Developing an Abdominal Palpation Simulator: Quantifying Forces Applied During Examination

Introduction: A clinical examination of the abdomen is performed as part of a routine physical examination, when a patient
presents with abdominal pain or a history that suggests a possible abdominal pathology, or when there is suspected internal
trauma. A clinician palpates the regions of the abdomen to feel for tenderness, guarding and underlying abnormalities. This
involves both observing the patient’s response and feeling the response of their abdomen to various applied pressures in the
different regions.
We aim to develop a simulator that can teach and train abdominal palpation examination skills by determining the applied
force and position of an examiner’s hand on a patient’s abdomen.
In order to incorporate the training of appropriate palpation forces into the design of the simulator, it was necessary to know
the location and magnitude of typical forces applied to the abdomen during palpation. A search of the literature found only
initial studies1,2 on a limited number of test cases recording forces applied to the abdomen.
Methods: Ethics approval was obtained to perform a pilot study in the South Australian Movement Analysis Centre to
investigate the palpation examination forces applied to a subject’s abdomen. For each trial, reflective markers were attached
to the subject’s abdomen and the clinician’s dominant hand to track their motion with the infrared cameras in the VICON
three dimensional motion analysis system while AMTI force plates recorded the force.