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Scronce G, Ramakrishnan V, Vatinno AA, Seo NJ. Effect of Self-Directed Home Therapy Adherence Combined with TheraBracelet on Poststroke Hand Recovery: A Pilot Study. Stroke Res Treat 2023; 2023:3682898. [PMID: 36936523 PMCID: PMC10017223 DOI: 10.1155/2023/3682898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/26/2023] [Accepted: 02/17/2023] [Indexed: 03/10/2023] Open
Abstract
Hand impairment is a common consequence of stroke, resulting in long-term disability and reduced quality of life. Recovery may be augmented through self-directed therapy activities at home, complemented by the use of rehabilitation devices such as peripheral sensory stimulation. The objective of this study was to determine the effect of adherence to self-directed therapy and the use of TheraBracelet (subsensory random-frequency vibratory stimulation) on hand function for stroke survivors. In a double-blind, randomized controlled pilot trial, 12 chronic stroke survivors were assigned to a treatment or control group (n = 6/group). All participants were instructed to perform 200 repetitions of therapeutic hand tasks 5 days/week while wearing a wrist-worn device 8 hours/day for 4 weeks. The treatment group received TheraBracelet vibration from the device, while the control group received no vibration. Home task repetition adherence and device wear logs, as well as hand function assessment (Stroke Impact Scale Hand domain), were obtained weekly. Repetition adherence was comparable between groups but varied among participants. Participants wore the device to a greater extent than adhering to completing repetitions. A linear mixed model analysis showed a significant interaction between repetition and group (p = 0.01), with greater adherence resulting in greater hand function change for the treatment group (r = 0.94; R 2 = 0.88), but not for the control group. Secondary analysis revealed that repetition adherence was greater for those with lower motor capacity and greater self-efficacy at baseline. This pilot study suggests that adherence to self-directed therapy at home combined with subsensory stimulation may affect recovery outcomes in stroke survivors. This trial is registered with NCT04026399.
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Affiliation(s)
- Gabrielle Scronce
- 1Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
- 2Ralph H. Johnson VA Health Care System, Charleston, SC, USA
| | - Viswanathan Ramakrishnan
- 3Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Amanda A. Vatinno
- 1Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Na Jin Seo
- 1Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
- 2Ralph H. Johnson VA Health Care System, Charleston, SC, USA
- 4Division of Occupational Therapy, Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
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Seim CE, Ritter B, Starner TE, Flavin K, Lansberg MG, Okamura AM. Design of a wearable vibrotactile stimulation device for individuals with upper-limb hemiparesis and spasticity. IEEE Trans Neural Syst Rehabil Eng 2022; 30:1277-1287. [PMID: 35552152 PMCID: PMC10139869 DOI: 10.1109/tnsre.2022.3174808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Vibratory stimulation may improve post-stroke symptoms such as spasticity; however, current studies are limited by the large, clinic-based apparatus used to apply this stimulation. A wearable device could provide vibratory stimulation in a mobile form, enabling further study of this technique. An initial device, the vibrotactile stimulation (VTS) Glove, was deployed in an eight-week clinical study in which sixteen individuals with stroke used the device for several hours daily. Participants reported wearing the glove during activities such as church, social events, and dining out. However, 69% of participants struggled to extend or insert their fingers to don the device. In a follow-up study, eight individuals with stroke evaluated new VTS device prototypes in a three-round iterative design study with the aims of creating the next generation of VTS devices and understanding features that influence interaction with a wearable device by individuals with impaired upper-limb function. Interviews and interaction tasks were used to define actionable design revisions between each round of evaluation. Our analysis identified six new themes from participants regarding device designs: hand supination is challenging, separate finger attachments inhibit fit and use, fingers may be flexed or open, fabric coverage impacts comfort, a reduced concern for social comfort, and the affected hand is infrequently used. Straps that wrap around the arm and fixtures on the anterior arm were other challenging features. We discuss potential accommodations for these challenges, as well as social comfort. New VTS device designs are presented and were donned in an average time of 48 seconds.
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Seo NJ, Ramakrishnan V, Woodbury ML, Bonilha L, Finetto C, Schranz C, Scronce G, Coupland K, Blaschke J, Baker A, Howard K, Meinzer C, Velozo CA, Adams RJ. Concomitant sensory stimulation during therapy to enhance hand functional recovery post stroke. Trials 2022; 23:262. [PMID: 35382902 PMCID: PMC8981199 DOI: 10.1186/s13063-022-06241-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background Post-stroke hand impairment is prevalent and persistent even after a full course of rehabilitation. Hand diminishes stroke survivors’ abilities for activities of daily living and independence. One way to improve treatment efficacy is to augment therapy with peripheral sensory stimulation. Recently, a novel sensory stimulation, TheraBracelet, has been developed in which imperceptible vibration is applied during task practice through a wrist-worn device. The objective of this trial is to determine if combining TheraBracelet with hand task practice is superior to hand task practice alone. Methods A double-blind randomized controlled trial will be used. Chronic stroke survivors will undergo a standardized hand task practice therapy program (3 days/week for 6 weeks) while wearing a device on the paretic wrist. The device will deliver TheraBracelet vibration for the treatment group and no vibration for the control group. The primary outcome is hand function measured by the Wolf Motor Function Test. Other outcomes include the Box and Block Test, Action Research Arm Test, upper extremity use in daily living, biomechanical measure of the sensorimotor grip control, and EEG-based neural communication. Discussion This research will determine clinical utility of TheraBracelet to guide future translation. The TheraBracelet stimulation is delivered via a wrist-worn device, does not interfere with hand motion, and can be easily integrated into clinical practice. Enhancing hand function should substantially increase stroke survivors' independence and quality of life and reduce caregiver burden. Trial registration NCT04569123. Registered on September 29, 2020
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Affiliation(s)
- Na Jin Seo
- Department of Rehabilitation Sciences, Department of Health Science and Research, Medical University of South Carolina, 151B Rutledge Ave, MSC 962, Charleston, SC, 29425, USA. .,Ralph H. Johnson VA Medical Center, Charleston, SC, USA. .,Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA.
| | - Viswanathan Ramakrishnan
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon St, Charleston, SC, 29425, USA
| | - Michelle L Woodbury
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas St, MSC 606, Charleston, SC, 29425, USA
| | - Christian Finetto
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Christian Schranz
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Gabrielle Scronce
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Kristen Coupland
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Jenna Blaschke
- Department of Rehabilitation Sciences, Department of Health Science and Research, Medical University of South Carolina, 151B Rutledge Ave, MSC 962, Charleston, SC, 29425, USA
| | - Adam Baker
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Keith Howard
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Caitlyn Meinzer
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon St, Charleston, SC, 29425, USA
| | - Craig A Velozo
- Department of Rehabilitation Sciences, Department of Health Science and Research, Medical University of South Carolina, 151B Rutledge Ave, MSC 962, Charleston, SC, 29425, USA
| | - Robert J Adams
- Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas St, MSC 606, Charleston, SC, 29425, USA
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Blaschke J, Vatinno A, Scronce G, Ramakrishnan V, Seo NJ. Effect of Sensory Impairment on Hand Functional Improvement with Therapy and Sensory Stimulation. NEUROLOGY AND NEUROREHABILITATION 2022; 4:1-4. [PMID: 36780248 PMCID: PMC9918228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Sensory impairment may impact individual stroke survivors' motor recovery as well as their response to peripheral sensory stimulation treatment. The objective of this study was to determine the effect of sensory impairment level of individual stroke survivors on motor improvement with therapy and peripheral sensory stimulation. A secondary analysis of a pilot triple-blind randomized controlled trial was used. Twelve chronic stroke survivors were randomly assigned to the treatment group receiving peripheral sensory stimulation or the control group receiving no stimulation during 2-week hand task practice therapy. Sensory impairment level was quantified as the pre-intervention sensory threshold. Motor improvement was assessed as change in the Box and Block Test score from pre- to post-intervention. The association between sensory impairment level and motor improvement was examined using a regression analysis, accounting for groups. This study found that participants with better sensation (i.e., with lower sensory threshold) had better motor improvement than patients with worse sensation (i.e., with higher sensory threshold). Sensory impairment level did not alter the effect of peripheral sensory stimulation. These findings suggest that the level of sensory impairment may predict recovery potentials and direct rehabilitation treatment for stroke survivors.
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Affiliation(s)
- Jenna Blaschke
- Department of Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Amanda Vatinno
- Department of Health Science and Research, Medical University of South Carolina, Charleston, SC, USA
| | - Gabrielle Scronce
- Department of Health Science and Research, Medical University of South Carolina, Charleston, SC, USA
| | | | - Na Jin Seo
- Department of Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC, USA,Department of Health Science and Research, Medical University of South Carolina, Charleston, SC, USA,Ralph H. Johnson VA Medical Center, Charleston, SC, USA
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Morrow CM, Johnson E, Simpson KN, Seo NJ. Determining Factors that Influence Adoption of New Post-Stroke Sensorimotor Rehabilitation Devices in the USA. IEEE Trans Neural Syst Rehabil Eng 2021; 29:1213-1222. [PMID: 34143736 PMCID: PMC8249076 DOI: 10.1109/tnsre.2021.3090571] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Rehabilitation device efficacy alone does not lead to clinical practice adoption. Previous literature identifies drivers for device adoption by therapists but does not identify the best settings to introduce devices, the roles of different stakeholders including rehabilitation directors, or specific criteria to be met during device development. The objective of this work was to provide insights into these areas to increase clinical adoption of post-stroke restorative rehabilitation devices. We interviewed 107 persons including physical/occupational therapists, rehabilitation directors, and stroke survivors and performed content analysis. Unique to this work, care settings in which therapy goals are best aligned for restorative devices were found to be outpatient rehabilitation, followed by inpatient rehabilitation. Therapists are the major influencers for adoption because they typically introduce new rehabilitation devices to patients for both clinic and home use. We also learned therapists' utilization rate of a rehabilitation device influences a rehabilitation director's decision to acquire the device for facility use. Main drivers for each stakeholder are identified, along with specific criteria to add details to findings from previous literature. In addition, drivers for home adoption of rehabilitation devices by patients are identified. Rehabilitation device development should consider the best settings to first introduce the device, roles of each stakeholder, and drivers that influence each stakeholder, to accelerate successful adoption of the developed device.
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Hauguel-Moreau M, Naudin C, N’Guyen L, Squara P, Rosencher J, Makowski S, Beverelli F. Smart bracelet to assess physical activity after cardiac surgery: A prospective study. PLoS One 2020; 15:e0241368. [PMID: 33259484 PMCID: PMC7707519 DOI: 10.1371/journal.pone.0241368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 09/30/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives Little is known about the physical activity of patients after cardiac surgery. This study was designed to assess this activity using a connected bracelet. Methods In this prospective, monocentric study, patients scheduled for cardiac surgery were offered to wear an electronic bracelet. The main objective was to measure the physical activity recovery. Secondary objectives were the predictors of the correct use of the monitoring system, of the physical recovery and, if any, the relationship between physical activity and out-of-hospital morbidity. Results One hundred patients were included. Most patients (86%) were interested in participating in the study. The compliance to the device and to the study protocol was good (94%). At discharge, the mean number of daily steps was 1454 ± 145 steps, increasing quite homogeneously, reaching 5801±1151 steps at Day 60. The best fit regression curve gave a maximum number of steps at 5897±119 (r2 = 0.97). The 85% level of activity was achieved at Day 30±3. No predictor of noncompliance was found. At discharge, age was independently associated with a lower number of daily steps (p <0.001). At Day 60, age, peripheral arterial disease and cardio-pulmonary bypass duration were independently associated with a lower number of daily steps (p = 0.039, p = 0.041 and p = 0.033, respectively). Conclusions After cardiac surgery, wearing a smart bracelet recording daily steps is simple, well tolerated and suitable for measuring physical activity. Standard patients achieved around 6000 daily steps 2 months after discharge. 85% of this activity is reached in the first month. Clinical trial registry number NCT03113565
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Affiliation(s)
| | - Cécile Naudin
- Research Department, CMC Ambroise Paré, Neuilly sur Seine, France
| | - Lee N’Guyen
- Research Department, CMC Ambroise Paré, Neuilly sur Seine, France
- Critical Care Department, CMC Ambroise Paré, Neuilly sur Seine, France
| | - Pierre Squara
- Research Department, CMC Ambroise Paré, Neuilly sur Seine, France
- Critical Care Department, CMC Ambroise Paré, Neuilly sur Seine, France
- * E-mail:
| | - Julien Rosencher
- Cardiology Department, CMC Ambroise Paré, Neuilly sur Seine, France
| | - Serge Makowski
- Cardiology Department, CMC Ambroise Paré, Neuilly sur Seine, France
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Tobler-Ammann BC, Surer E, Knols RH, Borghese NA, de Bruin ED. User Perspectives on Exergames Designed to Explore the Hemineglected Space for Stroke Patients With Visuospatial Neglect: Usability Study. JMIR Serious Games 2017; 5:e18. [PMID: 28842390 PMCID: PMC5591406 DOI: 10.2196/games.8013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/12/2017] [Accepted: 07/27/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Visuospatial neglect due to stroke is characterized by the inability to perceive stimuli emerging in the area opposite to the side of brain damage. Besides adopting conventional rehabilitation methods to treat neglect symptoms, the use of virtual reality (VR) is becoming increasingly popular. We designed a series of 9 exergames aimed to improve exploration of the neglected side of space. When new VR interventions are designed, it is important to assess the usability aspects of such management strategies within the target population. To date, most studies used questionnaires to assess user satisfaction with the intervention or product being tested. However, only a combination of both quantitative and qualitative data allows a full picture of user perspective. OBJECTIVE The purpose of this study was to quantitatively and qualitatively assess patient and therapist perspectives of a VR intervention based on the series of 9 exergames designed to explore hemineglected space. Specifically, we wanted to evaluate (1) perceived-user friendliness of the exergames, (2) attitude towards using the exergames, and (3) intention to use the exergames in the future. METHODS A total of 19 participants (7 patients, 12 therapists) evaluated the exergames they had used 5 times a week during 3 weeks. The Technology Acceptance Model (TAM) questionnaire was filled out after the intervention. Based on those responses, we conducted focus group interviews (with therapists) and individual interviews (with patients). To analyze the TAM questionnaires, we used descriptive statistics. We adopted content and comparative analysis to analyze the interviews and drew illustration maps to analyze the focus group interviews. RESULTS The therapists took a more critical stance with a mean TAM questionnaire total score of 48.6 (SD 4.5) compared to the patients who had a mean total score of 56.1 (SD 12.3). The perceived user-friendliness score was 5.6 (SD 1.4) for patients and 4.9 (SD 1.4) for therapists. The attitude towards using the exergames was rated 4.8 (SD 1.9) by patients and 3.6 (SD 1.4) by therapists, respectively. The intention to use the exergames in the future was rated 3.9 (SD 2.1) by patients and 3.7 (SD 1.8) by therapists. We gained information on how to improve the exergames in the interviews. CONCLUSIONS Patients and therapists perceived the exergames as user-friendly; however, using the games further with the actual test version was not perceived as conceivable. The therapists were generally more critical towards future use than the patients. Therefore, involving both users to achieve acceptable and user-friendly versions of game-based rehabilitation for the future is deemed crucial and warranted. TRIAL REGISTRATION Clinicaltrials.gov NCT02353962; https://clinicaltrials.gov/ct2/show/NCT02353962 (Archived by WebCite at http://www.webcitation.org/6soxIJlAZ).
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Affiliation(s)
- Bernadette C Tobler-Ammann
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland.,Care and Public Health Research Institute [CAPHRI], Maastricht University, Maastricht, Netherlands
| | - Elif Surer
- Graduate School of Informatics, Department of Modeling and Simulation, Middle East Technical University, Ankara, Turkey.,Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Ruud H Knols
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
| | - N Alberto Borghese
- Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Eling D de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
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Remsik A, Young B, Vermilyea R, Kiekhoefer L, Abrams J, Evander Elmore S, Schultz P, Nair V, Edwards D, Williams J, Prabhakaran V. A review of the progression and future implications of brain-computer interface therapies for restoration of distal upper extremity motor function after stroke. Expert Rev Med Devices 2017; 13:445-54. [PMID: 27112213 DOI: 10.1080/17434440.2016.1174572] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Stroke is a leading cause of acquired disability resulting in distal upper extremity functional motor impairment. Stroke mortality rates continue to decline with advances in healthcare and medical technology. This has led to an increased demand for advanced, personalized rehabilitation. Survivors often experience some level of spontaneous recovery shortly after their stroke event, yet reach a functional plateau after which there is exiguous motor recovery. Nevertheless, studies have demonstrated the potential for recovery beyond this plateau. Non-traditional neurorehabilitation techniques, such as those incorporating the brain-computer interface (BCI), are being investigated for rehabilitation. BCIs may offer a gateway to the brain's plasticity and revolutionize how humans interact with the world. Non-invasive BCIs work by closing the proprioceptive feedback loop with real-time, multi-sensory feedback allowing for volitional modulation of brain signals to assist hand function. BCI technology potentially promotes neuroplasticity and Hebbian-based motor recovery by rewarding cortical activity associated with sensory-motor rhythms through use with a variety of self-guided and assistive modalities.
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Affiliation(s)
- Alexander Remsik
- a Department of Radiology Clinical Science Center , University of Wisconsin Madison School of Medicine and Public Health Ringgold Standard Institution , Madison , WI , USA
| | - Brittany Young
- a Department of Radiology Clinical Science Center , University of Wisconsin Madison School of Medicine and Public Health Ringgold Standard Institution , Madison , WI , USA
| | - Rebecca Vermilyea
- a Department of Radiology Clinical Science Center , University of Wisconsin Madison School of Medicine and Public Health Ringgold Standard Institution , Madison , WI , USA
| | - Laura Kiekhoefer
- a Department of Radiology Clinical Science Center , University of Wisconsin Madison School of Medicine and Public Health Ringgold Standard Institution , Madison , WI , USA
| | - Jessica Abrams
- a Department of Radiology Clinical Science Center , University of Wisconsin Madison School of Medicine and Public Health Ringgold Standard Institution , Madison , WI , USA
| | - Samantha Evander Elmore
- a Department of Radiology Clinical Science Center , University of Wisconsin Madison School of Medicine and Public Health Ringgold Standard Institution , Madison , WI , USA
| | - Paige Schultz
- a Department of Radiology Clinical Science Center , University of Wisconsin Madison School of Medicine and Public Health Ringgold Standard Institution , Madison , WI , USA
| | - Veena Nair
- a Department of Radiology Clinical Science Center , University of Wisconsin Madison School of Medicine and Public Health Ringgold Standard Institution , Madison , WI , USA
| | - Dorothy Edwards
- a Department of Radiology Clinical Science Center , University of Wisconsin Madison School of Medicine and Public Health Ringgold Standard Institution , Madison , WI , USA
| | - Justin Williams
- a Department of Radiology Clinical Science Center , University of Wisconsin Madison School of Medicine and Public Health Ringgold Standard Institution , Madison , WI , USA
| | - Vivek Prabhakaran
- a Department of Radiology Clinical Science Center , University of Wisconsin Madison School of Medicine and Public Health Ringgold Standard Institution , Madison , WI , USA
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