The use of real-time ultrasound imaging for biofeedback of lumbar multifudus muscle contraction in healthy subjects

Study Design: Randomized controlled trial. Objective: To determine if the provision of visual biofeedback using real-time ultrasound imaging enhances the ability to activate the multifidus muscle. Background: Increasingly clinicians are using real-time ultrasound as a form of biofeedback when re-educating muscle activation. The effectiveness of this form of biofeedback for the multifidus muscle has not been reported. Methods and Measures: Healthy subjects were randomly divided into groups that received different forms of biofeedback. All subjects received clinical instruction on how to activate the multifidus muscle isometrically prior to testing and verbal feedback regarding the amount of multifidus contraction, which occurred during 10 repetitions (acquisition phase). In addition, 1 group received visual biofeedback (watched the multifidus muscle contract) using real-time ultrasound imaging. All subjects were reassessed a week later (retention phase). Results: Subjects from both groups improved their voluntary contraction of the multifidus muscle in the acquisition phase (P

Real-time evaluation of diffusion of the local anesthetic solution during peribulbar block using ultrasound imaging and clinical correlates of diffusion

The aims of this prospective observational study were to assess the incidence of intraconal spread during peribulbar (extraconal) anesthesia by real-time ultrasound imaging of the retro-orbital compartment and to determine whether a complete sensory and motor block (with akinesia) of the eye is directly related to the intraconal spread.

Real-time ultrasound to predict rabbit carcass composition and volume of longissimus dorsi muscle

Real-time ultrasonography (RTU) was used to measure the longissimus dorsi muscle (LM) volume in vivo and to predict the carcass composition of rabbits. For this, 63 New Zealand White × Californian rabbits with 2093±63 g live weight were used. Animals were scanned between the 6th and 7th lumbar vertebrae using an RTU equipment with a 7.5 MHz probe. Measurements of LM volume were obtianed both in vivo and on carcass. Regression equations were used for the prediction of carcass composition and LM volume using the LM volume measured obtained with RTU (LMVU) as independent variable. Carcass meat, bone and total dissectible fat weights represented 780, 164 and 56 g/kg of the reference carcass weight, respectively. Regression equations showed a strong relationship between LMVU and the correspondent volume in carcass. Furthermore, LMVU was also useful in predicting the amounts of carcass tissues. It is possible to predict LM volume in the carcass using the LM volume measured in vivo by RTU. The amount of carcass tissues can be predicted by the LM volume measured in vivo by RTU.

Real-time ultrasound-guided spinal anaesthesia: a prospective observational study of a new approach

Identification of the subarachnoid space has traditionally been achieved by either a blind landmark-guided approach or using prepuncture ultrasound assistance. To assess the feasibility of performing spinal anaesthesia under real-time ultrasound guidance in routine clinical practice we conducted a single center prospective observational study among patients undergoing lower limb orthopaedic surgery. A spinal needle was inserted unassisted within the ultrasound transducer imaging plane using a paramedian approach (i.e., the operator held the transducer in one hand and the spinal needle in the other). The primary outcome measure was the success rate of CSF acquisition under real-time ultrasound guidance with CSF being located in 97 out of 100 consecutive patients within median three needle passes (IQR 1-6). CSF was not acquired in three patients. Subsequent attempts combining landmark palpation and pre-puncture ultrasound scanning resulted in successful spinal anaesthesia in two of these patients with the third patient requiring general anaesthesia. Median time from spinal needle insertion until intrathecal injection completion was 1.2 minutes (IQR 0.83-4.1) demonstrating the feasibility of this technique in routine clinical practice.

Ultrasound imaging in rehabilitation: Just a fad?

Real-time ultrasound imaging provides an unrivalled opportunity to observe muscle morphology and contraction. This has obvious potential for clinical practice and the tool is beginning to be adopted into physical therapy. The implementation of ultrasound imaging has become particularly widespread for assessment of size and activation of deep trunk muscles, such as the transversus abdominis and lumbar multifidus, and for assessment of the pelvic floor muscles. The obvious benefit for these areas is that ultrasound permits observation of muscles that are difficult to assess through noninvasive means. This realization of the clinical potential of ultrasound imaging has been paralleled by an explosion of clinical and physiological research. However, despite the enthusiasm for utilization of ultrasound imaging, a question that is critical to address is whether ultrasound can actually improve rehabilitation.

Genetic associations between carcass traits measured by real-time ultrasound and scrotal circumference and growth traits in Nelore cattle

The aim of the present study was to evaluate the genetic correlations among real-time ultrasound carcass, BW, and scrotal circumference (SC) traits in Nelore cattle. Carcass traits, measured by real-time ultrasound of the live animal, were recorded from 2002 to 2004 on 10 farms across 6 Brazilian states on 2,590 males and females ranging in age from 450 to 599 d. Ultrasound records of LM area (LMA) and backfat thickness (BF) were obtained from cross-sectional images between the 12th and 13th ribs, and rump fat thickness (RF) was measured between the hook and pin bones over the junction between gluteus medius and biceps femoris muscles. Also, BW (n = 22,778) and SC ( n = 5,695) were recorded on animals born between 1998 and 2003. The BW traits were 120, 210, 365, 450, and 550-d standardized BW (W120, W210, W365, W450, and W550), plus BW (WS) and hip height (HH) on the ultrasound scanning date. The SC traits were 365-, 450-, and 550-d standardized SC (SC365, SC450, and SC550). For the BW and SC traits, the database used was from the Nelore Breeding Program-Nelore Brazil. The genetic parameters were estimated with multivariate animal models and REML. Estimated genetic correlations between LMA and other traits were 0.06 (BF), -0.04 ( RF), 0.05 (HH), 0.58 (WS), 0.53 (W120), 0.62 (W210), 0.67 (W365), 0.64 ( W450 and W550), 0.28 (SC365), 0.24 (SC450), and 0.00 ( SC550). Estimated genetic correlations between BF and with other traits were 0.74 ( RF), -0.32 (HH), 0.19 (WS), -0.03 (W120), -0.10 (W210), 0.04 (W365), 0.01 (W450), 0.06 ( W550), 0.17 (SC365 and SC450), and -0.19 (SC550). Estimated genetic correlations between RF and other traits were -0.41 (HH), -0.09 (WS), -0.13 ( W120), -0.09 ( W210), -0.01 ( W365), 0.02 (W450), 0.03 (W550), 0.05 ( SC365), 0.11 ( SC450), and -0.18 (SC550). These estimates indicate that selection for carcass traits measured by real-time ultrasound should not cause antagonism in the genetic improvement of SC and BW traits. Also, selection to increase HH might decrease subcutaneous fat as correlated response. Therefore, to obtain animals suited to specific tropical production systems, carcass, BW, and SC traits should be considered in selection programs.

Relationship between motion of coronary arteries and diaphragm during free breathing: lessons from real-time MR imaging.

OBJECTIVE: Diaphragmatic navigators are frequently used in free-breathing coronary MR angiography, either to gate or prospectively correct slice position or both. For such approaches, a constant relationship between coronary and diaphragmatic displacement throughout the respiratory cycle is assumed. The purpose of this study was to evaluate the relationship between diaphragmatic and coronary artery motion during free breathing. SUBJECTS AND METHODS: A real-time echoplanar MR imaging sequence was used in 12 healthy volunteers to obtain 30 successive images each (one per cardiac cycle) that included the left main coronary artery and the domes of both hemidiaphragms. The coronary artery and diaphragm positions (relative to isocenter) were determined and analyzed for effective diaphragmatic gating windows of 3, 5, and 7 mm (diaphragmatic excursions of 0-3, 0-5, and 0-7 mm from the end-expiratory position, respectively). RESULTS: Although the mean slope correlating the displacement of the right diaphragm and the left main coronary artery was approximately 0.6 for all diaphragmatic gating windows, we also found great variability among individual volunteers. Linear regression slopes varied from 0.17 to 0.93, and r2 values varied from .04 to .87. CONCLUSION: Wide individual variability exists in the relationship between coronary and diaphragmatic respiratory motion during free breathing. Accordingly, coronary MR angiographic approaches that use diaphragmatic navigator position for prospective slice correction may benefit from patient-specific correction factors. Alternatively, coronary MR angiography may benefit from a more direct assessment of the respiratory displacement of the heart and coronary arteries, using left ventricular navigators.

Real-time MR imaging of myocardial regional function using strain-encoding (SENC) with tissue through-plane motion tracking.

PURPOSE: To implement real-time myocardial strain-encoding (SENC) imaging in combination with tracking the tissue displacement in the through-plane direction. MATERIALS AND METHODS: SENC imaging was combined with the slice-following technique by implementing three-dimensional (3D) selective excitation. Certain adjustments were implemented to reduce scan time to one heartbeat. A total of 10 volunteers and five pigs were scanned on a 3T MRI scanner. Spatial modulation of magnetization (SPAMM)-tagged images were acquired on planes orthogonal to the SENC planes for comparison. Myocardial infarction (MI) was induced in two pigs and the resulting SENC images were compared to standard delayed-enhancement (DE) images. RESULTS: The strain values computed from SENC imaging with slice-following showed significant difference from those acquired without slice-following, especially during systole (P < 0.01). The strain curves computed from the SENC images with and without slice-following were similar to those computed from the orthogonal SPAMM images, with and without, respectively, tracking the tag line displacement in the strain direction. The resulting SENC images showed good agreement with the DE images in identifying MI in infarcted pigs. CONCLUSION: Correction of through-plane motion in real-time cardiac functional imaging is feasible using slice-following. The strain measurements are more accurate than conventional SENC measurements in humans and animals, as validated with conventional MRI tagging.

Genetic associations between carcass traits measured by real-time ultrasound and scrotal circumference and growth traits in Nelore cattle

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Predicting beef carcass retail products of Mediterranean buffaloes by real-time ultrasound measures

Twenty eight Mediterranean buffaloes bulls were scanned with real-time ultrasound (RTU), slaughtered, and fabricated into retail cuts to determine the potential for ultrasound measures to predict carcass retail yield. Ultrasound measures of fat thickness, ribeye area and rump fat thickness were recorded three to five days prior to slaughter. Carcass measurements were taken, and one side of each carcass was fabricated into retail cuts. Stepwise regression analysis was used to compare possible models for prediction of either kilograms or percent retail product from carcass mesaurements and ultrasound measures. Results indicate that possible prediction models for percent or kilograms of retail products using RTU measures were similar in their predictive power and accuracy when compared to models derived from carcass measurements. Both fat thickness and ribeye area were over-predicted when measured ultrasonically compared to measurements taken on the carcass in the cooler. The mean absolute differences for both traits are larger than the mean differences, indicating that some images were interpreted to be larger and some smaller than actual carcass measurements. Ultrasound measurements of REA and FT had positive correlations with carcass measures of the same traits (r=.96 for REA and r=.99 for FT). Standard errors of prediction currently are being used as the standard to certify ultrasound technicians for accuracy. Regression equations using live weight (LW), rib eye area (REAU) and subcutaneous fat thickness (FTU) between 12(th) and 13 (th) ribs and also over the biceps femoris muscle (FTP8) by ultrasound explained 95% of the variation in the hot carcass weight when measure immediately before slaughter.

Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement

Because the structure of the spine is inherently unstable, muscle activation is essential for the maintenance of trunk posture and intervertebral control when the limbs are moved. To investigate how the central nervous system deals with this situation the temporal components of the response of the muscles of the trunk were evaluated during rapid limb movement performed in response to a visual stimulus. Fine-wire electromyography (EMG) electrodes were inserted into transversus abdominis (TrA), obliquus internus abdominis (OI) and obliquus externus abdominis (OE) of 15 subjects under the guidance of real-time ultrasound imaging. Surface electrodes were placed over rectus abdominis (RA), lumbar multifidus (MF) and the three parts of deltoid. In a standing position, ten repetitions of shoulder flexion, abduction and extension were performed by the subjects as fast as possible in response to a visual stimulus. The onset of TrA EMG occurred in advance of deltoid irrespective of the movement direction. The time to onset of EMC activity of OI, OE, RA and MF varied with the movement direction, being activated earliest when the prime action of the muscle opposed the reactive forces associated with the specific limb movement. It is postulated that the non-direction-specific contraction of TrA may be related to the control of trunk. stability independent of the requirement for direction-specific control of the centre of gravity in relation to the base of support.

Perfomance do transverso do abdómen : recurso à ecografia como informação de retorno extrínseca

RESUMO: Desenho do estudo: Estudo quantitativo, experimental prospectivo de factor único, desenho pré-teste, pós-teste. Objectivos: Determinar a efectividade da ecografia em tempo real, como Informação de Retorno Extrínseca Visual Ecográfica (IRE-VE) na performance do transverso do abdómen (TrA), em sujeitos saudáveis; analisar eventuais diferenças entre a IRE-VE e a Informação de Retorno Extrínseca Verbal Clínica (IRE-VC); medir a performance da musculatura abdominal, através das diferenças na espessura dos músculos TrA e oblíquo interno (OI) e deslizamento do TrA, em repouso e em contracção. Enquadramento: A maioria dos indivíduos não tem conhecimentos nem consciência do contributo de uma boa performance do TrA para a estabilidade da coluna lombar. Vários estudos recentes se têm dedicado a este assunto, tendo sido mostrado o importante contributo da ecografia como Informação de Retorno Extrínseca (IRE). Uma vez que o TrA e o OI contribuem para a estabilidade lombo pélvica, e que a aprendizagem do seu controlo motor é essencial para a recuperação da função, torna-se relevante clarificar o contributo da informação de retorno na primeira fase da aprendizagem da performance desses músculos, bem como encontrar as melhores estratégias para a sua realização. A ecografia foi o instrumento escolhido para servir esse objectivo. Métodos: Participaram no estudo 75 sujeitos, sem queixas lombares, com idades compreendidas entre os 18 e os 38 anos com um valor médio de 21,9 anos (±4,03), divididos aleatoriamente em três grupos com uma tarefa comum: a “Manobra do Transverso”, em que um grupo não recebeu IRE (GC), outro recebeu IRE verbal clínica e palpatória (GIRE-VC) e ooutro recebeu IRE visual ecográfica (GIRE-VE). Para efeitos de análise da contracção da musculatura abdominal, foram estudadas a espessura dos músculos TrA e OI e o deslizamento do TrA, visualizados em imagens ecográficas em tempo real, e congeladas para medição em diferido. Estes procedimentos foram apurados num estudo piloto de fidedignidade das medições em causa. Quanto à abordagem estatística das variáveis de performance muscular foi realizada uma análise da variância simples paramétrica para amostras independentes e um teste para a diferença de médias para amostras emparelhadas. Resultados: Observamos que no GC, a ausência de IRE cursou com uma performance idêntica nos dois momentos de avaliação e que nos dois grupos com IRE, das variáveis de performance, é significativamente diferente a contracção do TrA, para uma diferença de 1,95 mm no GIRE-VE (p=0,000) e de 0,84 mm no GIRE-VC (p=0,000). Ao comparar os grupos entre si houve diferenças no limiar da significância (p=0,056) para uma melhor contracção do TrA no GIRE-VE. As outras variáveis, contracção do OI e deslizamento do TrA, não revelaram efeito relacionado com a IRE em nenhum dos grupos. Conclusão: Dos resultados obtidos, podemos concluir que a IRE-VE, quando usada isoladamente, na Manobra do Transverso provoca um maior aumento na espessura do TrA, quando comparada com a IRE-VC . O uso da ecografia mostrou ser efectivo na facilitação da performance da Manobra do Transverso em sujeitos saudáveis.---------------------ABSTRACT: Study Design: Single Factor Experimental Design: Pre-Test Post-test Control Group Design. Objectives: To measure the contribution of different types of biofeedack on Transversus Abdominis (TrA) and Internal Oblique (IO) performance through changes in thickness and lateral slide of TrA anterior fascia during abdominal hollowing exercise (AHE). Background: Increasingly clinicians are using real-time ultrasound imaging as a form of supplementing feedback when teaching trunk stabilization exercises to patients; however, there has been no evidence of its effectiveness when used alone. Material and Methods: Seventy-five healthy subjects were divided randomly into 3 groups that received: group 1, no feedback; group 2, verbal and palpatory feedback, and group 3, realtime ultrasound feedback. The TrA and IO performance of each subject was twice assessed (before and after receiving feedback) when performing the AHE in a supine hook-lying position. Analysis of variance and T-test were used for the independent and paired samples, respectively, to determine significant changes in the performance of TrA and IO, based on intra and inter group analysis. Results: Group 1 had no differences between moments; group 2 had significant differences concerning TrA thickness (p=0,000) to a 0,84 mm thickness difference; group 3 had significant differences concerning TrA thickness (p=0,000) to a 1,94 mm difference; The ability to perform the AHE differed only among group 3 and group 1 (p=0.056), and only for changes in thickness of TrA muscle. No differences among groups were found neither for the lateral slide of TrA anterior fascia, nor for the internal oblique thickness. Conclusion: From the results of this study we conclude that real-time ultrasound feedback, when used alone during an AHE, can have a larger increase in TrA thickness when compared to verbal and palpatory feedback. The use of real time ultrasound showed to be effective as a feedback tool to facilitate the performance of the AHE in a supine hook-lying position in healthy subjects.