Saturday, June 19, 2010

K7 Project No. 1 and 2 Data Comparison

The following is some preliminary Scan 18 (Mean Frequency Graph) data comparing K7 Project No. 1 with the recent K7 Project No. 2 which the NMR team has been able to compile thus far.

Scan 18 to date is considered by most clinicians to be still in a state of research. It is designed as a diagnostic tool to assist in determining whether there exists muscle fatigue patterns or not.

Scan 18 displays an initial habitual rest activity for 2 seconds followed by a sustained maximal motor recruitment clench over a 10 second period followed by a post habitual rest activity for 2 seconds. Scan 18 hypothesizes an ability to distinguish a mean frequency shift of the motor recruitment clench of temporalis anterior and massetter muscle activity before and after TENS. This shift in frequency would further indicate a decrease or increase in muscle recruitment relating to descending problems of the masticatory muscles above the neck region vs. ascending problems caused by the cervical or postural regions below the neck.

Sample Scan 18:
The following are Scan 18 Mean Frequency graphs that have been purposely overlayed and scaled for comparison purposes only to assess any observable differences in the Asymptomatic vs. Symptomatic groups as they related to upward sloping or downward sloping mean frequency graphs prior to TENS.  Evaluators feel that establishing baseline recordings prior to TENS is significantly important to have a better and more complete understanding of what the upward and downward slopes mean frequency graphs mean and their relationship to asymptomatic as well as symptomatic groups of patients.  Knowing this information is fundamental to properly interpret whether one can definitely determine an ascending or descending pattern from Scan 18 mean frequency graph and its relationship to muscle fatigue if and when one follows the classic protocol after TENS.

In order to further a complete understanding of Scan 18 classical protocols a post TENS study should be conducted.  
PRELIMINARY SUMMARY OF FINDINGS: Data was collected by 41 Clinical Research Associates in K7 Project No.1.  21 Clinical Research Associates participated in K7 Project No. 2.  Both groups who participated in these 2 studies followed the protocols designated for these projects.

Asymptomatic Group - Scan 18 mean frequency graphs overlayed and scaled (41 candidates).

The red lines represents predominate visual (mean frequencies) of 41 compiled scan 18 graphs (see K7 Project No. 1 for details of data)

Symptomatic Group - Scan 18 mean frequency graphs overlayed and scaled (55 candidates).
The red line represents a visual average (mean frequency) of 55 compiled scan 18 graphs (see K7  Project No. 2 for details of data)

Diagram 1 – Asymptomatic Group (41 candidates) shows a compilation of overlayed and scaled Mean Frequency Average graphs.
When evaluating the Asymptomatic Group Scan 18 mean frequency average slopes, 37 out of 39 (94.87%) (LTA, RTA, LMM, RMM) showed at least one or more down arrows.

Diagram 2 – Symptomatic Group (55 candidates) shows a compilation of overlayed and scaled Mean Frequency Average graphs.

When evaluating the Symptomatic Group Scan 18 mean frequency average slopes, 51 out of 55 (92.73%) (LTA, RTA, LMM, RMM) showed at least one or more down arrows.

Scan 18 mean frequency slope averages were tallied.  Data has been compiled showing average values of all temporalis anterior (LTA, RTA) and masseter (LMM, RMM) up arrows and down arrows subgroups.  Upward arrows represent upward sloping mean frequency graph averages (mV),  Downward arrows represent downward sloping mean frequency graph averages (mV).

Analysis of the mean frequency shift of the LTA, RTA, LMM and RMM for both Asymptomatic and Symptomatic groups were evaluated for upward and downward sloping averages of the scan 18 mean frequency graphs.  The following are some of the observations:

  • Asymptomatic averages of the temporalis anterior LTA and RTA down arrows showed prominent down arrow sloping graphs as well as high LMM and RMM down arrow sloping graphs: LTA% 5.2 (up arrow), LTA% 8.33 (down arrow), RTA% 6.13 (up arrow), RTA% 9.34 (down arrow), LMM% 6.45 (up arrow), LMM% 11.65 (down arrow), RMM% 7.0 (up arrow), RMM% 11.19 (down arrow).  This brings into question whether this prominent pattern really should be interpreted as muscle fatique (ascending patterns) according to classic scan 18 theory and interpretation.
  • Symptomatic averages of the temporalis anterior left and right recorded LTA% were 9.37 mV (up arrow), LTA% 5.72 mV (down arrow), RTA% 12.74 mV (up arrow) and RTA% 7.44 mV (down arrow). It is intersting to note that both LTA and RTA (arrow down) show a higher value in the asymptomatic group (LTA% 8.3 mV, RTA% 9.34 mV (arrow down) than the symptomatic group (LTA% 5.72, RTA% 7.44 (arrow down) which recorded lower mV values.  This brings into question whether this symptomatic pattern really should be interpreted as no muscle fatique (descending patterns) according to classic scan 18 theory and interpretation.
  • Masseter muscle average values for the Asymptomatic group recorded - LMM% 6.45mV (up arrow), LMM% 11.65 mV (down arrow), RMM% 7.0 mV (up arrow), RMM% 11.19 mV (down arrow).
  • Masseter muscle average values for the Symptomatic group - LMM% 8.56 mV (up arrow), LMM% 8.93 mV (down arrow), RMM% 7.10 mV (up arrow), RMM% 9.47 mV (down arrow).
  • Masseter muscles average values LMM and RMM in the Asymptomatic group showed significantly higher values (down arrows) than the symptomatic group. 
According to classic Scan 18 theory and hypothesis, if the scan 18 mean frequency graph is going up it would indicate a descending problem.  Based on these studies that the 92.73% of the symptomatic patients with symptom's according to the classic hypothesis would indicate that the origin of these problems is from a descending order (mandible misalignment and head posture).

In addition when we look at the LMM and RMM groups with arrows down they have a higher value in the asymptomatic group than the symptomatic group and LTA and RTA arrow down again have a higher value in the asymptomatic than compared to the symptomatic.  Data indicates that 94.87% of the time within the Asymptomatic group there is at least 1 or more down arrows represented in either of the LTA, RTA, LMM or RMM muscle groups.  92.73% of the time 1 or more down arrows are indicated in the Symptomatic group.   According to classic interpretation, this would assume the asymptomatic group would all have an ascending disorder.  Based on the objective data gathered from 92 candidates (41 Asymptomatic and 51 Symptomatic) both show similarly high percentage of downward sloping patterns.  According to classic scan 18 theory and hypothesis this would indicate muscle fatigue with an asending origin, although 41 of the subjects did not report any known musculoskeletal occlusal signs and symptoms.  It seems a bit presumptuous to use classic scan 18 interpretation and theories to hypothesize ascending or descending patterns based on the present objective findings as to their correlation to muscle fatigue.

Factors Effecting Scan 18 Mean Frequency Graph Outcomes - To be considered:
Box positioning and size should be standardized, but has not been over the past years. In the older K6/K7 versions the boxes were narrower (0.71 sec), but more recently the newer K7 version boxes are defaulted to a 1.42 sec box for box 2 and 3. The newer K7 versions have standardized box placements at the beginning of the clench and at the end of the clench.

Changing box positioning can alter % values, but typically does not effect the mean frequency shift or slope line when placing the boxes at the begining and at the end of the 10 second clench.

In these studies we have purposely not used the up and down arrow % values because the positioning and size of the boxes effect these % values. Values or range of values have not been standardized or accurately determined even though they have been used by some.  Box positioning does not alter the sloping graph generally, even though box size or positioning can alter the % values. That is why in this study we have not based our evaluation and assessment on % values of up and down arrows.  Observing whether the arrows are up or down have been mainly used with emphasis on observing the sloping average line which represents whether the graph is sloping upward or downward.

Here is an example of the SAME Scan 18 values changing based on box positioning and size:
Standard K7 version 9 box default position (many of you have recorded with this size boxes 2 and 3 – (LTA shows 5% down arrow, LMM 2% down arrow).

Moved Box 2 and 3 inward position – Note change in LTA 4% downward, LMM 2% upward.

Larger box 2 and 3 size (which we don’t do typically) – Note: (LTA 6% down arrow, LMM 3% up arrow)  

Smaller box 2 and 3 size (most of you who have older K7 versions recorded) – Note: (LTA 9% down arrow, LMM 4% down arrow)

Data is still being tabulated to better assess the average downward and upward sloping graphs and whether if there is any significant differences between the two Asymptomatic and Symptomatic Scan 18 groups.  From visual analysis of the Scan 18 results, there is no observable sigificant difference.

These NMR research studies are purposely establishing baseline parameters to for clinicians to better understand what Scan 18 actually means and how to best interpret the data as to their clinical relevance if muscle fatigue, ascending and or descending patterns truly exist prior to and after TENS.

The values and preliminary observations indicate that one cannot definitively conclude an ascending or descending pattern diagnosis from scan 18 mean frequency analysis data as per the classic theory.  As far as the LMM and RMM values they appear to be affected by occlusion and clench factors.

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