator can repeat the calibration by touching a “Repeat” button. If the FCE sensors are calibrated correctly, the operator touches an “OK” button.
After the sEMG sensors are attached and the ROM sensors are calibrated and attached (and if necessary, the FCE sensor is appropriately placed), the operator can touch a “Start” button to proceed with the test (Step S807). One testing protocol usually includes several sub steps.
FIG. 13 shows an exemplary screen view during the testing (Step S808). In ananimation area1302, an animation is displayed to demonstrate and instruct the patient how to move body parts. In aninstruction area1303, detailed instructions on the command are shown so the operator or the patient can perform appropriate actions. The instructions may be provided by audio.
Avideo screen area1304, which can be the same area as thearea1103, shows a live video image taken by acamera207 attached to thecomputer20. Thecomputer20 can record the video image of the patient taken by thecamera207 and audio taken by themicrophone208 throughout the testing. Thevideo image1301 can be switched at any time with themuscle map1102, by touching a switch button.
Thecomputer20 acquires signals detected by each sensor via the POD device10 (Step S809). The screen also shows a status of eachsEMG sensor1305. If the system cannot correctly detect a signal, an error status will be shown at the corresponding sEMG sensor. For example, thePOD device10 can detect an error in the sensors. Further, when the operator touches one of the status monitors of the sEMG sensors, the currently received signals are shown in asignal area1306. At the same time, a corresponding muscle map may be shown on thearea1304. Similarly, aROM signal1307 is also shown for monitoring the ROM sensors.
The screen ofFIG. 13 also provides anote area1308 so that the operator can input patient's comments, physician's comments and/or operator's comments. Thecomputer20 stores such comments in the storage device or transfers them to theoutside server60.
It is noted that any sub-step of the testing protocol can be repeated by touching a “Repeat” button (Step S810). If one sub step is completed, the operator may touch a “Next” button to proceed with the next sub step (S811). If all sub steps are completed, the operator can finish the program (S813), or can select a new testing protocol (S812). Optionally, the program returns to the login screen.
Upon completion of one testing protocol, thecomputer20 may upload the acquired data to theoutside server60 in connection with the patient information, or may locally retain the acquired data in the storage device. The data may include measured signal data, a video image acquired during the testing, and/or comments input to thenote area1308.
In the above example, the testing protocol is first selected (S802 and5803) and then the patient information is input to the computer20 (S804 and S805). Alternatively, the patient information is input first and then the testing protocol is selected.
Further, if the patient information indicates a required testing protocol, the system automatically runs the required testing protocol and in such a case, the operator does not need to select the testing protocol. For example, when the patient is tested more than one time, the system already knows the patient's information and tested protocol. As shown inFIG. 14, when the operator starts the muscular evaluation program (S1401), the system requires the operator input patient information, e.g., the name or any identification number of the patient (S1402). If the patient record exists (S1403), the system obtains the patient record from a database (S1048). The database may be located in thecomputer20 or in theoutside server60. When the patient records indicate the testing protocol was previously applied to the patient, the system runs the testing protocol (S806). The testing protocol can be automatically executed or executed by the operator's input. The system can further display patient information for the operator to confirm the patient's information and/or modify the patient's information.
If the patient is a first-time patient (S1404), the system displays the patient information screen requesting input of patient information (S1404). When the patient information is input, the system displays a protocol selection screen (S1406). When a proper testing protocol is selected (S1407), the system runs the testing protocol (S806).
The foregoing muscular function monitoring and evaluating system may further include additional programs/modules. For example, the system may include a comprehensive impairment rating evaluation program that is designed to assist physicians in determining whether an injured patient has reached maximum medical improvement (MMI) and /or permanent and stationary (P&S) status based on the measured and acquired results by utilizing the muscular function monitoring and evaluating system. This program compares the measured results against, for example, the AMA guide for impairment rating, and provides the physicians with evaluation results.
Another example of the programs is a comprehensive pre-employment physical evaluation program that provides employers an objective assessment of an individual's ability to perform the physical job functions of the position for which he/she has been hired. This program can provide the assessment of the person tested by the muscular function monitoring and evaluating system.
Further, muscular function monitoring and evaluating system may includes a comprehensive activity interactive program that is a tool for physical therapist or their assistant to assure patient compliance with their therapy regimen and its course. This program allows the patient to place goals into the program and observe the performance against those goals. This program can monitor progress of recovery of muscular function of the patient with respect to the set goals based on the measured results by utilizing the muscular function monitoring and evaluating system. The program can also print out the progress for the patients' records.
Although certain specific examples have been disclosed, it is noted that the present teachings may be embodied in other forms without departing from the spirit or essential characteristics thereof. The present examples described above are considered in all respects as illustrative and not restrictive. The patent scope is indicated by the appended claims, and all changes that come within the meaning and range of equivalency of the claims are therefore intended to be embraced therein.
Unless otherwise stated, all measurements, values, ratings, positions, magnitudes, sizes, and other specifications that are set forth in this specification, including in the claims that follow, are approximate, not exact. They are intended to have a reasonable range that is consistent with the functions to which they relate and with what is customary in the art to which they pertain.
The scope of protection is limited solely by the claims that now follow. That scope is intended and should be interpreted to be as broad as is consistent with the ordinary meaning of the language that is used in the claims when interpreted in light of this specification and the prosecution history that follows and to encompass all structural and functional equivalents. Notwithstanding, none of the claims are intended to embrace subject matter that fails to satisfy the requirement ofSections101,102, or103 of the Patent Act, nor should they be interpreted in such a way. Any unintended embracement of such subject matter is hereby disclaimed.
Except as stated immediately above, nothing that has been stated or illustrated is intended or should be interpreted to cause a dedication of any component, step, feature, object, benefit, advantage, or equivalent to the public, regardless of whether it is or is not recited in the claims.
It will be understood that the terms and expressions used herein have the ordinary meaning as is accorded to such terms and expressions with respect to their corresponding respective areas of inquiry and study except where specific meanings have otherwise been set forth herein. Relational terms such as first and second and the like may be used solely to distinguish one entity or action from another without necessarily requiring or implying any actual such relationship or order between such entities or actions. The terms “comprises,” “comprising,” or any other variation thereof, are intended to cover a non-exclusive inclusion, such that a process, method, article, or apparatus that comprises a list of elements does not include only those elements but may include other elements not expressly listed or inherent to such process, method, article, or apparatus. An element proceeded by “a” or “an” does not, without further constraints, preclude the existence of additional identical elements in the process, method, article, or apparatus that comprises the element.
The Abstract of the Disclosure is provided to allow the reader to quickly ascertain the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. In addition, in the foregoing Detailed Description, it can be seen that various features are grouped together in various embodiments for the purpose of streamlining the disclosure. This method of disclosure is not to be interpreted as reflecting an intention that the claimed embodiments require more features than are expressly recited in each claim. Rather, as the following claims reflect, inventive subject matter lies in less than all features of a single disclosed embodiment. Thus the following claims are hereby incorporated into the Detailed Description, with each claim standing on its own as a separately claimed subject matter.