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Goo M, Johnston LM, Tucker K. Shear modulus of lower limb muscles in school-aged children with mild hypotonia. J Biomech 2024; 174:112267. [PMID: 39141960 DOI: 10.1016/j.jbiomech.2024.112267] [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: 02/09/2024] [Revised: 06/24/2024] [Accepted: 08/06/2024] [Indexed: 08/16/2024]
Abstract
The objective of this study is to compare shear modulus of lower limb muscles between children with hypotonia versus typical development (TD) or developmental disorders associated with altered tone. Nineteen children with mild hypotonia (mean age 9.4 ± 2.3y, 13 male) completed assessment of resting shear modulus of rectus femoris, biceps femoris (BF), tibialis anterior (TA) and gastrocnemius lateralis (GL) at short and long lengths using shear wave elastography. Data was compared with previous data from TD children and a scoping review for children with developmental disorders. Data were collated according to Net-Longitudinal Tension Angle (Net-LTA), which is the muscle length expressed as the net proximal and distal joint angles. Effects of Net-LTA (e.g., short, neutral, long) were examined according to sex, age and body mass index (BMI). In children with hypotonia, shear modulus was: higher at longer versus shorter lengths for four muscles (p < 0.01); correlated with age for BF-short (r = 0.60, p < 0.03) and GL-short (r = -0.54, p < 0.03), with BMI for BF-short (r = 0.71, p < 0.05); and not different between sexes (p > 0.05). The shear modulus values for lower limb muscles for children with mild hypotonia were lower than those for children with Duchenne Muscular Dystrophy (TA-neutral), or Cerebral Palsy (GL-neutral), but not TD children (all four muscles). In conclusion, shear modulus increases with longer muscle length (i.e. higher Net-LTA) in mildly hypotonic children. Children with mild hypotonia have lower shear modulus than children with cerebral palsy and Duchenne muscular dystrophy.
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Affiliation(s)
- Miran Goo
- The University of Queensland, School of Biomedical Sciences, Brisbane, Australia
| | - Leanne M Johnston
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia
| | - Kylie Tucker
- The University of Queensland, School of Biomedical Sciences, Brisbane, Australia.
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2
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Ranger BJ, Moerman KM, Feigin M, Herr HM, Anthony BW. 3D Ultrasound Shear Wave Elastography for Musculoskeletal Tissue Assessment Under Compressive Load: A Feasibility Study. ULTRASONIC IMAGING 2024; 46:251-262. [PMID: 38770999 DOI: 10.1177/01617346241253798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Given its real-time capability to quantify mechanical tissue properties, ultrasound shear wave elastography holds significant promise in clinical musculoskeletal imaging. However, existing shear wave elastography methods fall short in enabling full-limb analysis of 3D anatomical structures under diverse loading conditions, and may introduce measurement bias due to sonographer-applied force on the transducer. These limitations pose numerous challenges, particularly for 3D computational biomechanical tissue modeling in areas like prosthetic socket design. In this feasibility study, a clinical linear ultrasound transducer system with integrated shear wave elastography capabilities was utilized to scan both a calibrated phantom and human limbs in a water tank imaging setup. By conducting 2D and 3D scans under varying compressive loads, this study demonstrates the feasibility of volumetric ultrasound shear wave elastography of human limbs. Our preliminary results showcase a potential method for evaluating 3D spatially varying tissue properties, offering future extensions to computational biomechanical modeling of tissue for various clinical scenarios.
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Affiliation(s)
- Bryan J Ranger
- Department of Engineering, Boston College, Chestnut Hill, MA, USA
| | - Kevin M Moerman
- School of Engineering, University of Galway, Galway, Ireland
| | - Micha Feigin
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Hugh M Herr
- MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Brian W Anthony
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
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Fraser AM, Aceros J, Lundy M, Bevill G. Safety analysis of adapted battery-powered ride-on toy car for children with disabilities using a modified test dummy with varying joint stiffness. Assist Technol 2024; 36:366-372. [PMID: 35114088 DOI: 10.1080/10400435.2022.2035850] [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] [Accepted: 01/24/2022] [Indexed: 10/19/2022] Open
Abstract
Adaptive ride-on toy programs have increased in popularity in recent years and provide novel rehabilitation tools as developmental aids for children with disabilities. While the adaptations made to these toys are intended to provide a safer experience for children with disabilities, safety concerns still exist. Within this context, the purpose of this study was to use a model with varying joint stiffness as a first-order approximation of a child with disabilities and to investigate whether modifications to ride-on toys are sufficient to prevent common injuries. Because the population of children with disabilities who are receiving adaptive ride-on toys have a wide range of musculoskeletal disorders, those with both decreased and increased muscle stiffness were considered in this safety study. A 5-point harness reduced movement regardless of change in joint stiffness and therefore, results from this study indicate that the use of these harnesses is effective regardless of joint stiffness. Furthermore, as excursion-related injuries are considered more critical to the user than injuries relating to kinetic variables and no known injury thresholds were exceeded, the addition of a belt is considered a necessary trade-off with little-to-no added risk.
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Affiliation(s)
- Abbey M Fraser
- College of Computing, Engineering and Construction, Mechanical Engineering, University of North Florida, Jacksonville, Florida, USA
| | - Juan Aceros
- College of Computing, Engineering and Construction, Mechanical Engineering, University of North Florida, Jacksonville, Florida, USA
| | - Mary Lundy
- College of Computing, Engineering and Construction, Mechanical Engineering, University of North Florida, Jacksonville, Florida, USA
| | - Grant Bevill
- College of Computing, Engineering and Construction, Mechanical Engineering, University of North Florida, Jacksonville, Florida, USA
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Chou WY, Shieh JY, Weng WC, Lin CW. Quantifying lower limb muscle stiffness in typically developing children and adolescents using acoustic radiation force impulse shear wave elastography (ARFI/SWE)-a pilot study. Skeletal Radiol 2024; 53:1111-1118. [PMID: 38057435 DOI: 10.1007/s00256-023-04534-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE To investigate and quantify age-related changes in lower limb muscle stiffness in typically developing children and adolescents using acoustic radiation force impulse shear wave elastography. MATERIALS AND METHODS Shear wave velocities of bilateral rectus femoris, tibialis anterior, and medial gastrocnemius muscles at rest were obtained in typically developing children and adolescents aged 3 to 18 years. The participants were classified into three age groups: Group 1 (children), 3 to 7 years old; Group 2, 8 to 12 (pre-adolescent); and Group 3 (adolescent), 13 to 18. The shear wave velocities of muscle were compared across the three age groups, as well as compared between right- and left-side limbs. The correlation between shear wave velocities and body weight or body mass index was assessed. RESULTS Of the 47 participants, 21 were in Group 1, 17 in Group 2, and 9 in Group 3. There were no significant differences among the three age groups' shear wave velocities of bilateral lower limb muscles, and no significant differences between right and left sides. There was no correlation between muscle stiffness and body weight or body mass index. CONCLUSION The present pilot study applied acoustic radiation force impulse shear wave elastography to quantify lower limb muscle stiffness in typically developing children and adolescents aged 3 to 18 years, suggesting no marked change in muscle stiffness occurs as they develop.
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Affiliation(s)
- Wen-Yu Chou
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No.1 Changde St., Taipei City, 100229, Taiwan
| | - Jeng-Yi Shieh
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No.1 Changde St., Taipei City, 100229, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pediatric Neurology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chia-Wei Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No.1 Changde St., Taipei City, 100229, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Cesaro E, Saliba T, Simoni P. The use of shear-wave elastography for the assessment of muscle spasticity in patients with cerebral palsy, a systematic review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 38708803 DOI: 10.1002/jcu.23706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/25/2024] [Accepted: 03/31/2024] [Indexed: 05/07/2024]
Abstract
We explore the use of shear wave elastography (SWE) for assessing muscle stiffness and treatment response in cerebral palsy (CP) children by way of a systematic review. SWE offers real-time muscle stiffness measurements, showing significant differences between CP patients and controls. Studies suggest that SWE can be used to follow muscle stiffness post-botulinum toxin treatment, correlating with clinical improvement. However, methodological variations and small sample sizes prevent comparison between different studies. Standardized protocols could enhance SWE's clinical utility. In conclusion, SWE holds promise for CP management, though standardized methodologies and larger studies are needed to validate its efficacy and integration into clinical practice.
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Affiliation(s)
- Edoardo Cesaro
- Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Thomas Saliba
- Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Paolo Simoni
- Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
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Billy J, Bensamoun SF, Mercier J, Durand S. Applications of ultrasound elastography to hand and upper limb disorders. HAND SURGERY & REHABILITATION 2024; 43:101636. [PMID: 38215880 DOI: 10.1016/j.hansur.2024.101636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/14/2024]
Abstract
Ultrasound elastography is a recently developed method for accurate measurement of soft tissue stiffness in addition to the clinician's subjective evaluation. The present review briefly describes the ultrasound elastography techniques and outlines clinical applications for tendon, muscle, nerve, skin and other soft tissues of the hand and upper limb. Strain elastography provides a qualitative evaluation of the stiffness, and shear-wave elastography generates quantitative elastograms superimposed on a B-mode image. The stiffness in degenerative tendinopathy and/or tendon injury was significantly lower than in a normal tendon in several studies. Elastography is also a reliable method to evaluate functional muscle activity, compared to conventional surface electromyography. The median nerve is consistently stiffer in patients with carpal tunnel syndrome than in healthy subjects, on whatever ultrasound elastography technique. Elastography distinguishes normal skin from scars and can be used to evaluate scar severity and treatment. Elastography has huge clinical applications in musculoskeletal tissues. Continued development of systems and increased training of clinicians will expand our knowledge of elastography and its clinical applications in the future.
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Affiliation(s)
- Jessica Billy
- Department of Hand Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Sabine F Bensamoun
- Sorbonne University, Université de Technologie de Compiègne, CNRS UMR 7338, Biomechanics and Bioengineering, Compiègne, France
| | - Julie Mercier
- Department of Hand Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Sébastien Durand
- Department of Hand Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland.
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Mongold SJ, Ricci AW, Hahn ME, Callahan DM. Skeletal Muscle Compliance and Echogenicity in Resistance-Trained and Nontrained Women. J Strength Cond Res 2024; 38:671-680. [PMID: 38513175 PMCID: PMC10956671 DOI: 10.1519/jsc.0000000000004669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
ABSTRACT Mongold, SJ, Ricci, AW, Hahn, ME, and Callahan, DM. Skeletal muscle compliance and echogenicity in resistance-trained and nontrained women. J Strength Cond Res 38(4): 671-680, 2024-Noninvasive assessment of muscle mechanical properties in clinical and performance settings tends to rely on manual palpation and emphasizes examination of musculotendinous stiffness. However, measurement standards are highly subjective. The purpose of the study was to compare musculotendinous stiffness in adult women with varying resistance training history while exploring the use of multiple tissue compliance measures. We identified relationships between tissue stiffness and morphology, and tested the hypothesis that combining objective measures of morphology and stiffness would better predict indices of contractile performance. Resistance-trained (RT) women (n = 11) and nontrained (NT) women (n = 10) participated in the study. Muscle echogenicity and morphology were measured using B-mode ultrasonography (US). Vastus lateralis (VL) and patellar tendon (PT) stiffness were measured using digital palpation and US across submaximal isometric contractions. Muscle function was evaluated during maximal voluntary isometric contraction (MVIC) of the knee extensors (KEs). Resistance trained had significantly greater PT stiffness and reduced echogenicity (p < 0.01). Resistance trained also had greater strength per body mass (p < 0.05). Muscle echogenicity was strongly associated with strength and rate of torque development (RTD). Patellar tendon passive stiffness was associated with RTD normalized to MVIC (RTDrel; r = 0.44, p < 0.05). Patellar tendon stiffness was greater in RT young women. No predictive models of muscle function incorporated both stiffness and echogenicity. Because RTDrel is a clinically relevant measure of rehabilitation in athletes and can be predicted by digital palpation, this might represent a practical and objective measure in settings where RTD may not be easy to measure directly.
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Affiliation(s)
- Scott J. Mongold
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Austin W. Ricci
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Michael E. Hahn
- Department of Human Physiology, University of Oregon, Eugene, Oregon
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Lim HJ, Yoon H, Kim J, Han K, So Y, Park M, Park KB, Lee MJ. Comparison of elasticity changes in the paraspinal muscles of adolescent patients with scoliosis treated with surgery and bracing. Sci Rep 2024; 14:5623. [PMID: 38453994 PMCID: PMC10920829 DOI: 10.1038/s41598-024-56189-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/04/2024] [Indexed: 03/09/2024] Open
Abstract
Scoliosis is a three-dimensional spinal deformity, and paraspinal muscles play an important role as stabilizers of the spinal curve. In this prospective study, we compared elasticity changes in the paraspinal muscles of adolescent patients with scoliosis after surgery or bracing. Elasticity was measured on the concave and convex sides of the paraspinal muscles at the apex of the curve at the beginning of treatment and 6 and 12 months after treatment. Twenty-six patients with correction surgery (n = 15) or bracing (n = 11) were included. At initial evaluation, the Cobb angle was larger in the surgery group (72.3 ± 20.2° in surgery vs. 30.6 ± 5.1° in brace, p < 0.001). The estimated mean elasticity value of the paraspinal muscles was lower in the surgery group at baseline on the convex side (15.8 vs. 22.8 kPa, p = 0.037) and 6 months on both the concave (12.1 vs. 22.7 kPa, p = 0.004) and convex (13.4 vs. 23.8 kPa, p = 0.005) sides. There was a significant stiffness decrease from baseline to 6 months on the concave side in the surgery group (5.9 kPa, p = 0.025). However, the elasticity change recovered at 12 months without significant differences between the two groups.
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Affiliation(s)
- Hyun Ji Lim
- Department of Pediatric Radiology, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Haesung Yoon
- Department of Pediatric Radiology, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Jisoo Kim
- Department of Pediatric Radiology, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Yuri So
- Department of Biostatistics and Computing, Yonsei University Graduate School, Seoul, South Korea
| | - Mincheol Park
- Division of Pediatric Orthopedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kun-Bo Park
- Division of Pediatric Orthopedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea.
| | - Mi-Jung Lee
- Department of Pediatric Radiology, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
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Zhu J, Qiu L, Ta D, Hua X, Liu H, Zhang H, Li J, Wang Y, Xi Z, Zheng Y, Shan Y, Liu B, Huang W, Liu W, Hao S, Cui L, Cai J, Zhang W, Zhang C, Chen S, Wei A, Dong F. Chinese Ultrasound Doctors Association Guideline on Operational Standards for 2-D Shear Wave Elastography Examination of Musculoskeletal Tissues. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:175-183. [PMID: 37949764 DOI: 10.1016/j.ultrasmedbio.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/19/2023] [Accepted: 10/13/2023] [Indexed: 11/12/2023]
Abstract
The Ultrasound Physician Branch of the Chinese Medical Doctor Association sought to develop evidence-based recommendations on the operational standards for 2-D shear wave elastography examination of musculoskeletal tissues. A consensus panel of 22 Chinese musculoskeletal ultrasound experts reviewed current scientific evidence and proposed a set of 12 recommendations for 13 key issues, including instruments, operating methods, influencing factors and image interpretation. A final consensus was reached through discussion and voting. On the basis of research evidence and expert opinions, the strength of recommendation for each proposition was assessed using a visual analog scale, while further emphasizing the best available evidence during the question-and-answer session. These expert consensus guidelines encourage facilitation of the standardization of clinical practices for collecting and reporting shear wave elastography data.
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Affiliation(s)
- Jiaan Zhu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China.
| | - Li Qiu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Dean Ta
- Center for Biomedical Engineering, Fudan University, Shanghai, China
| | - Xing Hua
- Department of Ultrasound, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Hongmei Liu
- Department of Ultrasound, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Huabin Zhang
- Department of Ultrasound, Beijing Tsinghua Changgung Hospital Affiliated with Tsinghua University, Beijing, China
| | - Jia Li
- Department of Ultrasound, Southeast University Zhongda Hospital, Nanjing, China
| | - Yuexiang Wang
- Department of Ultrasound, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhanguo Xi
- Department of Functional Examination, Henan Provincial Orthopedic Hospital Zhengzhou Campus, Zhengzhou, China
| | - Yuanyi Zheng
- Department of Ultrasound, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yong Shan
- Department of Ultrasound, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Bingyan Liu
- Department of Ultrasound, Hainan General Hospital, Haikou, China
| | - Weijun Huang
- Department of Interventional Ultrasound, First People's Hospital of Foshan, Foshan, China
| | - Weiyong Liu
- Department of Ultrasound, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Shaoyun Hao
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Guangzhou, China
| | - Ligang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Jin Cai
- Department of Ultrasound, Zhejiang Chinese Medical University Affiliated Third Hospital, Hangzhou, China
| | - Wei Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chao Zhang
- Department of Medical Ultrasound, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Shuqiang Chen
- Department of Ultrasound, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - An Wei
- Department of Ultrasound, Hunan Provincial People's Hospital, Changsha, China
| | - Fajin Dong
- Department of Ultrasound, Shenzhen People's Hospital, Shenzhen, China
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Pimenta R, Correia JP, Vaz JR, Veloso AP, Herzog W. Changes in passive and active hamstrings shear modulus are not related after a warmup protocol. J Biomech 2024; 163:111957. [PMID: 38266532 DOI: 10.1016/j.jbiomech.2024.111957] [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: 08/11/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 01/26/2024]
Abstract
This study aimed to determine whether changes in hamstrings passive and active shear modulus after a warmup protocol are correlated. Twenty males without a history of hamstring strain injury participated. Muscle shear modulus was assessed using ultrasound-based shear wave elastography at rest and during isometric contractions at 20% of maximal voluntary isometric effort before and immediately after a warmup protocol. Changes in passive shear modulus did not seem to be associated with changes in active shear modulus. The results of this study suggest that changes in passive and active hamstring shear modulus are not associated after a standardized warmup intervention.
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Affiliation(s)
- Ricardo Pimenta
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada Dafundo, Portugal; Research Center of the Polytechnic Institute of Maia (N2i), Maia Polytechnic Institute (IPMAIA),Castêlo da Maia, 4475-690 Maia, Portugal; Futebol Clube Famalicão - Futebol SAD, Department of Rehabilitation and Performance, Famalicão, Portugal.
| | - José P Correia
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada Dafundo, Portugal
| | - João R Vaz
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada Dafundo, Portugal; Egas Moniz - Cooperativa de Ensino Superior, Monte da Caparica, Portugal
| | - António P Veloso
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada Dafundo, Portugal
| | - Walter Herzog
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
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Kaya Keles CS, Ates F. How mechanics of individual muscle-tendon units define knee and ankle joint function in health and cerebral palsy-a narrative review. Front Bioeng Biotechnol 2023; 11:1287385. [PMID: 38116195 PMCID: PMC10728775 DOI: 10.3389/fbioe.2023.1287385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
This study reviews the relationship between muscle-tendon biomechanics and joint function, with a particular focus on how cerebral palsy (CP) affects this relationship. In healthy individuals, muscle size is a critical determinant of strength, with muscle volume, cross-sectional area, and moment arm correlating with knee and ankle joint torque for different isometric/isokinetic contractions. However, in CP, impaired muscle growth contributes to joint pathophysiology even though only a limited number of studies have investigated the impact of deficits in muscle size on pathological joint function. As muscles are the primary factors determining joint torque, in this review two main approaches used for muscle force quantification are discussed. The direct quantification of individual muscle forces from their relevant tendons through intraoperative approaches holds a high potential for characterizing healthy and diseased muscles but poses challenges due to the invasive nature of the technique. On the other hand, musculoskeletal models, using an inverse dynamic approach, can predict muscle forces, but rely on several assumptions and have inherent limitations. Neither technique has become established in routine clinical practice. Nevertheless, identifying the relative contribution of each muscle to the overall joint moment would be key for diagnosis and formulating efficient treatment strategies for patients with CP. This review emphasizes the necessity of implementing the intraoperative approach into general surgical practice, particularly for joint correction operations in diverse patient groups. Obtaining in vivo data directly would enhance musculoskeletal models, providing more accurate force estimations. This integrated approach can improve the clinicians' decision-making process and advance treatment strategies by predicting changes at the muscle and joint levels before interventions, thus, holding the potential to significantly enhance clinical outcomes.
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12
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Smith DR, Helm CA, Zonnino A, McGarry MD, Johnson CL, Sergi F. Individual Muscle Force Estimation in the Human Forearm Using Multi-Muscle MR Elastography (MM-MRE). IEEE Trans Biomed Eng 2023; 70:3206-3215. [PMID: 37279119 PMCID: PMC10636590 DOI: 10.1109/tbme.2023.3283185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To establish the sensitivity of magnetic resonance elastography (MRE) to active muscle contraction in multiple muscles of the forearm. METHODS We combined MRE of forearm muscles with an MRI-compatible device, the MREbot, to simultaneously measure the mechanical properties of tissues in the forearm and the torque applied by the wrist joint during isometric tasks. We measured shear wave speed of thirteen forearm muscles via MRE in a series of contractile states and wrist postures and fit these outputs to a force estimation algorithm based on a musculoskeletal model. RESULTS Shear wave speed changed significantly upon several factors, including whether the muscle was recruited as an agonist or antagonist (p = 0.0019), torque amplitude (p = <0.0001), and wrist posture (p = 0.0002). Shear wave speed increased significantly during both agonist (p = <0.0001) and antagonist (p = 0.0448) contraction. Additionally, there was a greater increase in shear wave speed at greater levels of loading. The variations due to these factors indicate the sensitivity to functional loading of muscle. Under the assumption of a quadratic relationship between shear wave speed and muscle force, MRE measurements accounted for an average of 70% of the variance in the measured joint torque. CONCLUSION This study shows the ability of MM-MRE to capture variations in individual muscle shear wave speed due to muscle activation and presents a method to estimate individual muscle force through MM-MRE derived measurements of shear wave speed. SIGNIFICANCE MM-MRE could be used to establish normal and abnormal muscle co-contraction patterns in muscles of the forearm controlling hand and wrist function.
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Affiliation(s)
- Daniel R. Smith
- Department of Biomedical Engineering, University of Delaware, Newark DE, 19713
| | - Cody A. Helm
- Department of Biomedical Engineering, University of Delaware, Newark DE, 19713
| | | | | | - Curtis L. Johnson
- Department of Biomedical Engineering, University of Delaware, Newark DE, 19713
| | - Fabrizio Sergi
- Department of Biomedical Engineering, University of Delaware, Newark DE, 19713
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Nakamura S, Kimoto M, Okada K, Kawanobe U, Sakamoto H. Impact of lower muscle stiffness on ankle dorsiflexion restriction in children with cerebral palsy evaluated using ultrasound elastography. Clin Biomech (Bristol, Avon) 2023; 109:106092. [PMID: 37738919 DOI: 10.1016/j.clinbiomech.2023.106092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 08/21/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Plantar flexor muscles always contribute to limiting the range of motion of ankle dorsiflexion in children with spastic cerebral palsy, but the individual contributions of these muscles are not well defined. This study aimed to identify which muscles' stiffness impacts the dorsiflexion range of motion in children with cerebral palsy. METHODS Twenty-five children with cerebral palsy were included. The maximum passive dorsiflexion range of motion was measured in two positions: hip and knee joints in flexion, and both joints in full extension. Strain ratios indicating muscle stiffness were measured using strain elastography of the lateral and medial gastrocnemius, soleus, flexor hallucis longus, peroneus longus, peroneus brevis, and tibialis posterior muscles. To analyze which muscles impact the limitation of the dorsiflexion range, multiple regression analyses were conducted. The values of muscle stiffness were included as independent valuables, and the values of the dorsiflexion range were included as dependent valuables. A p-value <0.05 was considered statistically significant. FINDINGS In the analyses, the soleus and flexor hallucis longus muscle stiffness were significant independent factors for the dorsiflexion range of motion of hip and knee flexion (adjusted R2: 0.50). The lateral gastrocnemius muscle stiffness was a significant independent factor for the dorsiflexion range of motion with both joints in full extension (adjusted R2: 0.61). INTERPRETATION Flexor hallucis longus muscle stiffness, in addition to triceps surae muscle stiffness, was shown to impact dorsiflexion range; attention should be paid to muscle stiffness in children with cerebral palsy.
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Affiliation(s)
- Shinya Nakamura
- Department of Rehabilitation, Akita Prefectural Center on Development and Disability, 1-1-2, Minamigaoka, Akita 010-1409, Japan; Department of Physical Therapy, Akita University Graduate School of Health Sciences, 1-1-1 Hondo, Akita 010-8543, Japan.
| | - Minoru Kimoto
- Department of Rehabilitation, Akita Prefectural Center on Development and Disability, 1-1-2, Minamigaoka, Akita 010-1409, Japan; Department of Physical Therapy, Akita University Graduate School of Health Sciences, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Kyoji Okada
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Uki Kawanobe
- Department of Rehabilitation, Akita Prefectural Center on Development and Disability, 1-1-2, Minamigaoka, Akita 010-1409, Japan
| | - Hitoshi Sakamoto
- Department of Medicine, Akita Prefectural Center on Development and Disability, 1-1-2, Minamigaoka, Akita 010-1409, Japan
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Hu H, Ma Y, Gao X, Song D, Li M, Huang H, Qian X, Wu R, Shi K, Ding H, Lin M, Chen X, Zhao W, Qi B, Zhou S, Chen R, Gu Y, Chen Y, Lei Y, Wang C, Wang C, Tong Y, Cui H, Abdal A, Zhu Y, Tian X, Chen Z, Lu C, Yang X, Mu J, Lou Z, Eghtedari M, Zhou Q, Oberai A, Xu S. Stretchable ultrasonic arrays for the three-dimensional mapping of the modulus of deep tissue. Nat Biomed Eng 2023; 7:1321-1334. [PMID: 37127710 DOI: 10.1038/s41551-023-01038-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/05/2023] [Indexed: 05/03/2023]
Abstract
Serial assessment of the biomechanical properties of tissues can be used to aid the early detection and management of pathophysiological conditions, to track the evolution of lesions and to evaluate the progress of rehabilitation. However, current methods are invasive, can be used only for short-term measurements, or have insufficient penetration depth or spatial resolution. Here we describe a stretchable ultrasonic array for performing serial non-invasive elastographic measurements of tissues up to 4 cm beneath the skin at a spatial resolution of 0.5 mm. The array conforms to human skin and acoustically couples with it, allowing for accurate elastographic imaging, which we validated via magnetic resonance elastography. We used the device to map three-dimensional distributions of the Young's modulus of tissues ex vivo, to detect microstructural damage in the muscles of volunteers before the onset of soreness and to monitor the dynamic recovery process of muscle injuries during physiotherapies. The technology may facilitate the diagnosis and treatment of diseases affecting tissue biomechanics.
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Affiliation(s)
- Hongjie Hu
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Yuxiang Ma
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Xiaoxiang Gao
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Dawei Song
- Institute for Medicine and Engineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Mohan Li
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Hao Huang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Xuejun Qian
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Ray Wu
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Keren Shi
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Hong Ding
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Muyang Lin
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Xiangjun Chen
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Wenbo Zhao
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Baiyan Qi
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Sai Zhou
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Ruimin Chen
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Yue Gu
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Yimu Chen
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Yusheng Lei
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Chonghe Wang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Chunfeng Wang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Yitian Tong
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA
| | - Haotian Cui
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
| | - Abdulhameed Abdal
- Department of Mechanical and Aerospace Engineering, University of California San Diego, La Jolla, CA, USA
| | - Yangzhi Zhu
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Xinyu Tian
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Zhaoxin Chen
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Chengchangfeng Lu
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA
| | - Xinyi Yang
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Jing Mu
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Zhiyuan Lou
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Mohammad Eghtedari
- Department of Radiology, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Qifa Zhou
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Assad Oberai
- Department of Aerospace and Mechanical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Sheng Xu
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA.
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA.
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA.
- Department of Radiology, School of Medicine, University of California San Diego, La Jolla, CA, USA.
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA.
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15
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Hao CJ, Kang XY, Kang CS, Li TT, Huo JZ, Xu Q, Xiao WL, Zhao ZX, Ji XH, Zhang QB. Upper trapezius muscle elasticity in cervical myofascial pain syndrome measured using real-time ultrasound shear-wave elastography. Quant Imaging Med Surg 2023; 13:5168-5181. [PMID: 37581083 PMCID: PMC10423376 DOI: 10.21037/qims-22-797] [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: 07/29/2022] [Accepted: 05/26/2023] [Indexed: 08/16/2023]
Abstract
Background Myofascial pain syndrome (MPS) is a common cause of neck pain, which is a global public health problem. Because MPS does not present morphological changes within lesioned muscles, there are no imaging diagnostic criteria for this condition. In this study, we evaluate elasticity changes in upper trapezius muscles most frequently involved in cervical MPS using real-time ultrasound shear-wave elastography, and we examine their potential diagnostic value. Methods We consecutively enrolled 109 right posterior neck pain patients for this prospective study. Of these, 51 were diagnosed with MPS and 58 with non-MPS in the right side of their neck. Among MPS patients, 19 fell into the 1-3 range (mild pain) for pain scores on the visual analog scale (VAS), 25 fell into the 4-6 range (moderate pain), and 7 into the 7-10 range (severe pain). MPS was diagnosed by two independent clinicians using the diagnostic criteria proposed by Simons et al. Using real-time ultrasound shear-wave elastography, we measured right trapezius mean shear-wave velocity (SWVmean). The midpoint of the line between the foramen magnum and the end of the right acromion served as measuring point. Regions of interest were scaled to span 0-8.0 m/s. Results Trapezius SWVmean was significantly higher in MPS patients compared with non-MPS patients (P<0.001). Stratified analysis of MPS patients according to pain severity revealed similar trapezius SWVmean between mild pain and non-MPS patients (P=0.324), however SWVmean was higher in moderate and severe pain MPS patients compared with non-MPS patients (P<0.001). The area under the curve (AUC) value for upper trapezius SWVmean in MPS patients was 0.791 (95% CI: 0.703-0.863). Corresponding sensitivity and specificity values were 86.27% (95% CI: 73.7-94.3%) and 62.07% (95% CI: 48.4-74.5%). Stratified analysis of MPS patients by pain severity produced the following AUC values for trapezius SWVmean in MPS patients with mild, moderate, and severe pain: 0.578 (95% CI: 0.460-0.690), 0.899 (95% CI: 0.814-0.955), and 0.983 (95% CI: 0.914-0.999), respectively. Conclusions Elasticity changes and increased stiffness in the trapezius occur in cervical MPS patients with moderate and severe pain. The SWVmean parameter reflecting trapezius muscle elasticity may be valuable for successful screening of cervical MPS, especially in patients with moderate and severe pain.
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Affiliation(s)
- Chang-Juan Hao
- Department of Ultrasound, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Shanxi Tongji Hospital, Taiyuan, China
| | - Xiao-Yan Kang
- Department of Ultrasound, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Shanxi Tongji Hospital, Taiyuan, China
| | - Chun-Song Kang
- Department of Ultrasound, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Shanxi Tongji Hospital, Taiyuan, China
| | - Ting-Ting Li
- Department of Ultrasound, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Shanxi Tongji Hospital, Taiyuan, China
| | - Jian-Zhong Huo
- Department of Orthopedics, Central Hospital in Taiyuan, Taiyuan, China
| | - Qian Xu
- Business Division, Hologic (Shanghai) Medical Supplies Co. Ltd., Shanghai, China
| | - Wen-Li Xiao
- Department of Ultrasound, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Shanxi Tongji Hospital, Taiyuan, China
| | - Zhe-Xia Zhao
- Department of Ultrasound, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Shanxi Tongji Hospital, Taiyuan, China
| | - Xing-Hua Ji
- Department of Orthopedics, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Shanxi Tongji Hospital, Taiyuan, China
| | - Quan-Bin Zhang
- Department of Ultrasound, Sixth Hospital of Shanxi Medical University, Taiyuan, China
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16
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Močnik M, Marčun Varda N. Ultrasound Elastography in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1296. [PMID: 37628295 PMCID: PMC10453784 DOI: 10.3390/children10081296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023]
Abstract
Ultrasound elastography is a novel ultrasound technique, being extensively researched in children in the last decade. It measures tissue elasticity with the observation of tissue response after an external stimulus. From research to clinical practice, ultrasound elastography has evolved significantly in liver fibrosis evaluation in children; however, several other applications of the technique are available in both clinical practice and research environments. Practically, in children any organ can be assessed, including the brain in early ages, along with muscle and connective tissue elasticity evaluation, spleen, kidney, skin, lymphatic tissue, etc. The elastography method, age, body mass index and technical points should be considered when performing ultrasound elastography. This review highlights its vast potential as a diagnostic tool in the pediatric population, where ultrasound is a dominant imaging tool; however, the indications and exam protocol for its clinical use in several fields in pediatrics have yet to be elucidated.
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Affiliation(s)
- Mirjam Močnik
- Department of Paediatrics, University Medical Centre Maribor, 2000 Maribor, Slovenia;
| | - Nataša Marčun Varda
- Department of Paediatrics, University Medical Centre Maribor, 2000 Maribor, Slovenia;
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
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17
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Brandenburg JE, Rabatin AE, Driscoll SW. Spasticity Interventions: Decision-Making and Management. Pediatr Clin North Am 2023; 70:483-500. [PMID: 37121638 DOI: 10.1016/j.pcl.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Spasticity results from an abnormality of the central nervous system and is characterized by a velocity-dependent increase in muscle tone or stiffness. In children, it can cause functional impairments, delays in achieving developmental or motor milestones, participation restrictions, discomfort, and musculoskeletal differences. Unique to children is the ongoing process of a maturing central nervous system and body, which can create the appearance of worsening or changing spasticity. Treatment options include physical interventions such as stretching, serial casting, and bracing; oral and injectable medications; and neurosurgical procedures such as selective dorsal rhizotomy and intrathecal baclofen pump.
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Affiliation(s)
- Joline E Brandenburg
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
| | - Amy E Rabatin
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Sherilyn W Driscoll
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
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18
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Boulard C, Gautheron V, Lapole T. Acute passive stretching has no effect on gastrocnemius medialis stiffness in children with unilateral cerebral palsy. Eur J Appl Physiol 2023; 123:467-477. [PMID: 36318307 DOI: 10.1007/s00421-022-05046-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/07/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE The aim of this study was to investigate the effects of an acute high-intensity, long-duration passive stretching session of the plantar flexor muscles, on maximal dorsiflexion (DF) angle and passive stiffness at both ankle joint and gastrocnemius medialis (GM) muscle levels in children with unilateral cerebral palsy (CP). METHODS 13 children [mean age: 10 years 6 months, gross motor function classification system (GMFCS): I] with unilateral CP underwent a 5 min passive stretching session at 80% of maximal DF angle. Changes in maximal DF angle, slack angle, passive ankle joint and GM muscle stiffness from PRE- to POST-intervention were determined during passive ankle mobilization performed on a dynamometer coupled with shear wave elastography measurements (i.e., ultrasound) of the GM muscle. RESULTS Maximal DF angle and maximal passive torque were increased by 6.3° (P < 0.001; + 50.4%; 95% CI 59.9, 49.9) and 4.2 Nm (P < 0.01; + 38.9%; 95% CI 47.7, 30.1), respectively. Passive ankle joint stiffness remained unchanged (P = 0.9; 0%; 95% CI 10.6, - 10.6). GM muscle shear modulus was unchanged at maximal DF angle (P = 0.1; + 34.5%; 95% CI 44.7, 24.7) and at maximal common torque (P = 0.5; - 4%; 95% CI - 3.7, - 4.3), while it was decreased at maximal common angle (P = 0.021; - 35%; 95% CI - 11.4, - 58.5). GM slack angle was shifted in a more dorsiflexed position (P = 0.02; + 20.3%; 95% CI 22.6, 18). CONCLUSION Increased maximal DF angle can be obtained in the paretic leg in children with unilateral CP after an acute bout of stretching using controlled parameters without changes in passive stiffness at joint and GM muscle levels. CLINICAL TRIAL NUMBER NCT03714269.
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Affiliation(s)
- Clément Boulard
- Univ Lyon, UJM Saint-Etienne, Laboratoire Interuniversitaire de Biologie de La Motricité, EA 7424, 42023, Saint-Etienne, France. .,Department of Pediatrics Physical Medicine and Rehabilitation, Faculty of Medicine, University Hospital of Saint-Etienne, Saint-Etienne, France.
| | - Vincent Gautheron
- Univ Lyon, UJM Saint-Etienne, Laboratoire Interuniversitaire de Biologie de La Motricité, EA 7424, 42023, Saint-Etienne, France
| | - Thomas Lapole
- Univ Lyon, UJM Saint-Etienne, Laboratoire Interuniversitaire de Biologie de La Motricité, EA 7424, 42023, Saint-Etienne, France
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19
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Hao CJ, Xiao WL, Zhang QB, Tan XM. Viscoelasticity in trapezius myofascial pain syndrome: quantitative assessment using Real-Time Shear-Wave Elastography. Ann Med 2023; 55:2252442. [PMID: 37676997 PMCID: PMC10486288 DOI: 10.1080/07853890.2023.2252442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE To investigate the differences in the viscoelastic properties between normal trapezius muscles and those in patients with trapezius myofascial pain syndrome (MPS) using real-time shear-wave elastography (SWE). MATERIALS AND METHODS This study included 31 patients with trapezius MPS and 31 volunteers. Sixty-one trapezius muscles (41 and 20 on the affected and non-affected side, respectively) of patients with MPS and 62 normal trapezius muscles in volunteers were assessed. Conventional ultrasonic parameters, including skeletal muscle thickness, resistance index (RI), and mean shear wave velocity (SWVmean) of trapezius muscles, were obtained in the seated position with the shoulders and neck relaxed. The daily neck leaning time (unit:hours) of all participants was obtained using a questionnaire. RESULTS Ultrasound showed no statistically significant differences in thickness or RI of the trapezius muscles of the affected and non-affected sides in MPS patients versus normal trapezius muscles (p = 0.976 and 0.106, respectively). In contrast, the SWVmean of trapezius muscles in patients with MPS was significantly higher than that of normal trapezius muscles in both the affected and non-affected sides (4.41 ± 1.02 m/s vs. 3.35 ± 0.79 m/s, p < 0.001; 4.05 ± 0.63 m/s vs. 3.35 ± 0.79 m/s, p = 0.002). There was no significant difference between the SWVmean of the trapezius muscles on the affected and non-affected sides in patients with MPS (4.41 ± 1.02 m/s vs. 4.05 ± 0.63 m/s, p = 0.225). Correlation analysis showed that daily neck forward time was positively correlated with the SWVmean of the trapezius muscles on the affected and non-affected sides in patients with MPS (r = 0.635, p < 0.001; r = 0.576, p = 0.008). CONCLUSION SWE can quantitatively evaluate stiffness of trapezius muscles in patients with trapezius MPS. The stiffness of both affected and non-affected trapezius muscles increased in patients with trapezius MPS, and the degree of increase positively correlated with the time of cervical forward leaning.
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Affiliation(s)
- Chang-Juan Hao
- Department of Ultrasound, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Shanxi Tongji Hospital, Taiyuan, China
| | - Wen-Li Xiao
- Department of Ultrasound, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Shanxi Tongji Hospital, Taiyuan, China
| | - Quan-Bin Zhang
- Department of Ultrasound, Sixth Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiao-Mei Tan
- Device management and maintenance center, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Shanxi Tongji Hospital, Taiyuan, China
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20
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Roots J, Trajano GS, Drovandi C, Fontanarosa D. Variability of Biceps Muscle Stiffness Measured Using Shear Wave Elastography at Different Anatomical Locations With Different Ultrasound Machines. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:398-409. [PMID: 36266142 DOI: 10.1016/j.ultrasmedbio.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Shear wave elastography is an emerging diagnostic tool used to assess for changes in the stiffness of muscle. Each region of the muscle may have a different stiffness; therefore, the anatomical region should be carefully selected. Machine vendors each have unique methods for calculating the returned stiffness values and, consequently, a high level of agreement in measurement between machines (quantified using the intraclass correlation coefficient [ICC] and Bland-Altman analysis) will allow research findings to be translated to the clinic. This study assessed three locations within the biceps muscle (50% and 75% of the distance between the acromioclavicular joint and antecubital fossa, and superior to distal myotendinous junction [MTJ]) of 32 healthy volunteers with two different machines, the Canon Aplio i600 and SuperSonic Imagine Aixplorer (SSI), to compare the reported shear wave velocities and the variability by coefficient of variation (CV) and ICC. There was no difference in the CV between machines, but a significant difference in the CV at muscle regions, with the 75% location having a 40.2% reduction in CV. The 75% location had the highest ICC values with good posterior mean ICCs of 0.84 on the Canon and 0.83 on the SSI. The 50% and MTJ locations had poor ICC values. The 75% location provided the lowest CV and highest ICC and should be used for future stiffness assessments.
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Affiliation(s)
- Jacqueline Roots
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Gabriel S Trajano
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Christopher Drovandi
- Centre of Data Science, Queensland University of Technology, Brisbane, Queensland, Australia; School of Mathematical Sciences, Faculty of Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Davide Fontanarosa
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
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Shear Wave Velocity to Evaluate the Effect of Botulinum Toxin on Post-Stroke Spasticity of the Lower Limb. Toxins (Basel) 2022; 15:toxins15010014. [PMID: 36668834 PMCID: PMC9865964 DOI: 10.3390/toxins15010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/11/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
(1) Background: The evaluation of muscles with spasticity using ultrasound elastography has attracted attention recently, and the shear wave velocity (SWV) technique can measure the mechanical properties of tissues objectively and quantitatively. The purpose of this study was to evaluate the effect of using SWV to assess the effect of Botulinum toxin type A (BoNT-A) treatment in adult patients with post-stroke lower limb spasticity. (2) Methods: We assessed the modified Ashworth Scale, the modified Tardieu Scale, and SWV at rest and after stretching before and at 1 month after BoNT-A treatment in 10 adult participants with post-stroke lower limb spasticity. (3) Results: Significant changes in SWV of the ankle joint in maximum dorsiflexion to the extent possible (SWV stretched) were observed after BoNT-A treatment. SWV stretched was positively correlated with joint range of motion. Participants whose joint range of motion did not improve (i.e., gastrocnemius medialis muscle (GCM) extension distance did not change) had significantly more reductions in SWV stretched after BoNT-A treatment. (4) Conclusions: Our results suggest that the SWV measurements may serve as a quantitative assessment to determine the effect of the BoNT-A treatment in adult stroke patients. SWV measurements to assess GCM spasticity should consider the effects of tension, material properties and activation level of muscles. The challenge is to measure SWV with matching limb positions in patients without contractures.
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22
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Botulinum Toxin Intervention in Cerebral Palsy-Induced Spasticity Management: Projected and Contradictory Effects on Skeletal Muscles. Toxins (Basel) 2022; 14:toxins14110772. [PMID: 36356022 PMCID: PMC9692445 DOI: 10.3390/toxins14110772] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/22/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Spasticity, following the neurological disorder of cerebral palsy (CP), describes a pathological condition, the central feature of which is involuntary and prolonged muscle contraction. The persistent resistance of spastic muscles to stretching is often followed by structural and mechanical changes in musculature. This leads to functional limitations at the respective joint. Focal injection of botulinum toxin type-A (BTX-A) is effectively used to manage spasticity and improve the quality of life of the patients. By blocking acetylcholine release at the neuromuscular junction and causing temporary muscle paralysis, BTX-A aims to reduce spasticity and hereby improve joint function. However, recent studies have indicated some contradictory effects such as increased muscle stiffness or a narrower range of active force production. The potential of these toxin- and atrophy-related alterations in worsening the condition of spastic muscles that are already subjected to changes should be further investigated and quantified. By focusing on the effects of BTX-A on muscle biomechanics and overall function in children with CP, this review deals with which of these goals have been achieved and to what extent, and what can await us in the future.
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Assessment of Neck Muscle Shear Modulus Normalization in Women with and without Chronic Neck Pain. Diagnostics (Basel) 2022; 12:diagnostics12081791. [PMID: 35892502 PMCID: PMC9331943 DOI: 10.3390/diagnostics12081791] [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: 06/14/2022] [Revised: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
Identifying the objective stiffness of the neck muscles facilitates the early and specific diagnosis of neck pain and targeted therapy. However, individual variation in the muscle shear modulus obscures differences between healthy and diseased individuals. Normalization may improve the comparability between individuals. The shear modulus at different functional tasks served as a reference for normalizing the neck muscles’ shear modulus of 38 women, 20 with chronic neck pain and 18 asymptomatic. Reference tasks were maximal voluntary contraction, relaxed sitting, prone head lift, balancing 1 kg on the head, and neck extension at 48 N. The effects of normalization on within-group variation and between-group differences were compared. Normalization with maximal voluntary contraction was discarded due to imaging problems. Normalization with relaxed sitting, prone head lift, balancing 1 kg, and neck extension at 48 N reduced within-group variation, by 23.2%, 26.8%, 11.6%, and 33.6%, respectively. All four normalization approaches reduced the p-values when testing for between-group differences. For the pain group, normalization with relaxed sitting and head lift indicated less normalized muscle stiffness, while normalization with balancing 1 kg and extension at 48 N indicated higher stiffness. The contradictory results are explainable by non-significant group differences in the reference tasks. Normalization of the muscle shear modulus is effective to reduce within-group variation, but a trustworthy normalization approach for group comparisons has yet to be identified.
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Zhang H, Peng W, Qin C, Miao Y, Zhou F, Ma Y, Gao Y. Lower Leg Muscle Stiffness on Two-Dimensional Shear Wave Elastography in Subjects With Medial Tibial Stress Syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1633-1642. [PMID: 34617298 DOI: 10.1002/jum.15842] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/17/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES We aimed to explore, which muscle stiffness changes may be related to medial tibial stress syndrome (MTSS) and the correlation between the medial tibial periosteal thickness and lower leg muscle stiffness. METHODS This study included 63 subjects distributed into 3 groups: the symptomless group, the MTSS group, and the control group. The lower leg muscle stiffness of the tibialis anterior (TA), extensor digitorum longus (EDL), peroneus longus (PL), soleus (SOL), lateral gastrocnemius (LG), medial gastrocnemius (MG), tibialis posterior (TP), and flexor digitorum longus (FDL) in the 3 groups was obtained by two-dimensional shear wave elastography. Differences in the muscle stiffness and medial tibial periosteal thickness in the 3 groups were determined by one-way analysis of variance (ANOVA) and least significant difference tests. The relationships between the periosteal thickness and the muscle stiffness were assessed using Pearson correlations. RESULTS The shear wave velocity (SWV) of all lower leg muscles except the EDL was higher in the symptomless and MTSS groups than in the control group (TA, P = .001; PL, P = .006; SOL, P < .001; LG, P < .001; MG, P < .001; TP, P < .001; FDL, P = .013; and ANOVA). A significant difference was found in the SWV of the SOL, TP, and FDL between the control and symptomless groups (P = .041, P < .001, and P = .013, respectively). Moreover, the medial tibial periosteum was thickened after running training, and its thickness was positively correlated with muscle stiffness. CONCLUSION The medial tibia periosteal thickness is positively correlated with the lower leg muscles stiffness. Changes in SOL, TP, and FDL stiffness may be related to the occurrence of MTSS.
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Affiliation(s)
- Haixiang Zhang
- Department of Ultrasound, The Third Medical Centre of Chinese PLA General Hospital, The Training Site for Postgraduate of Jinzhou Medical University, Beijing, China
| | - Weiping Peng
- Department of Wounded and Sick Management, The Third Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Chi Qin
- Department of Ultrasound, The Third Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Yuqian Miao
- Department of Ultrasound, The Third Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Fan Zhou
- Department of Ultrasound, The Third Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Yutong Ma
- Department of Ultrasound, The Third Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Yongyan Gao
- Department of Ultrasound, The Third Medical Centre of Chinese PLA General Hospital, Beijing, China
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Yu HK, Liu X, Pan M, Chen JW, Liu C, Wu Y, Li ZB, Wang HY. Performance of Passive Muscle Stiffness in Diagnosis and Assessment of Disease Progression in Duchenne Muscular Dystrophy. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:414-421. [PMID: 34893358 DOI: 10.1016/j.ultrasmedbio.2021.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/07/2021] [Accepted: 09/02/2021] [Indexed: 06/14/2023]
Abstract
The aim of this study was to evaluate the performance of passive muscle stiffness in diagnosing and assessing disease progression in Duchenne muscular dystrophy (DMD). Boys with DMD and age-matched controls were recruited. Shear wave elastography (SWE) videos were collected by performing dynamic stretching of the gastrocnemius medius (GM). At ankle angles from plantar flexion (PF) 30° to dorsiflexion (DF) 20°, the shear modulus of the GM was measured for each 10° of ankle movement. Shear modulus at each ankle angle was compared between the DMD and control group. Correlation between passive muscle stiffness and motor function grading was also analyzed. A total of 26 patients with DMD and 20 healthy boys were enrolled. At multiple stretch levels, passive muscle stiffness of the GM was significantly higher in patients with DMD than in those in the control group (all p values <0.05). The shear modulus of GM at an ankle angle of DF 10° had the largest area under the receiver operating characteristic curve in differentiating DMD patients from normal subjects (AUC = 0.902, 95% confidence interval: 0.814-0.990). Motor function grading was a significant determinant of passive muscle stiffness at an ankle angle of DF 10° (B = 21.409, t = 3.372, p = 0.003). Passive muscle stiffness may potentially serve as a useful non-invasive tool to monitor disease progression in DMD patients.
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Affiliation(s)
- Hong-Kui Yu
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiao Liu
- Department of Ultrasonography, Shenzhen Hospital of Guangzhou University of Chinese Medicine (Fu-tian), Shenzhen, Guangdong, China
| | - Min Pan
- Department of Ultrasonography, Shenzhen Hospital of Guangzhou University of Chinese Medicine (Fu-tian), Shenzhen, Guangdong, China
| | - Jin-Wei Chen
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Chen Liu
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yu Wu
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhi-Bin Li
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Hong-Ying Wang
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China.
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Cao J, Xiao Y, Qiu W, Zhang Y, Dou Z, Ren J, Zheng R, Zheng H, Chen Z. Reliability and diagnostic accuracy of corrected slack angle derived from 2D-SWE in quantitating muscle spasticity of stroke patients. J Neuroeng Rehabil 2022; 19:15. [PMID: 35120556 PMCID: PMC8817514 DOI: 10.1186/s12984-022-00995-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 01/25/2022] [Indexed: 12/21/2022] Open
Abstract
Background To explore the feasibility of corrected slack angle acquired from two-dimensional shear wave elastography (2D-SWE) for quantitating the spasticity of medial gastrocnemius (MG) in stroke patients. Methods Consecutive stroke patients with spastic MG and matched healthy controls were recruited. Intra- and interobserver reliability of 2D-SWE measurement were evaluated, and the correlation between corrected slack angle and modified Ashworth scale (MAS) score was examined. The corrected slack angle before and after botulinum toxin A (BoNT-A) injection was compared and its diagnostic performance in classifying the severity of spasticity were assessed with receiver operating characteristic (ROC) curve analysis. Results The intra- (0.791 95% CI 0.432–0.932) and interobserver (0.751 95% CI 0.382–0.916) reliability of slack angle acquired with 2D-SWE were good. Significant correlation was found between corrected slack angle and MAS score (R = − 0.849, p < 0.001). The corrected slack angle increased after BoNT-A injection. The cutoff value of MAS ≥ 3 had the highest sensitivity (100%) and specificity (93.33%). The positive predictive value (PPV) for classification of MAS ≥ 1+ and the negative predictive value (NPV) for classification of MAS ≥ 3 were greater than 90%. Conclusion 2D-SWE was a reliable method to quantitate the post-stroke spasticity. The corrected slack angle had advantage in classifying the severity of spasticity, especially in early identification of mild spasticity and confirmation of severe spasticity. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-00995-8.
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Affiliation(s)
- Junyan Cao
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Yang Xiao
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen, 518055, China
| | - Weihong Qiu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Yanling Zhang
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Zulin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Jie Ren
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Rongqin Zheng
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Hairong Zheng
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen, 518055, China
| | - Zhaocong Chen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China.
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Konno RN, Nigam N, Wakeling JM, Ross SA. The Contributions of Extracellular Matrix and Sarcomere Properties to Passive Muscle Stiffness in Cerebral Palsy. Front Physiol 2022; 12:804188. [PMID: 35153814 PMCID: PMC8827041 DOI: 10.3389/fphys.2021.804188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
Cerebral palsy results from an upper motor neuron lesion and significantly affects skeletal muscle stiffness. The increased stiffness that occurs is partly a result of changes in the microstructural components of muscle. In particular, alterations in extracellular matrix, sarcomere length, fibre diameter, and fat content have been reported; however, experimental studies have shown wide variability in the degree of alteration. Many studies have reported changes in the extracellular matrix, while others have reported no differences. A consistent finding is increased sarcomere length in cerebral palsy affected muscle. Often many components are altered simultaneously, making it difficult to determine the individual effects on muscle stiffness. In this study, we use a three dimensional modelling approach to isolate individual effects of microstructural alterations typically occurring due to cerebral palsy on whole muscle behaviour; in particular, the effects of extracellular matrix volume fraction, stiffness, and sarcomere length. Causation between the changes to the microstructure and the overall muscle response is difficult to determine experimentally, since components of muscle cannot be manipulated individually; however, utilising a modelling approach allows greater control over each factor. We find that extracellular matrix volume fraction has the largest effect on whole muscle stiffness and mitigates effects from sarcomere length.
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Affiliation(s)
- Ryan N. Konno
- Department of Mathematics, Simon Fraser University, Burnaby, BC, Canada
- *Correspondence: Ryan N. Konno
| | - Nilima Nigam
- Department of Mathematics, Simon Fraser University, Burnaby, BC, Canada
| | - James M. Wakeling
- Department of Mathematics, Simon Fraser University, Burnaby, BC, Canada
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Stephanie A. Ross
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
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Knight AE, Trutna CA, Rouze NC, Hobson-Webb LD, Caenen A, Jin FQ, Palmeri ML, Nightingale KR. Full Characterization of in vivo Muscle as an Elastic, Incompressible, Transversely Isotropic Material Using Ultrasonic Rotational 3D Shear Wave Elasticity Imaging. IEEE TRANSACTIONS ON MEDICAL IMAGING 2022; 41:133-144. [PMID: 34415833 PMCID: PMC8754054 DOI: 10.1109/tmi.2021.3106278] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Using a 3D rotational shear wave elasticity imaging (SWEI) setup, 3D shear wave data were acquired in the vastus lateralis of a healthy volunteer. The innate tilt between the transducer face and the muscle fibers results in the excitation of multiple shear wave modes, allowing for more complete characterization of muscle as an elastic, incompressible, transversely isotropic (ITI) material. The ability to measure both the shear vertical (SV) and shear horizontal (SH) wave speed allows for measurement of three independent parameters needed for full ITI material characterization: the longitudinal shear modulus μL , the transverse shear modulus μT , and the tensile anisotropy χE . Herein we develop and validate methodology to estimate these parameters and measure them in vivo, with μL = 5.77±1.00 kPa, μT = 1.93±0.41 kPa (giving shear anisotropy χμ = 2.11±0.92 ), and χE = 4.67±1.40 in a relaxed vastus lateralis muscle. We also demonstrate that 3D SWEI can be used to more accurately characterize muscle mechanical properties as compared to 2D SWEI.
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29
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Abstract
Physicians have used palpation as a diagnostic examination to understand the elastic properties of pathology for a long time since they realized that tissue stiffness is closely related to its biological characteristics. US elastography provided new diagnostic information about elasticity comparing with the morphological feathers of traditional US, and thus expanded the scope of the application in clinic. US elastography is now widely used in the field of diagnosis and differential diagnosis of abnormality, evaluating the degree of fibrosis and assessment of treatment response for a range of diseases. The World Federation of Ultrasound Medicine and Biology divided elastographic techniques into strain elastography (SE), transient elastography and acoustic radiation force impulse (ARFI). The ARFI techniques can be further classified into point shear wave elastography (SWE), 2D SWE, and 3D SWE techniques. The SE measures the strain, while the shear wave-based techniques (including TE and ARFI techniques) measure the speed of shear waves in tissues. In this review, we discuss the various techniques separately based on their basic principles, clinical applications in various organs, and advantages and limitations and which might be most appropriate given that the majority of doctors have access to only one kind of machine.
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30
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EKŞİOĞLU AS, AKCA ÇAĞLAR A, KAYNAK ŞAHAP S, KARACAN CD, TUYGUN N. Value of strain-wave sonoelastography as an imaging modality in assessment of benign acute myositis in children. Turk J Med Sci 2021; 51:2951-2958. [PMID: 34365785 PMCID: PMC10734879 DOI: 10.3906/sag-2103-290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 12/13/2021] [Accepted: 08/07/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim Although sonoelastography is applied in assessment of many organs, studies for evaluation of muscles are very few in number and are mostly limited to adults. With this prospective study, we aimed to evaluate the value of sonoelastography in assessment of influenza related benign acute myositis in children. Materials and methods This study enrolled 25 patients with a clinical diagnosis of benign acute childhood myositis (BACM) and 25 age and sex-matched healthy controls. All patients presented to our emergency department with the complaint of inability to walk and had increased serum creatine kinase (CK) levels. All patients underwent strain elastography of the gastrocnemius muscle, and an elastography score was assigned to each patient by using a previously published 5 point-color scoring system. The findings were compared with those of the control group. Results No statistically significant difference was detected regarding age, weight, height, or body mass index (BMI) between patient and control groups. A statistically significant difference was found between the final elastography scores of the patient and control groups, mean values being 4.16 ± 0.75 versus 3.08 ±0.40, respectively (p < 0.001). Sonoelastography yielded a sensitivity of 80%, positive predictive value of 87%, specificity 88%, negative predictive value of 81.5%, and an overall accuracy of 84 %. Conclusion Sonoelastography proves to be a valuable tool for diagnosis of BACM. It is one of the available ultrasound techniques in a radiology department and may particularly evolve to become a useful routine ancillary technique for investigation and follow-up in these cases.
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Affiliation(s)
- Ayşe Seçil EKŞİOĞLU
- Division of Pediatric Radiology, Department of Radiology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara,
Turkey
| | - Ayla AKCA ÇAĞLAR
- Division of Pediatric Emergency Care, Department of Pediatrics, Dr Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, University of Health Sciences, Ankara,
Turkey
| | - Seda KAYNAK ŞAHAP
- Division of Pediatric Radiology, Department of Radiology, Pediatric Radiology, Dr Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, University of Health Sciences, Ankara,
Turkey
| | - Can Demir KARACAN
- Division of Pediatric Emergency Care, Department of Pediatrics, Dr Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, University of Health Sciences, Ankara,
Turkey
| | - Nilden TUYGUN
- Division of Pediatric Emergency Care, Department of Pediatrics, Dr Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, University of Health Sciences, Ankara,
Turkey
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31
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Kwon DR, Kwon DG. Botulinum Toxin a Injection Combined with Radial Extracorporeal Shock Wave Therapy in Children with Spastic Cerebral Palsy: Shear Wave Sonoelastographic Findings in the Medial Gastrocnemius Muscle, Preliminary Study. CHILDREN 2021; 8:children8111059. [PMID: 34828772 PMCID: PMC8622460 DOI: 10.3390/children8111059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022]
Abstract
Therapeutic strategies to boost the effect of botulinum toxin may lead to some advantages, such as long lasting effects, the injection of lower botulinum toxin dosages, fewer side effects, and lower costs. The aim of this study is to investigate the combined effect of botulinum toxin A (BTA) injection and extracorporeal shock wave therapy (ESWT) for the treatment of spasticity in children with spastic cerebral palsy (CP). Fifteen patients with spastic CP were recruited through a retrospective chart review to clarify what treatment they received. All patients received a BTA injection on gastrocnemius muscle (GCM), and patients in group 1 underwent one ESWT session for the GCM immediately after BTA injection and two consecutive ESWT sessions at weekly intervals. Ankle plantar flexor and the passive range of motion (PROM) of ankle dorsiflexion were measured by a modified Ashworth scale (MAS) before treatment and at 1 and 3 month(s) post-treatment. In group 1, the shear wave velocity (SWV) of GCM was measured. The PROM and MAS in group 1 and 2 before treatment significantly improved at 1 and 3 month(s) after treatment. The change in PROM was significantly different between the two groups at 1 and 3 month(s) after treatment. The SWV before treatment significantly decreased at 1 month and 3 months after treatment in group 1. Our study has shown that the combination of BTA injection and ESWT would be effective at controlling spasticity in children with spastic CP, with sustained improvement at 3 months after treatment.
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Affiliation(s)
- Dong Rak Kwon
- Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, Daegu 42472, Korea
- Correspondence:
| | - Dae Gil Kwon
- Department of Rehabilitation Medicine, Comprehensive and Integrative Medicine Hospital, Daegu 42473, Korea;
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Cebula A, Cebula M, Kopyta I. Muscle Ultrasonographic Elastography in Children: Review of the Current Knowledge and Application. CHILDREN 2021; 8:children8111042. [PMID: 34828755 PMCID: PMC8623756 DOI: 10.3390/children8111042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/06/2021] [Accepted: 11/10/2021] [Indexed: 02/07/2023]
Abstract
Ultrasonographic elastography is a relatively new imaging modality for the qualitative and quantitative assessments of tissue elasticity. While it has steadily gained use in adult clinical practice, including for liver diseases, breast cancer, thyroid pathologies, and muscle and tendon diseases, data on its paediatric application is still limited. Moreover, diagnosis of muscular diseases in children remains challenging. The gold standard methods, namely biopsy, electroneurography, and electromyography, are often limited owing to their invasive characteristics, possible contraindications, complications, and need for good cooperation, that is, a patient’s ability to perform certain tasks during the examination while withstanding discomfort, which is a significant problem especially in younger or uncooperative children. Genetic testing, which has broad diagnostic possibilities, often entails a high cost, which limits its application. Thus, a non-invasive, objective, repeatable, and accessible tool is needed to aid in both the diagnosis and monitoring of muscle pathologies. We believe that elastography may prove to be such a method. The aim of this review was to present the current knowledge on the use of muscle elastography in the paediatric population and information on the limitations of elastography in relation to examination protocols and factors for consideration in everyday practice and future studies.
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Affiliation(s)
- Agnieszka Cebula
- Department of Paediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Medykow Str 16, 40-752 Katowice, Poland;
- Correspondence: ; Fax: +48-322071546
| | - Maciej Cebula
- Department of Radiodiagnostics, Invasive Radiology and Nuclear Medicine, Department of Radiology and Nuclear Medicine, Faculty of Medicine in Katowice, Medical University of Silesia in Katowice, Medykow Str 14, 40-752 Katowice, Poland;
| | - Ilona Kopyta
- Department of Paediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Medykow Str 16, 40-752 Katowice, Poland;
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Olchowy C, Olchowy A, Pawluś A, Więckiewicz M, Sconfienza LM. Stiffness of the Masseter Muscle in Children-Establishing the Reference Values in the Pediatric Population Using Shear-Wave Elastography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189619. [PMID: 34574544 PMCID: PMC8469581 DOI: 10.3390/ijerph18189619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/23/2021] [Accepted: 09/09/2021] [Indexed: 12/16/2022]
Abstract
In children, the quality and muscle function are altered in many pathologic conditions, including temporomandibular disorders. Although several methods have been used to evaluate muscle tonus, none became a golden standard. Moreover, the masseter muscle characteristics in children have not been investigated to date. This study aimed to measure the stiffness of the masseter muscle using shear-wave elastography in healthy children. We enrolled 30 healthy children (mean age 10.87 ± 3.38 years). The stiffness of masseter muscles was measured with shear wave elastography. Stiffness for the total sample was 6.37 ± 0.77 kPa. A comparison of the measurements did not show significant differences between the right and the left masseter muscles (left—6.47 ± 0.78 kPa; right—6.24 ± 0.76 kPa; p = 0.3546). A significant difference was seen between boys and girls (boys—5.94 ± 0.50 kPa; girls—6.63 ± 0.80; p = 0.0006). Shear-wave elastography is a promising diagnostic tool. It may help to detect changes in the stiffness of the masseter muscle and draw attention to pathological processes within the jaw muscles. Directions for further research shall include determining stiffness values in pathological conditions and the impact of biological and functional factors on the stiffness of the masseter muscle.
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Affiliation(s)
- Cyprian Olchowy
- Department of Oral Surgery, Wroclaw Medical University, 50-425 Wroclaw, Poland
- Correspondence:
| | - Anna Olchowy
- Department of Experimental Dentistry, Wroclaw Medical University, 50-425 Wroclaw, Poland; (A.O.); (M.W.)
| | - Aleksander Pawluś
- Department of General Radiology, Provincial Specialist Hospital in Legnica, 59-220 Legnica, Poland;
| | - Mieszko Więckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, 50-425 Wroclaw, Poland; (A.O.); (M.W.)
| | - Luca Maria Sconfienza
- Unità Operativa di Radiologia Diagnostica e Interventistica, IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy;
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20161 Milano, Italy
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34
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Xiao Y, Wang C, Pan M, Chen Z, Ma T, Zhou Y, Liu X. Ultrasonic characterization of localized passive elastic properties of human pennate muscle with a single-probe setup. ULTRASONICS 2021; 116:106512. [PMID: 34274743 DOI: 10.1016/j.ultras.2021.106512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 06/09/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
Quantitative evaluation of passive elastic properties of an individual skeletal muscle in vivo is among the major challenges of biomechanics, and its clinical application is severely limited. By combining shear-wave elastography (SWE) and B-mode imaging techniques, this study develops a novel non-invasive method to measure the local elastic modulus-fascicle strain curve of human pennation muscle during passive stretching using a single probe. Physiologically meaningful parameters are estimated and compared in subjects with different ages or pathological conditions. The in vivo experimental group comprised 12 healthy subjects (four children, four adults, and four seniors) and eight patients (four suffering from pseudohypertrophy, four from atrophy). Their gastrocnemius muscles were passively stretched using an ankle joint motion instrument. Local elastic moduli of the muscle were measured using SWE imaging frames and a built-in 'F-ROI' tool. The corresponding fascicle strains were simultaneously obtained using B-mode imaging frames and a gradient Radon transform. Three parameters (η, μ, G0) were estimated from a normalized elastic modulus-strain curve using the Gauss-Newton method. The measured elastic modulus-strain curves all agreed with models of the estimated parameters (0.910 < R2 < 0.999) and presented different patterns among normal and diseased subjects. η values were lower for pseudohypertrophies (1.93 ± 0.12), but higher for atrophies (63.40 ± 98.89), compared with normal ones (6.02 ± 2.53). In addition, μ values were higher for pseudohypertrophies (22.65 ± 16.40), but lower for atrophies (0.28 ± 0.41), compared with normal ones (1.07 ± 1.22). The proposed method may provide novel insight into the biomechanics of pennate muscle and has the potential to serve for clinical musculoskeletal medical diagnosis, as the single-probe scanning setup is broadly accepted.
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Affiliation(s)
- Yang Xiao
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Congzhi Wang
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Min Pan
- Department of Ultrasonography, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen 518034, China
| | - Zengtong Chen
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518055, China; Marshall Laboratory of Biomedical Engineering, China
| | - Teng Ma
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Yongjin Zhou
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518055, China; Marshall Laboratory of Biomedical Engineering, China
| | - Xiao Liu
- Department of Ultrasonography, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen 518034, China
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Nwawka OK, Gutierrez N, Lin B, Ko LM, Miller TT. Quantitative assessment of change in upper extremity muscle stiffness following fluid injection using shear wave elastography. Skeletal Radiol 2021; 50:1455-1460. [PMID: 33108511 DOI: 10.1007/s00256-020-03648-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To quantitatively assess changes in muscle stiffness following intramuscular saline injection using shear wave elastography (SWE). MATERIALS AND METHODS Thirty muscles (lateral deltoid (LD), biceps brachii (BB), brachialis, pronator teres (PT), flexor carpi radialis (FCR), flexor carpi ulnaris (FCU)) from fresh-frozen cadaveric specimens were injected with saline under ultrasound guidance. Pre- and post-injection muscle thickness (MT) (mm) and SWE (kPa) measurements were recorded. RESULTS All muscles demonstrated a decrease in the mean SWE value post-injection, with the largest differences ± standard error noted in the LD (14.76 ± 3.55 kPa, p = 0.021) and brachialis muscles (12.02 ± 2.51 kPa, p = 0.013). Muscle thickness increased following injection, although the degree of changes poorly correlated with the change in SWE. CONCLUSION In summary, following intramuscular injection of saline injection, a decrease in upper extremity muscle stiffness is detected using SWE. It is important to note that if performing a longitudinal assessment of muscle stiffness after intramuscular injection, saline will likely contribute to a decrease in muscle stiffness in the immediate post-injection time period.
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Affiliation(s)
- O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, 3rd Floor, New York, NY, 10021, USA. .,Department of Radiology, Weill Cornell Medical College of Cornell University, New York, NY, USA.
| | - Nicholas Gutierrez
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, 3rd Floor, New York, NY, 10021, USA
| | - Bin Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, 3rd Floor, New York, NY, 10021, USA
| | - Lydia M Ko
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, 3rd Floor, New York, NY, 10021, USA
| | - Theodore T Miller
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, 3rd Floor, New York, NY, 10021, USA.,Department of Radiology, Weill Cornell Medical College of Cornell University, New York, NY, USA
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Mechanical properties of ankle joint and gastrocnemius muscle in spastic children with unilateral cerebral palsy measured with shear wave elastography. J Biomech 2021; 124:110502. [PMID: 34126561 DOI: 10.1016/j.jbiomech.2021.110502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/27/2021] [Accepted: 05/02/2021] [Indexed: 11/22/2022]
Abstract
The aim of this study was to describe passive mechanical and morphological properties of the ankle joint and gastrocnemius medialis (GM) muscle in paretic and contralateral legs in highly functional children with unilateral cerebral palsy (UCP) using shear wave elastography (SWE). SWE measurements on the GM muscle were performed in both paretic and contralateral legs during passive ankle dorsiflexion using a dynamometer in 11 children (mean age: 10 years 6 months) with UCP. Torque-angle and shear modulus-angle relationships were fitted using an exponential model to determine passive ankle joint and GM muscle stiffness respectively. Based on shear-modulus-angle relationship, slack angle and shear modulus of GM muscle were compared between legs. GM and Achilles tendon length were determined at rest using ultrasonography. No significant difference was found between legs for passive ankle joint (p = 0.26; 11.2%; 95 %CI: 31.9, -9.4) and GM muscle passive stiffness (p = 0.62; -4.4%; 95 %CI: 14.7, -23.4). GM shear modulus at a common angle was significantly higher on the paretic leg (p = 0.02; +56.5%; 95 %CI: 100.5, 12.6). GM slack angle on the paretic leg was significantly shifted to a more plantarflexed position (p = 0.04; +25.5%; 95 %CI: 49.7, 1.3) and this was associated with a non-significant lower muscle length compared to the contralateral leg (p = 0.05; -4.5%; 95 %CI: -0.4, -8.7). Increased passive tension on the paretic leg when compared to the contralateral one may be explained in large part by muscle shortening. The role of altered mechanical properties remains unknown.
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Zúñiga LDO, López CAG, González ER. Ultrasound Elastography in the Assessment of the Stiffness of Spastic Muscles: A Systematic Review. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1448-1464. [PMID: 33707090 DOI: 10.1016/j.ultrasmedbio.2021.01.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 01/22/2021] [Accepted: 01/29/2021] [Indexed: 06/12/2023]
Abstract
The incidence of muscle spasticity is high in patients with diseases of the central nervous system. This condition leads to significant limitations in movement and impaired functional capacities. Muscle spasticity manifests as changes in the mechanical properties of the muscles. This muscle disorder is generally assessed using qualitative methods, whose validity, reliability and sensitivity are questionable. In recent years, ultrasound elastography (USE) has been used as a non-invasive technique for characterizing the stress response and mechanical properties of individual muscles in the evaluation of spasticity. This article presents a systematic review of the USE techniques, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration guidelines, used for the evaluation of muscle stiffness caused by spasticity. The articles selected in this study were evaluated using the Quality Appraisal of Diagnostic Reliability (QAREL) tool. Mainly, studies on the assessment of spasticity involving the evaluation of muscle stiffness with USE techniques (i.e., shear-wave elastography [SWE] or compression elastography [CE]) were selected. Then, common topics related to the assessment of spastic muscles and the statistical results of these studies were classified. Of 21 articles, nine used only CE, 10 used only SWE and two used both techniques. In the studies, statistically significant differences were observed in the measurements of muscle stiffness between the paretic and non-paretic sides as well as between patients and healthy patients. The clinical measurements obtained, devices used and assessment and probe positions for both techniques were discussed. The most frequently studied muscles were the biceps (n = 7) and gastrocnemius (n = 11). On applying the QAREL tool, we found that only two studies showed compliance at 80%-90%, seven studies at 50%-70% and the remaining 12 at 10%-40%. The results showed that USE techniques have limitations in spasticity assessment, such as subjectivity because of the lack of standardized protocols. A deficit of studies on intra-operator and inter-operator measurements indicates that this technique is not yet mature for spasticity diagnosis, although it is a promising diagnostic tool for designing treatment plans and monitoring the effectiveness of therapeutic modalities.
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Affiliation(s)
- Laura Daniela Ordierez Zúñiga
- University of Cauca, Electronics and Telecommunications Engineering Faculty, Electronics Deparment, Automation research group, Popayán, Colombia.
| | - Carlos Alberto Gaviria López
- University of Cauca, Electronics and Telecommunications Engineering Faculty, Electronics Deparment, Automation research group, Popayán, Colombia
| | - Elizabeth Roldán González
- Fundación Universitaria María Cano, Physiotherapy program, research group importance of movement of human development, Fisioter, Colombia
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Sedlackova Z, Vita M, Herman J, Furst T, Dornak T, Herman M. Elasticity of neck muscles in cervicogenic headache. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 166:328-333. [PMID: 34017143 DOI: 10.5507/bp.2021.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the elasticity of the sternocleidomastoid and trapezius muscles in patients with cervicogenic headache and in healthy volunteers. METHODS The medical history of 23 patients with cervicogenic headache was taken with a focus on pain characteristics. Elasticity of the sternocleidomastoid and trapezius muscles was measured by using shear wave elastography. Results were then compared with 23 healthy volunteers. RESULTS The sternocleidomastoid muscle was significantly stiffer in patients with cervicogenic headache compared to healthy volunteers. The stiffness increased gradually from the parasternal area, where it was negligible, to the area near the mastoid process where it reached over 20 kPa. There was no difference in the stiffness of the trapezius muscle. The stiffness of the sternocleidomastoid muscle does show a significant dependence on headache characteristics (e.g., laterality, severity, or frequency). CONCLUSION The results of this pilot study show that patients with cervicogenic headache have a higher stiffness of the sternocleidomastoid muscle than healthy volunteers. These findings suggest that elastography could be used as a diagnostic tool in cervicogenic headache.
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Affiliation(s)
- Zuzana Sedlackova
- Department of Radiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, Olomouc, Czech Republic.,Department of Radiological Methods, Faculty of Health Sciences, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, Olomouc, Czech Republic
| | - Martin Vita
- Department of Radiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, Olomouc, Czech Republic
| | - Jan Herman
- Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, Olomouc, Czech Republic
| | - Tomas Furst
- Department of Radiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, Olomouc, Czech Republic
| | - Tomas Dornak
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, Olomouc, Czech Republic
| | - Miroslav Herman
- Department of Radiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, Olomouc, Czech Republic
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Boulard C, Mathevon L, Arnaudeau LF, Gautheron V, Calmels P. Reliability of Shear Wave Elastography and Ultrasound Measurement in Children with Unilateral Spastic Cerebral Palsy. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1204-1211. [PMID: 33579563 DOI: 10.1016/j.ultrasmedbio.2021.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 01/06/2021] [Accepted: 01/12/2021] [Indexed: 06/12/2023]
Abstract
In clinical practice, few data exist on the feasibility of performing reliable shear wave elastography (SWE) and ultrasonography (US) measurements in spastic muscles of children with cerebral palsy (CP). Ten children with unilateral CP took part in SWE and US assessment of the tibialis anterior and medialis gastrocnemius muscles during two sessions separated by a 1-wk interval. Intra- and inter-investigator reliability of shear modulus (µ) and muscle thickness (MT) measurements, at neutral and maximal dorsiflexion angles on both legs, was assessed by two investigators with different levels of experience. Reliability was assessed with the coefficient of variation (CV), standard error of measurement and intra-class correlation coefficient (ICC). Reliability of the µ measurement was insufficient, regardless of angle position (CV >10% and >20% for neutral and maximal dorsiflexion angles, respectively). The intra- and inter-investigator reliability of MT measurements was good (CV >10%, ICC >0.74) for both muscles in both legs. SWE measurements must be performed using a rigorous standardized protocol while MT should be considered an important parameter to monitor change in muscle morphology.
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Affiliation(s)
- Clément Boulard
- Université Lyon, UJM Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, Saint-Etienne, France; Pediatric and Adult Units, Department of Physical Medicine and Rehabilitation, University Hospital of Saint-Etienne, Saint-Etienne, France.
| | - Laure Mathevon
- Université Lyon, UJM Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, Saint-Etienne, France; Centre Médico-Chirurgical de Réadaptation des Massues, Lyon, France
| | - Louis Florian Arnaudeau
- Université Lyon, UJM Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, Saint-Etienne, France
| | - Vincent Gautheron
- Université Lyon, UJM Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, Saint-Etienne, France; Pediatric and Adult Units, Department of Physical Medicine and Rehabilitation, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Paul Calmels
- Université Lyon, UJM Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, Saint-Etienne, France; Pediatric and Adult Units, Department of Physical Medicine and Rehabilitation, University Hospital of Saint-Etienne, Saint-Etienne, France
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Smith LR, Pichika R, Meza RC, Gillies AR, Baliki MN, Chambers HG, Lieber RL. Contribution of extracellular matrix components to the stiffness of skeletal muscle contractures in patients with cerebral palsy. Connect Tissue Res 2021; 62:287-298. [PMID: 31779492 PMCID: PMC7253322 DOI: 10.1080/03008207.2019.1694011] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose: Joint contractures in children with cerebral palsy contain muscle tissue that is mechanically stiffer with higher collagen content than typically developing children. Interestingly, the correlation between collagen content and stiffness is weak. To date, no data are available on collagen types or other extracellular matrix proteins in these muscles, nor any information regarding their function. Thus, our purpose was to measure specific extracellular protein composition in cerebral palsy and typically developing human muscles along with structural aspects of extracellular matrix architecture to determine the extent to which these explain mechanical properties. Materials and Methods: Biopsies were collected from children with cerebral palsy undergoing muscle lengthening procedures and typically developing children undergoing anterior cruciate ligament reconstruction. Tissue was prepared for the determination of collagen types I, III, IV, and VI, proteoglycan, biglycan, decorin, hyaluronic acid/uronic acid and collagen crosslinking. Results: All collagen types increased in cerebral palsy along with pyridinoline crosslinks, total proteoglycan, and uronic acid. In all cases, type I or total collagen and total proteoglycan were positive predictors, while biglycan was a negative predictor of stiffness. Together these parameters accounted for a greater degree of variance within groups than across groups, demonstrating an altered relationship between extracellular matrix and stiffness with cerebral palsy. Further, stereological analysis revealed a significant increase in collagen fibrils organized in cables and an increased volume fraction of fibroblasts in CP muscle. Conclusions: These data demonstrate a novel adaptation of muscle extracellular matrix in children with cerebral palsy that includes alterations in extracellular matrix protein composition and structure related to mechanical function.
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Affiliation(s)
- Lucas R. Smith
- Departments of Neurobiology, Physiology, and Behavior and Physical Medicine and Rehabilitation, University of California, Davis, CA, 95616, USA
| | - Rajeswari Pichika
- Shirley Ryan AbilityLab and Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, 60611, USA
| | - Rachel C. Meza
- Department of Orthopaedic Surgery, University of California San Diego,La Jolla, CA, 92093-0863, USA,Department of Biology, University of California San Diego, La Jolla, CA, 92093, USA
| | - Allison R. Gillies
- Department of Orthopaedic Surgery, University of California San Diego,La Jolla, CA, 92093-0863, USA
| | - Marwan N. Baliki
- Shirley Ryan AbilityLab and Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, 60611, USA
| | - Henry G. Chambers
- Department of Orthopaedics, Rady Children’s Hospital, San Diego, CA, USA
| | - Richard L. Lieber
- Shirley Ryan AbilityLab and Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, 60611, USA,Department of Orthopaedic Surgery, University of California San Diego,La Jolla, CA, 92093-0863, USA,Hines V.A. Medical Center, Maywood, IL, USA
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41
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Goo M, Tucker K, Johnston LM. A profile of reference data for shear modulus for lower limb muscles in typically developing children. Clin Biomech (Bristol, Avon) 2021; 83:105254. [PMID: 33740498 DOI: 10.1016/j.clinbiomech.2020.105254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 12/10/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Shear wave elastography can measure shear wave speed in muscles, which is used to estimate shear modulus. Normative values and standardized methodology are needed for children. Study aims were to: estimate shear modulus behavior of lower limb muscles of typically developing children; and establish a profile of reference data and recommendations for clinical assessment. METHODS Forty-one typically developing children (mean 9.7 y, SD 1.9 y) completed assessment of resting shear modulus of rectus femoris, biceps femoris, gastrocnemius lateralis and tibialis anterior at short and long lengths using shear wave elastography. Effects of muscle length, age, sex and BMI were examined. Then, our data and data from a scoping review for typical individuals were collated according to Net-Longitudinal Tension Angle (net proximal and distal joint angles). FINDINGS Shear modulus was: higher at long versus short muscle lengths for all four muscles (P < 0.001); correlated with increasing age for tibialis anterior at short (r = 0.39) and long lengths (r = 0.42) (both P = 0.01); but not related to sex or BMI. Shear modulus: tended to increase with increasing Net-Longitudinal Tension Angle for 18 lower limb muscles; and was higher for children than adults for some muscles (e.g. tibialis anterior and gastrocnemius lateralis, both P < 0.001). INTERPRETATION In typically developing children, shear modulus of lower limb muscles increases with increasing Net-Longitudinal Tension Angle. Recommendations enable comparison of values across different test positions and populations. Some relation between shear modulus and age was identified, but more research is needed.
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Affiliation(s)
- Miran Goo
- The University of Queensland, School of Biomedical Sciences, Brisbane, QLD 4072, Australia
| | - Kylie Tucker
- The University of Queensland, School of Biomedical Sciences, Brisbane, QLD 4072, Australia
| | - Leanne M Johnston
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD 4072, Australia.
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Ultrasound shearwave elastography to characterize muscles of healthy and cerebral palsy children. Sci Rep 2021; 11:3577. [PMID: 33574381 PMCID: PMC7878773 DOI: 10.1038/s41598-021-82005-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/07/2021] [Indexed: 11/09/2022] Open
Abstract
Shear wave elastography (SWE) is an ultrasound technique to obtain soft tissue mechanical properties. The aim of this study was to establish the reliability of SWE in young children, define reference data on healthy ones and compare the shear modulus of healthy and spastic muscles from cerebral palsy (CP). The reproducibility is evaluated: at rest, on 7 children without any musculoskeletal pathology by 3 different operators, on 2 muscles: biceps brachii long head and medial gastrocnemius. The comparison study was made, on the same 2 muscles, at rest and under passive stretching, with a control group (29 healthy children), a spastic group (spastic muscles of 16 children from CP) and a non-spastic group (non-spastic muscles of 14 children from CP). The intra-operator reliability and inter-operator reliability, in terms of standard deviation, were 0.6 kPa (11.2% coefficient of variation (CV)) and 0.8 kPa (14.9% CV) for the biceps, respectively, and 0.4 kPa (11.5% CV) and 0.5 kPa (13.8% CV) for the gastrocnemius. At rest, no significant difference was found. Under passive stretching, the non-spastic CP biceps were significantly stiffer than the control ones (p = 0.033). Spastic gastrocnemius had a higher shear modulus than in the control muscles (p = 0.0003) or the non-spastic CP muscles (p = 0.017). CP stretched medial gastrocnemius presented an abnormally high shear moduli for 50% of patients.
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Miller T, Ying M, Sau Lan Tsang C, Huang M, Pang MYC. Reliability and Validity of Ultrasound Elastography for Evaluating Muscle Stiffness in Neurological Populations: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:5928445. [PMID: 33508855 DOI: 10.1093/ptj/pzaa188] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/04/2020] [Accepted: 09/10/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Ultrasound elastography is an emerging diagnostic technology used to investigate the biomechanical properties of the musculoskeletal system. The purpose of this study was to systematically review the psychometric properties of ultrasound elastography techniques for evaluating muscle stiffness in people with neurological conditions. METHODS A systematic search of MEDLINE, EMBASE, CINAHL, and Cochrane Library databases was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Using software, reviewers independently screened citations for inclusion. Peer-reviewed studies that evaluated in vivo muscle stiffness in people with neurological conditions and reported relevant psychometric properties were considered for inclusion. Twenty-one articles were included for final review. Data relevant to measurement technique, site, and neurological condition were extracted. The Consensus-Based Standards for the Selection of Health Measurement Instruments checklist was used to rate the methodological quality of included studies. The level of evidence for specific measurement outcomes was determined using a best-evidence synthesis approach. RESULTS Reliability varied across populations, ultrasound systems, and assessment conditions (ie, joint/body positions, active/passive muscle conditions, probe orientation), with most studies indicating moderate to good reliability (ICC = 0.5-0.9, n = 13). Meta-analysis results showed a good overall correlation across studies (r = 0.78, 95% confidence interval = 0.64-0.86), with no between-group difference based on population (Q1 = 0.00). Convergent validity was demonstrated by strong correlations between stiffness values and measures of spasticity (n = 5), functional motor recovery or impairment (n = 5), and grayscale or color histogram pixel intensities (n = 3). Discriminant or known-groups validity was also established for multiple studies and indicated either significant between-group differences in stiffness values (n = 12) or within-group differences between more and less affected limbs (n = 6). Responsiveness was observed in all intervention studies reporting posttreatment stiffness changes (n = 6). CONCLUSIONS Overall, ultrasound elastography techniques showed moderate reliability in evaluating in vivo muscle stiffness, good convergent validity with relevant clinical assessments, and good divergent validity in discriminating tissue changes within and between groups. IMPACT Ultrasound elastography has clinical utility in assessing muscle stiffness, monitoring its temporal changes, and measuring the response to intervention in people with neurological conditions.
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Affiliation(s)
- Tiev Miller
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hong Kong, S.A.R
| | - Michael Ying
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, S.A.R
| | - Charlotte Sau Lan Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hong Kong, S.A.R
| | - Meizhen Huang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hong Kong, S.A.R
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hong Kong, S.A.R
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Fogarty MJ, Brandenburg JE, Sieck GC. Diaphragm neuromuscular transmission failure in a mouse model of an early-onset neuromotor disorder. J Appl Physiol (1985) 2020; 130:708-720. [PMID: 33382958 DOI: 10.1152/japplphysiol.00864.2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The spa transgenic mouse displays spasticity and hypertonia that develops during the early postnatal period, with motor impairments that are remarkably similar to symptoms of human cerebral palsy. Previously, we observed that spa mice have fewer phrenic motor neurons innervating the diaphragm muscle (DIAm). We hypothesize that spa mice exhibit increased susceptibility to neuromuscular transmission failure (NMTF) due to an expanded innervation ratio. We retrogradely labeled phrenic motor neurons with rhodamine and imaged them in horizontal sections (70 µm) using confocal microscopy. Phrenic nerve-DIAm strip preparations from wild type and spa mice were stretched to optimal length, and force was evoked by phrenic nerve stimulation at 10, 40, or 75 Hz in 330-ms duration trains repeated each second (33% duty cycle) across a 120-s period. To assess NMTF, force evoked by phrenic nerve stimulation was compared to force evoked by direct DIAm stimulation superimposed every 15 s. Total DIAm fiber number was estimated in hematoxylin and eosin-stained strips. Compared to wild type, spa mice had over twofold greater NMTF during the first stimulus train that persisted throughout the 120 s period of repetitive activation. In both wild type and spa mice, NMTF was stimulation-frequency dependent. There was no difference in neuromuscular junction morphology or the total number of DIAm fibers between wild type and spa mice, however, there was an increase innervation ratio (39%) in spa mice. We conclude that early-onset developmental neuromotor disorders impair the efficacy of DIAm neuromuscular transmission, likely to contribute to respiratory complications.NEW & NOTEWORTHY Individuals with motor control deficits, including cerebral palsy (CP) often have respiratory impairments. Glycine-receptor mutant spa mice have early-onset hypertonia, and limb motor impairments, similar to individuals with CP. We hypothesized that in the diaphragm of spa mice, disruption of glycinergic inputs to MNs would result in increased phrenic-DIAm neuromuscular transmission failure. Pathophysiologic abnormalities in neuromuscular transmission may contribute to respiratory dysfunction in conditions where early developmental MN loss or motor control deficits are apparent.
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Affiliation(s)
- Matthew J Fogarty
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota.,School of Biomedical Sciences, The University of Queensland, Brisbane, Australia
| | - Joline E Brandenburg
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Gary C Sieck
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota.,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
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Bastijns S, De Cock AM, Vandewoude M, Perkisas S. Usability and Pitfalls of Shear-Wave Elastography for Evaluation of Muscle Quality and Its Potential in Assessing Sarcopenia: A Review. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2891-2907. [PMID: 32843232 DOI: 10.1016/j.ultrasmedbio.2020.06.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 06/18/2020] [Accepted: 06/30/2020] [Indexed: 05/08/2023]
Abstract
Sarcopenia is age-related progressive and generalized loss of skeletal muscle mass and strength. Its prevalence is rising, which poses a burden for society because it increases disability and dependency and therefore raises health care costs. Muscle mass quality, however-an essential part of sarcopenia-is not easily diagnosable yet. Recent interest has risen for ultrasonographic evaluation of muscle. This review introduces muscle elastography as a possible, easy and cheap tool to evaluate qualitative muscle parameters. Basic principles of muscle elastography are described, as well as different elastography techniques and some technical considerations. Furthermore, a proposal for practical guidelines is offered and factors influencing muscle stiffness are highlighted.
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Affiliation(s)
- Sophie Bastijns
- Department of Medicine, University of Antwerp, Antwerp, Belgium; Ziekenhuisnetwerk Antwerpen, Antwerp, Belgium.
| | - Anne-Marie De Cock
- Department of Medicine, University of Antwerp, Antwerp, Belgium; Ziekenhuisnetwerk Antwerpen, Antwerp, Belgium
| | - Maurits Vandewoude
- Department of Medicine, University of Antwerp, Antwerp, Belgium; Ziekenhuisnetwerk Antwerpen, Antwerp, Belgium; Belgian Ageing Muscle Society, Liege, Belgium
| | - Stany Perkisas
- Department of Medicine, University of Antwerp, Antwerp, Belgium; Ziekenhuisnetwerk Antwerpen, Antwerp, Belgium; Belgian Ageing Muscle Society, Liege, Belgium
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Liu X, Yu HK, Sheng SY, Liang SM, Lu H, Chen RY, Pan M, Wen ZB. Quantitative evaluation of passive muscle stiffness by shear wave elastography in healthy individuals of different ages. Eur Radiol 2020; 31:3187-3194. [PMID: 33052467 DOI: 10.1007/s00330-020-07367-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/27/2020] [Accepted: 10/01/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate age-related changes on passive muscle stiffness in healthy individuals and measure the shear modulus in different age groups. METHODS Shear wave elastography (SWE) movies of gastrocnemius medialis (GM) were collected during passive stretching induced by ankle rotation from plantarflexion (PF) to dorsiflexion (DF). A series of SWE images at ankle angles of PF 40°, PF 30°, PF 20°, PF 10°, 0°, DF 10°, DF 20°, and DF 30° were collected and shear moduli measured accordingly for analyses. RESULTS Eighty-six healthy volunteers (27 children, 31 middle-aged adults, and 28 older people) were recruited. No significant difference was observed in the shear modulus between the three groups at ankle angles of PF 40°, PF 30°, PF 20°, PF 10°, and 0° (p > 0.05). The difference in the shear modulus among the three groups became significant as DF increased. At ankle angles of DF 10°, DF 20°, and DF 30°, the shear modulus was the greatest in the older group, followed by the middle-aged group and then the children group (p = 0.007, 0.000, and 0.000, respectively). CONCLUSIONS Passive muscle stiffness increases with age, and the difference between age groups was pronounced only after reaching a certain degree of stretching. KEY POINTS • The influence of age on passive muscle stiffness becomes pronounced only after reaching a certain degree of stretching. • Age should be considered when evaluating passive muscle stiffness in muscular disorders.
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Affiliation(s)
- Xiao Liu
- Department of Radiology, Zhujiang Hospital, Southern Medical University, 253, Gongye Avenue, Guangzhou, 510282, Guangdong, China
- Department of Ultrasonography, Shenzhen Hospital of Guangzhou University of Chinese Medicine, 6001, Beihuan Avenue, Shenzhen, 518034, Guangdong, China
| | - Hong-Kui Yu
- Department of Radiology, Zhujiang Hospital, Southern Medical University, 253, Gongye Avenue, Guangzhou, 510282, Guangdong, China
| | - Shu-Ya Sheng
- Shenzhen Middle School, Shenzhen, Guangdong, China
| | - Si-Min Liang
- Department of Ultrasonography, Shenzhen Hospital of Guangzhou University of Chinese Medicine, 6001, Beihuan Avenue, Shenzhen, 518034, Guangdong, China
| | - Hao Lu
- Department of Ultrasonography, Shenzhen Hospital of Guangzhou University of Chinese Medicine, 6001, Beihuan Avenue, Shenzhen, 518034, Guangdong, China
| | - Rui-Yun Chen
- Department of Ultrasonography, Shenzhen Hospital of Guangzhou University of Chinese Medicine, 6001, Beihuan Avenue, Shenzhen, 518034, Guangdong, China
| | - Min Pan
- Department of Ultrasonography, Shenzhen Hospital of Guangzhou University of Chinese Medicine, 6001, Beihuan Avenue, Shenzhen, 518034, Guangdong, China.
| | - Zhi-Bo Wen
- Department of Radiology, Zhujiang Hospital, Southern Medical University, 253, Gongye Avenue, Guangzhou, 510282, Guangdong, China.
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Goo M, Johnston LM, Hug F, Tucker K. Systematic Review of Instrumented Measures of Skeletal Muscle Mechanical Properties: Evidence for the Application of Shear Wave Elastography with Children. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1831-1840. [PMID: 32423570 DOI: 10.1016/j.ultrasmedbio.2020.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/16/2020] [Accepted: 04/09/2020] [Indexed: 06/11/2023]
Abstract
The aim of this review was to identify instrumented devices that quantify skeletal muscle mechanical properties and to evaluate their potential clinical utility and clinimetric evidence with respect to children. Four databases were searched to identify articles reporting original clinimetric data for devices measuring muscle stiffness or elastic modulus, along a muscle's main fibre direction. Clinimetric evidence was rated using the Consensus-Based Standard for the Selection of Measurement Instruments (COSMIN) checklist. Sixty-five articles provided clinimetric data for two devices meeting our criteria: the Aixplorer and the Acuson. Both are shear wave elastography devices that determine the shear modulus of muscle tissue. The Aixplorer had strong construct validity and reliability, and the Acuson, moderate construct validity and reliability. Both devices have sound clinical utility with non-invasive application at various joint positions and data acquisition in real time, minimizing fatigue. Further research is warranted to evaluate utility for children with specific disorders of abnormal muscle structure or function.
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Affiliation(s)
- Miran Goo
- School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Leanne M Johnston
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Francois Hug
- School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia; Laboratory "Movement, Interactions, Performance", Nantes, France; Institut Universitaire de France, Faculty of Sport Sciences, University of Nantes, Paris, France
| | - Kylie Tucker
- School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia.
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The utility of shear wave elastography in the evaluation of muscle stiffness in patients with cerebral palsy after botulinum toxin A injection. J Med Ultrason (2001) 2020; 47:609-615. [PMID: 32705628 DOI: 10.1007/s10396-020-01042-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/07/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE The first aim of this study was to evaluate changes in the stiffness of the medial gastrocnemius muscle (GM) after a botulinum toxin A (BoNT-A) injection in children with cerebral palsy (CP) using shear wave elastography (SWE). We also wanted to investigate the usability of SWE for evaluating spasticity in a clinical setting. The second aim of this study was to show how treatment of the gastrocnemius muscle spasticity caused a change in the elasticity of the anterior tibial (TA) muscle. METHODS Twenty-four pediatric patients diagnosed with a spastic type of CP, who were scheduled to receive a BoNT-A injection in the gastrocnemius muscle, were included in the study. There was a total of 43 lower extremities to evaluate, and muscle stiffness was measured before the injection and a month post injection using SWE. The physiatrist evaluated muscle spasticity using the Modified Ashworth Scale (MAS) and the Modified Tardieu Scale at about the same time. RESULTS SWE values of the GM (pre-BoNT-A: 45.9 ± 6.5 kPa, post-BoNT-A: 25.0 ± 5.7 kPa) decreased significantly post BoNT-A injection (P < 0.01). SWE measurements of the GM had positive correlations with MAS, V1X, V3X, and R2-R1 (P < 0.01); and negative correlations with R2 and R1 (P < 0.05). SWE values of the TA muscle (pre: 36.9 ± 7.9 kPa, post: 28.4 ± 5.2 kPa) decreased significantly (P < 0.01). CONCLUSION Quantitative measurement of muscle stiffness using SWE may provide important information for the evaluation of spasticity and treatment efficiency in pediatric CP patients.
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Berrigan WA, Wickstrom J, Farrell M, Alter K. Hip position influences shear wave elastography measurements of the hamstring muscles in healthy subjects. J Biomech 2020; 109:109930. [PMID: 32807303 DOI: 10.1016/j.jbiomech.2020.109930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 11/26/2022]
Abstract
Ultrasound shear wave elastography (SWE) has recently emerged as a non-invasive tool for assessing muscle stiffness. The majority of studies utilizing SWE have focused primarily on upper-extremity muscles, with little attention attributed to lower-extremity muscles. In addition, of the studies that have been published, various joint and muscle positions have been examined, rendering it difficult to compare results across studies. Thus, the purpose of this investigation was to examine lower extremity medial hamstring muscles (semitendinosus and semimembranosus) and to determine how hip position (0° versus 90°) and muscle position (knee flexed versus extended) impacted resulting shear modulus values. Ten subjects varying widely in age participated in this study, and their hamstring stiffness was assessed in four separate positions: seated with the knee flexed and extended, and lying prone with the knee flexed and extended. Higher shear modulus values were found at the group-level when participants were seated compared to prone (hip placed at 90° compared to 0°). In addition, higher values were also found when the knee was extended compared to flexed, but only when the hip was placed at 90° (not 0°). These results demonstrate that joint and muscle position, particularly when assessing the hamstrings, largely impact resulting shear modulus values. Therefore, joint and muscle position need to be systematically controlled for and reported when establishing normative ranges for shear modulus values across specific age groups. This will enable physicians to more precisely determine whether patients' shear modulus values indicate clinically meaningful differences in comparison to normative data.
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Affiliation(s)
- William A Berrigan
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, United States; Medstar Georgetown University Hospital-National Rehabilitation Hospital, Washington, DC, United States
| | - Jordan Wickstrom
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, United States
| | - Michael Farrell
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, United States; Medstar Georgetown University Hospital-National Rehabilitation Hospital, Washington, DC, United States
| | - Katharine Alter
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, United States.
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Feigin M, Zwecker M, Freedman D, Anthony BW. Detecting muscle activation using ultrasound speed of sound inversion with deep learning. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:2092-2095. [PMID: 33018418 DOI: 10.1109/embc44109.2020.9175237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Functional muscle imaging is essential for diagnostics of a multitude of musculoskeletal afflictions such as degenerative muscle diseases, muscle injuries, muscle atrophy, and neurological related issues such as spasticity. However, there is currently no solution, imaging or otherwise, capable of providing a map of active muscles over a large field of view in dynamic scenarios.In this work, we look at the feasibility of applying longitudinal sound speed measurements to the task of dynamic muscle imaging of contraction or activation. We perform the assessment using a deep learning network applied to prebeamformed ultrasound channel data for sound speed inversion.Preliminary results show that dynamic muscle contraction can be detected in the calf and that this contraction can be positively assigned to the operating muscles. Potential frame rates in the hundreds to thousands of frames per second are necessary to accomplish this.
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