1
|
Panahi F, Ebrahimi S, Rojhani-Shirazi Z, Shakibafard A, Hemmati L. Effects of neurorehabilitation with and without dry needling technique on muscle thickness, reflex torque, spasticity and functional performance in chronic ischemic stroke patients with spastic upper extremity muscles: a blinded randomized sham-controlled clinical trial. Disabil Rehabil 2024; 46:1092-1102. [PMID: 36970837 DOI: 10.1080/09638288.2023.2190168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/08/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE Evaluation the effects of dry needling on sonographic, biomechanical and functional parameters of spastic upper extremity muscles. METHODS Twenty-four patients (35-65 years) with spastic hand were randomly allocated into two equal groups: intervention and sham-controlled groups. The treatment protocol was 12-sessions neurorehabilitation for both groups and 4-sessions dry needling or sham-needling for the intervention group and sham-controlled group respectively on wrist and fingers flexor muscles. The outcomes were muscle thickness, spasticity, upper extremity motor function, hand dexterity and reflex torque which were assessed before, after the 12th session, and after one-month follow-up by a blinded assessor. RESULTS The analysis showed that there was a significant reduction in muscle thickness, spasticity and reflex torque and a significant increment in motor function and dexterity in both groups after treatment (p < 0.01). However, these changes were significantly higher in the intervention group (p < 0.01) except for spasticity. Moreover, a significant improvement was seen in all outcomes measured one-month after the end of the treatment in the intervention group (p < 0.01). CONCLUSIONS Dry needling plus neurorehabilitation could decrease muscle thickness, spasticity and reflex torque and improve upper-extremity motor performance and dexterity in chronic stroke patients. These changes were lasted one-month after treatment.Trial Registration Number: IRCT20200904048609N1IMPLICATION FOR REHABILITATIONUpper extremity spasticity is one of the stroke consequences which interfere with motor function and dexterity of patient hand in activity of daily livingApplying the dry needling accompanied with neurorehabilitation program in post-stroke patients with muscle spasticity can reduce the muscle thickness, spasticity and reflex torque and improve upper extremity functions.
Collapse
Affiliation(s)
- Fatemeh Panahi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samaneh Ebrahimi
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Rehabilitation Sciences Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Rojhani-Shirazi
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Rehabilitation Sciences Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Ladan Hemmati
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
2
|
Katakis S, Barotsis N, Kakotaritis A, Tsiganos P, Economou G, Panagiotopoulos E, Panayiotakis G. Muscle Cross-Sectional Area Segmentation in Transverse Ultrasound Images Using Vision Transformers. Diagnostics (Basel) 2023; 13:diagnostics13020217. [PMID: 36673026 PMCID: PMC9858099 DOI: 10.3390/diagnostics13020217] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 01/10/2023] Open
Abstract
Automatically measuring a muscle’s cross-sectional area is an important application in clinical practice that has been studied extensively in recent years for its ability to assess muscle architecture. Additionally, an adequately segmented cross-sectional area can be used to estimate the echogenicity of the muscle, another valuable parameter correlated with muscle quality. This study assesses state-of-the-art convolutional neural networks and vision transformers for automating this task in a new, large, and diverse database. This database consists of 2005 transverse ultrasound images from four informative muscles for neuromuscular disorders, recorded from 210 subjects of different ages, pathological conditions, and sexes. Regarding the reported results, all of the evaluated deep learning models have achieved near-to-human-level performance. In particular, the manual vs. the automatic measurements of the cross-sectional area exhibit an average discrepancy of less than 38.15 mm2, a significant result demonstrating the feasibility of automating this task. Moreover, the difference in muscle echogenicity estimated from these two readings is only 0.88, another indicator of the proposed method’s success. Furthermore, Bland−Altman analysis of the measurements exhibits no systematic errors since most differences fall between the 95% limits of agreements and the two readings have a 0.97 Pearson’s correlation coefficient (p < 0.001, validation set) with ICC (2, 1) surpassing 0.97, showing the reliability of this approach. Finally, as a supplementary analysis, the texture of the muscle’s visible cross-sectional area was examined using deep learning to investigate whether a classification between healthy subjects and patients with pathological conditions solely from the muscle texture is possible. Our preliminary results indicate that such a task is feasible, but further and more extensive studies are required for more conclusive results.
Collapse
Affiliation(s)
- Sofoklis Katakis
- Electronics Laboratory, Department of Physics, University of Patras, 26504 Patras, Greece
- Correspondence:
| | - Nikolaos Barotsis
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Alexandros Kakotaritis
- Electronics Laboratory, Department of Physics, University of Patras, 26504 Patras, Greece
| | - Panagiotis Tsiganos
- Clinical Radiology Laboratory, School of Medicine, University of Patras, 26504 Patras, Greece
| | - George Economou
- Electronics Laboratory, Department of Physics, University of Patras, 26504 Patras, Greece
| | - Elias Panagiotopoulos
- Orthopaedic and Rehabilitation Department, Patras University Hospital, 26504 Patras, Greece
| | - George Panayiotakis
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
| |
Collapse
|
3
|
Pinto-Ramos J, Costa-Santos C, Costa F, Tavares H, Cabral J, Moreira T, Brito R, Barroso J, Sousa-Pinto B. Reliability of point-of-care ultrasound for measuring quadriceps femoris muscle thickness. Eur J Phys Rehabil Med 2022; 58:767-773. [PMID: 36052891 PMCID: PMC10019477 DOI: 10.23736/s1973-9087.22.07432-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Point-of-care ultrasound can be used to assess muscle thickness. However, its reliability has not been fully evaluated. AIM This study aimed to assess the intrarater and inter-rater reliability of point-of-care ultrasound for the estimation of quadriceps and rectus femoris thickness in patients from a rehabilitation setting. DESIGN This is a cross-sectional study. SETTING This study was conducted at the Department of Physical Medicine and Rehabilitation of a tertiary care hospital. POPULATION Twenty-nine inpatients consecutively selected after admission. METHODS Four observers, two trained and two untrained, used point-of-care ultrasound to measure quadriceps femoris and rectus femoris thickness. Each observer performed two measurements followed by a second set of two measurements three hours later. Intraclass correlation coefficients (ICC) were then calculated. RESULTS Both intrarater and inter-rater ICC were higher than 0.888 for both quadriceps and rectus femoris measurements. Reliability was highest when ICC were calculated based on the average of two measurements, with the intrarater ICC being of 0.956 (95% CI: 0.937-0.970) for rectus femoris and of 0.966 (95% CI: 0.951-0.976) for quadriceps femoris; and with the inter-rater ICC being of 0.919 (95% CI: 0.863-0.957) for rectus femoris and 0.945 (95% CI: 0.907- 0.971) for quadriceps femoris. Trained and untrained observers did not have significantly different ICC values. CONCLUSIONS These results suggest that point-of-care ultrasound is a reliable option to measure muscle thickness of knee extensors by the same or different observers. CLINICAL REHABILITATION IMPACT Measuring knee extensors thickness may aid to adequately modulate treatment choices in patients with disability. This study suggests that quadriceps and rectus femoris muscle thickness measured after a short training course, by either an experienced or inexperienced clinician, presents high reliability. Reliability can be increased if the average of two measurements is used. Besides being inexpensive and portable, point-of-care ultrasound is a reliable tool for measuring knee extensors' thickness, rendering it potentially adequate to be used in clinical practice.
Collapse
Affiliation(s)
- João Pinto-Ramos
- Department of Physical Medicine and Rehabilitation, São João University Hospital Center, Porto, Portugal - .,Center for Health Technologies and Services Research - CINTESIS, University of Porto, Porto, Portugal -
| | - Cristina Costa-Santos
- Center for Health Technologies and Services Research - CINTESIS, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences - MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Frederico Costa
- Department of Physical Medicine and Rehabilitation, São João University Hospital Center, Porto, Portugal
| | - Helena Tavares
- Department of Physical Medicine and Rehabilitation, São João University Hospital Center, Porto, Portugal
| | - João Cabral
- Department of Physical Medicine and Rehabilitation, São João University Hospital Center, Porto, Portugal
| | - Tiago Moreira
- Department of Physical Medicine and Rehabilitation, São João University Hospital Center, Porto, Portugal
| | - Rui Brito
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar do Porto, Porto, Portugal
| | - Joana Barroso
- Department of Physical Medicine and Rehabilitation, São João University Hospital Center, Porto, Portugal.,Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal.,Institute for Health Research and Innovation - i3s, University of Porto, Porto, Portugal.,Feinberg School of Medicine, Departments of Neuroscience and Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Bernardo Sousa-Pinto
- Center for Health Technologies and Services Research - CINTESIS, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences - MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
4
|
Mihai EE, Popescu MN, Iliescu AN, Berteanu M. A systematic review on extracorporeal shock wave therapy and botulinum toxin for spasticity treatment: a comparison on efficacy. Eur J Phys Rehabil Med 2022; 58:565-574. [PMID: 35412036 PMCID: PMC9980509 DOI: 10.23736/s1973-9087.22.07136-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The complexity of spasticity requires a continuous effort in terms of more adapted treatments for patients, and accurate management. Through this systematic review, we aimed to evaluate and compare the effectiveness of extracorporeal shock wave therapy (ESWT) with botulinum toxin type A (BoNT-A) on reducing spasticity both in children and adults. EVIDENCE ACQUISITION An electronic search of PubMed/Medline, Scopus, Ovid Medline(R), and search engine of Google Scholar was performed. Publications ranging from January 2010 to January 2021, published in the English language and available as full-texts were eligible for inclusion and they were searched without any country restriction. The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines. EVIDENCE SYNTHESIS A total of five studies were included in the present systematic review. Screening of the references, data extraction, and risk of bias assessment were performed by two independent authors. The methodological quality and risk of bias were conducted using the Physiotherapy Evidence Database (PEDro) Scale. The primary outcome was spasticity grade assessed by the Modified Ashworth Scale (MAS) and/or Modified Tardieu Scale (MTS). Additional outcomes were active range of motion (AROM), passive range of motion (PROM), upper extremity Fugl-Meyer Assessment (UE-FMA), pain intensity assessed through Visual Analogue Scale (VAS), spasm frequency scale (SFS), sonographic parameters, between-group comparison, and treatment response rate. CONCLUSIONS A beneficial effect on spasticity was found for both treatments: evidence showed that ESWT and BoNT-A can ameliorate spasticity considering parameters such as MAS, MTS, AROM, PROM, UE-FMA, VAS and SFS in post-stroke, multiple sclerosis, and cerebral palsy patients. Further research is required to strengthen the evidence, and more suitable study protocols are highly needed.
Collapse
Affiliation(s)
- Emanuela E Mihai
- Department of Physical and Rehabilitation Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Marius N Popescu
- Department of Physical and Rehabilitation Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania - .,Department of Physical and Rehabilitation Medicine, Elias University Emergency Hospital, Bucharest, Romania
| | - Alina N Iliescu
- Department of Physical and Rehabilitation Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Mihai Berteanu
- Department of Physical and Rehabilitation Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Physical and Rehabilitation Medicine, Elias University Emergency Hospital, Bucharest, Romania
| |
Collapse
|
5
|
Automatic Extraction of Muscle Parameters with Attention UNet in Ultrasonography. SENSORS 2022; 22:s22145230. [PMID: 35890909 PMCID: PMC9324543 DOI: 10.3390/s22145230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 02/04/2023]
Abstract
Automatically delineating the deep and superficial aponeurosis of the skeletal muscles from ultrasound images is important in many aspects of the clinical routine. In particular, finding muscle parameters, such as thickness, fascicle length or pennation angle, is a time-consuming clinical task requiring both human labour and specialised knowledge. In this study, a multi-step solution for automating these tasks is presented. A process to effortlessly extract the aponeurosis for automatically measuring the muscle thickness has been introduced as a first step. This process consists mainly of three parts. In the first part, the Attention UNet has been incorporated to automatically delineate the boundaries of the studied muscles. Afterwards, a specialised post-processing algorithm was utilised to improve (and correct) the segmentation results. Lastly, the calculation of the muscle thickness was performed. The proposed method has achieved similar to a human-level performance. In particular, the overall discrepancy between the automatic and the manual muscle thickness measurements was equal to 0.4 mm, a significant result that demonstrates the feasibility of automating this task. In the second step of the proposed methodology, the fascicle’s length and pennation angle are extracted through an unsupervised pipeline. Initially, filtering is applied to the ultrasound images to further distinguish the tissues from the other muscle structures. Later, the well-known K-Means algorithm is used to isolate them successfully. As the last step, the dominant angle of the segmented muscle tissues is reported and compared with manual measurements. The proposed pipeline is showing very promising results in the evaluated dataset. Specifically, in the calculation of the pennation angle, the overall discrepancy between the automatic and the manual measurements was less than 2.22° (degrees), once more comparable with the human-level performance. Finally, regarding the fascicle length measurements, the results were divided based on the muscle properties. In the muscles where a large portion (or all) of the fascicles are located between the upper and lower aponeuroses, the proposed pipeline exhibits superb performance; otherwise, overall accuracy deteriorates due to errors caused by the trigonometric approximations needed for the length calculation.
Collapse
|
6
|
Miyachi R, Kanazawa Y, Fujii Y, Ohno N, Miyati T, Yamazaki T. Reliability of lower leg muscle thickness measurement along the long axis of the muscle using ultrasound imaging, in a sitting position. J Phys Ther Sci 2022; 34:515-521. [PMID: 35784606 PMCID: PMC9246410 DOI: 10.1589/jpts.34.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/27/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To verify the reliability and validity of lower leg muscle thickness (MT)
assessment along the muscle’s long axis using ultrasound imaging (USI) in a sitting
position. [Participants and Methods] Twenty healthy adult female participants (aged, 20.3
± 0.9 years) were included in the study. Intra- and inter-examiner reliability of the
proximal, middle, and distal MT of the tibialis anterior (TA) and medial head of the
gastrocnemius (GM) were verified using USI in a sitting position. Additionally, the
relationship between MT measurement using USI and muscle cross-sectional area (MCSA)
measurement using magnetic resonance imaging (MRI), as well as the ankle joint’s maximum
muscle strength, were examined. [Results] The reliability of TA and GM MT measurement
using USI was high for all regions. The relationship between MCSA measurement using MRI
and MT measurement using USI showed a significant correlation in all the regions for both
muscles. The relationship between ankle muscle strength and USI of MT was not
significantly correlated in any region for both muscles. [Conclusion] Measurement of MT
using USI is reliable and valid for MCSA, but must be combined with assessments of other
factors for muscle strength.
Collapse
Affiliation(s)
- Ryo Miyachi
- Faculty of Health and Medical Sciences, Hokuriku University: 1-1 Taiyogaoka, Kanazawa-shi, Ishikawa 920-1180, Japan.,Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Yuji Kanazawa
- Faculty of Health and Medical Sciences, Hokuriku University: 1-1 Taiyogaoka, Kanazawa-shi, Ishikawa 920-1180, Japan
| | - Yoshinari Fujii
- Faculty of Health and Medical Sciences, Hokuriku University: 1-1 Taiyogaoka, Kanazawa-shi, Ishikawa 920-1180, Japan
| | - Naoki Ohno
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Tosiaki Miyati
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| | - Toshiaki Yamazaki
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
| |
Collapse
|
7
|
Abiko T, Ohmae K, Murata S, Shiraiwa K, Horie J. Reliability of muscle thickness and echo intensity measurements of the quadriceps: A novice examiner. J Bodyw Mov Ther 2022; 31:164-168. [DOI: 10.1016/j.jbmt.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 12/06/2021] [Accepted: 03/14/2022] [Indexed: 11/17/2022]
|
8
|
Mihai EE, Mihai IV, Berteanu M. Effectiveness of Radial Extracorporeal Shock Wave Therapy and Visual Feedback Balance Training on Lower Limb Post-Stroke Spasticity, Trunk Performance, and Balance: A Randomized Controlled Trial. J Clin Med 2021; 11:jcm11010147. [PMID: 35011889 PMCID: PMC8745149 DOI: 10.3390/jcm11010147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 11/18/2022] Open
Abstract
Stroke remains one of the leading causes of disability in adults, and lower limb spasticity, affected stance, and balance impact everyday life and activities of such patients. Robotic therapy and assessment are becoming important tools to clinical evaluation for post-stroke rehabilitation. The aim of this study was to determine in a more objective manner the effects of visual feedback balance training through a balance trainer system and radial extracorporeal shock wave therapy (rESWT), along with conventional physiotherapy, on lower limb post-stroke spasticity, trunk control, and static and dynamic balance through clinical and stabilometric assessment. The study was designed as a randomized controlled trial. The experimental group underwent conventional physiotherapy, visual feedback balance training, and rESWT. The control group underwent conventional physiotherapy, visual feedback training and sham rESWT. The statistical analysis was performed using GraphPad Software and MATLAB. Primary clinical outcome measures were The Modified Ashworth Scale (MAS), passive range of motion (PROM), Visual Analogue Scale (VAS), and Clonus score. Secondary outcome measures were trunk performance, sensorimotor, and lower limb function. Stabilometric outcome measures were trunk control, static balance, and dynamic balance. Visual feedback training using the Prokin system and rESWT intervention, along with conventional physiotherapy, yielded statistically significant improvement both on clinical and stabilometric outcome measures, enhancing static and dynamic balance, trunk performance, sensorimotor outcome, and limb function and considerably diminishing lower limb spasticity, pain intensity, and clonus score in the experimental group.
Collapse
Affiliation(s)
- Emanuela Elena Mihai
- Physical and Rehabilitation Medicine Department, Carol Davila University of Medicine and Pharmacy Bucharest, 050451 Bucharest, Romania; (E.E.M.); (M.B.)
| | - Ilie Valentin Mihai
- Department of Telecommunications, University Politehnica of Bucharest, 060042 Bucharest, Romania
- Correspondence:
| | - Mihai Berteanu
- Physical and Rehabilitation Medicine Department, Carol Davila University of Medicine and Pharmacy Bucharest, 050451 Bucharest, Romania; (E.E.M.); (M.B.)
- Physical and Rehabilitation Medicine Department, Elias University Emergency Hospital, 011461 Bucharest, Romania
| |
Collapse
|
9
|
Pirri C, Fede C, Fan C, Guidolin D, Macchi V, De Caro R, Stecco C. Ultrasound Imaging of Head/Neck Muscles and Their Fasciae: An Observational Study. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:743553. [PMID: 36188862 PMCID: PMC9397964 DOI: 10.3389/fresc.2021.743553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 11/15/2021] [Indexed: 12/17/2022]
Abstract
Background: Masticatory muscle thickness provides objective measurements of the temporomandibular motor function, which may change in patients with oral myofascial pain. Moreover, they are considered as being part of the craniocervical unit by a crucial relationship with cervical muscles and their fasciae. In this study, we aimed to assess by ultrasound (US) imaging the fasciae of the masseter, temporal, and sternocleidomastoid muscles to understand their mean thickness and eventual variation in relationship with the muscles, sides, and sex. Methods: We studied 16 healthy volunteers without temporomandibular joint dysfunction. Concerning each subject were evaluated the range of motion of the temporomandibular joint and of the neck, the thickness of muscles and their fasciae of both sides, and the delta of muscle thickness. Results: All the motor evaluations of the subjects showed normal ranges. The US results showed that the fasciae have a mean thickness of 0.50 ± 0.1 mm, which did not change during muscle contraction. The evaluated muscles presented a symmetry between right and left (p > 0.05), even if the delta of muscle (US) thickness had a huge range between different subjects, for example in the masseter muscle from 0.7 to 4.2 mm. Conclusions: Ultrasound imaging is a suitable and reliable tool to study the muscles and fasciae of the head and neck region, permitting also the evaluation of the ability of the muscles to contract. Finally, identifying functional asymmetry that could become symptomatic, US imaging could allow an early rehabilitation treatment.
Collapse
|
10
|
Arai Y, Nakanishi N, Ono Y, Inoue S, Kotani J, Harada M, Oto J. Ultrasound assessment of muscle mass has potential to identify patients with low muscularity at intensive care unit admission: A retrospective study. Clin Nutr ESPEN 2021; 45:177-183. [PMID: 34620314 DOI: 10.1016/j.clnesp.2021.08.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND & AIMS Muscle mass is an important biomarker of survival from a critical illness; however, there is no widely accepted method for routine assessment of low muscularity at intensive care unit (ICU) admission. We hypothesize that ultrasound-based partial muscle mass assessments can reflect the trunk muscle mass. Therefore, we aimed to investigate whether ultrasound muscle mass measurements could reflect trunk muscle mass and identify patients with low muscularity. METHODS We performed a retrospective analysis of prospectively obtained ultrasound data at ICU admission. We included patients who underwent computed tomography (CT) imaging at the third lumbar vertebra (L3) within 2 days before and 2 days after ICU admission. Primary outcomes included the correlation between the femoral muscle mass measurements using ultrasound and the cross-sectional area (CSA) at L3 obtained by CT. Low muscularity was defined as a skeletal muscle index of 36.0 cm2/m2 for males and 29.0 cm2/m2 for females. Secondary outcomes included the correlation with the ultrasound measurements of the biceps brachii muscle mass and diaphragm thickness. RESULTS Among 133 patients, 89 underwent CT imaging, which included the L3. The patient mean age was 72 ± 13 years, and 60 patients (67%) were male. The correlation between the femoral muscle ultrasound and CT was ρ = 0.57 (p < 0.01, n = 89) and ρ = 0.48 (p < 0.01, n = 89) for quadriceps muscle layer thickness and rectus femoris muscle CSA, and these had the discriminative power to assess low muscularity, with the areas under the curve of 0.84 and 0.76, respectively. The ultrasound measurements of the biceps brachii muscle mass and diaphragm thickness were correlated with CT imaging [ρ = 0.57-0.60 (p < 0.01, n = 52) and ρ = 0.35 (p < 0.01, n = 79)]. CONCLUSIONS Ultrasound measurements of muscle mass were correlated with CT measurements, and the measurements of femoral muscle mass were useful to assess low muscularity at ICU admission. TRIAL REGISTRATION UMIN000044032 (retrospectively registered on April 25, 2021).
Collapse
Affiliation(s)
- Yuta Arai
- Emergency and Disaster Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503, Japan; Department of Radiology, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503, Japan
| | - Nobuto Nakanishi
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, 7-5-2 Kusunoki, Chuo-ward, Kobe, 650-0017, Japan; Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503, Japan.
| | - Yuko Ono
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, 7-5-2 Kusunoki, Chuo-ward, Kobe, 650-0017, Japan
| | - Shigeaki Inoue
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, 7-5-2 Kusunoki, Chuo-ward, Kobe, 650-0017, Japan
| | - Joji Kotani
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, 7-5-2 Kusunoki, Chuo-ward, Kobe, 650-0017, Japan
| | - Masafumi Harada
- Department of Radiology, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503, Japan
| | - Jun Oto
- Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503, Japan
| |
Collapse
|
11
|
Chang PH, Chen YJ, Chang KV, Wu WT, Özçakar L. Ultrasound measurements of superficial and deep masticatory muscles in various postures: reliability and influencers. Sci Rep 2020; 10:14357. [PMID: 32873849 PMCID: PMC7463001 DOI: 10.1038/s41598-020-71378-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/06/2020] [Indexed: 12/14/2022] Open
Abstract
Masticatory muscle thickness provides objective measurements of the oral motor function, which may change in patients with oral myofascial pain. In this study, we aimed to establish a reliable ultrasound (US) protocol for imaging the superficial and deep masticatory muscles and to identify the potential influencers of the measurements. Forty-eight healthy participants without orofacial pain were enrolled. The intra-and inter-rater reliabilities of US measurements for masseter, temporalis, and lateral pterygoid muscles were assessed. Intraclass correlation coefficients for all muscles were greater than 0.6. The generalised estimating equation was used to analyse the impact of age, gender, laterality, and body mass index on the measurements, whereby age and body mass index were likely to be associated with an increase in masticatory muscle thickness. The thickness tended to be lesser in females. Laterality seemed to exert minimal influence on masticatory muscle thickness. Our study shows acceptable reliability of US in the evaluation of superficial and deep masticatory muscle thickness. Future studies are warranted to validate the usefulness of US imaging in patients with oral myofascial pain syndrome.
Collapse
Affiliation(s)
- Pei-Hsuan Chang
- Department of Dentistry, School of Dentistry, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Yunn-Jy Chen
- Department of Dentistry, School of Dentistry, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan, ROC.
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan, ROC
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| |
Collapse
|
12
|
Barotsis N, Galata A, Hadjiconstanti A, Panayiotakis G. The ultrasonographic measurement of muscle thickness in sarcopenia. A prediction study. Eur J Phys Rehabil Med 2020; 56:427-437. [PMID: 32293812 DOI: 10.23736/s1973-9087.20.06222-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Sarcopenia is a common disease in the elderly. Although extensive research has been conducted on muscle mass and quality assessment tools, there are still certain drawbacks preventing their universal use. AIM The aim of this study was the evaluation of the thickness of head, neck, upper and lower limb muscles measured with ultrasonography, as a potential predictory tool in sarcopenia. DESIGN Prediction study. SETTING The Outpatient Sarcopenia Clinic of the Rehabilitation Department of the University Hospital of Patras. POPULATION Ninety-four individuals (27 men and 67 women) with a mean age of 75.6 years (SD=6.6), referred for sarcopenia screening, participated in this study. METHODS The muscle thickness was measured with transverse and longitudinal ultrasound scans bilaterally. RESULTS The thickness of the geniohyoid and medial head of gastrocnemius muscle in all ultrasound sections, and the thickness of the rectus femoris and vastus intermedius muscle, in specific sections, was found to be significantly decreased in patients with sarcopenia (P<0.05). The Receiver Operating Characteristic (ROC) curve analysis of the ultrasound muscle thickness measurements resulted in a significant association with sarcopenia. In the case of the geniohyoid muscle, the measured area under the ROC curve was found to be the highest (0.79). The optimal cut-off for the prediction of sarcopenia from the geniohyoid muscle was 0.65 cm with sensitivity equal to 75.0% and specificity equal to 66.7%. CONCLUSIONS The results of this study have shown that the thickness of the neck and lower limb muscles measured ultrasonographically can be utilized in the prediction of sarcopenia with high sensitivity and specificity. CLINICAL REHABILITATION IMPACT The prevalence of sarcopenia in the geriatric population and the rehabilitation wards is reported to be high. Therefore, an easy, fast, low cost and with no risk, widely available method such as ultrasonography could be an extremely valuable tool for the screening and follow-up of sarcopenia.
Collapse
Affiliation(s)
- Nikolaos Barotsis
- Department of Rehabilitation Medicine, University Hospital of Patras, Patras, Greece -
| | - Angeliki Galata
- Department of Rehabilitation Medicine, University Hospital of Patras, Patras, Greece
| | | | - George Panayiotakis
- Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
| |
Collapse
|