Identification of soft tissue injuries by ultrasonography for forensic medical purposes

Introducere. Ultrasonografia a ajuns, actualmente, una dintre cele mai larg utilizate proceduri în practica medicală. Având în vedere răspândirea, accesibilitatea și inocuitatea, importanța acestei proceduri este foarte mare. Peste 1/3 din toate explorările imagistice efectuate la nivel mondial sunt cele ultrasonografice ale țesuturile moi (tegumentelor, țesuturilor subcutanate, tendoanelor și mușchilor). Scopul lucrării. Evidențierea aplicabilității ultrasonografiei în practica medico-legală pentru identificarea leziunilor țesuturilor moi. Material și metode. A fost studiată literatura medicală și medico-legală privind posibilitățile ultrasonografiei în identificarea leziunilor țesuturilor moi și oportunitatea aplicării acestei metode de cercetare pentru scopuri medico-legale. Rezultate. Analiza literaturii medicale a arătat că această tehnică imagistică permite depistarea hemoragiilor din țesuturile moi, rupturilor fibrelor musculare, rupturilor ligamentelor articulare, afectării meniscului și determinarea prezenței diverselor procese inflamatorii la nivel de sistem musculo-scheletal. În același timp, în literatura medico-legală nu există publicații care ar descrie utilitatea acestei metode clinice pentru scopuri judiciare, fapt care, în mod indirect, pledează pentru neutilizarea ei. Cu toate acestea, în practica medico-legală sunt adeseori examinate victime ale diferitor incidente traumatice, care acuză dureri, însă nu prezintă leziuni externe vizibile. Concluzii. Ultrasonografia țesuturilor moi poate avea o aplicabilitate enormă pentru activitatea medico-legală și deveni o metodă de investigare decisivă pentru depistarea leziunilor profunde ale țesuturilor moi, care nu au o exteriorizare vizibilă. Considerăm că, în asemenea cazuri, ultrasonografia ar putea deveni o metodă de elecție și un suport științific argumentat pentru confirmarea prezenței leziunilor profunde și constatarea vechimii acestora.Background. Nowadays, ultrasonography has become one of the most widely used procedures in medical practice. The importance of this procedure is very high given its widespread, accessibility and harmlessness. More than 1/3 of all imaging examinations performed all over the world are ultrasonographic investigations of soft tissues (skin, subcutaneous tissues, tendons, and muscles). Objective of the study. To highlight the applicability of ultrasonography in forensic medical practice for the identification of soft tissue injuries. Material and methods. Medical and forensic medical literature on the possibilities of ultrasonography in the identification of soft tissue injuries and the suitability of this research method for forensic purposes was reviewed. Results. The review of medical literature showed that this imaging technique allows the detection of soft tissue hemorrhages, muscle fiber tears, joint ligament tears, meniscus damage, and various inflammatory processes in the musculoskeletal system. At the same time, in the forensic medical literature, there are no publications describing the usefulness of this clinical method for forensic purposes, which indirectly argues against its use. However, in forensic medical practice, victims of various traumatic incidents who are in pain but have no visible external injuries are often examined. Conclusions. Soft tissue ultrasonography may have enormous applications for forensic medical practice and sometimes can become a decisive method for the detection of deep soft tissue injuries not visible externally. We do believe that, in such cases, ultrasonography could become a selective method and scientific support for proving the deep lesions and estimating their age

Gait Characterization in Duchenne Muscular Dystrophy (DMD) Using a Single-Sensor Accelerometer: Classical Machine Learning and Deep Learning Approaches

Differences in gait patterns of children with Duchenne muscular dystrophy (DMD) and typically-developing (TD) peers are visible to the eye, but quantifications of those differences outside of the gait laboratory have been elusive. In this work, we measured vertical, mediolateral, and anteroposterior acceleration using a waist-worn iPhone accelerometer during ambulation across a typical range of velocities. Fifteen TD and fifteen DMD children from 3-16 years of age underwent eight walking/running activities, including five 25 meters walk/run speed-calibration tests at a slow walk to running speeds (SC-L1 to SC-L5), a 6-minute walk test (6MWT), a 100 meters fast-walk/jog/run (100MRW), and a free walk (FW). For clinical anchoring purposes, participants completed a Northstar Ambulatory Assessment (NSAA). We extracted temporospatial gait clinical features (CFs) and applied multiple machine learning (ML) approaches to differentiate between DMD and TD children using extracted temporospatial gait CFs and raw data. Extracted temporospatial gait CFs showed reduced step length and a greater mediolateral component of total power (TP) consistent with shorter strides and Trendelenberg-like gait commonly observed in DMD. ML approaches using temporospatial gait CFs and raw data varied in effectiveness at differentiating between DMD and TD controls at different speeds, with an accuracy of up to 100%. We demonstrate that by using ML with accelerometer data from a consumer-grade smartphone, we can capture DMD-associated gait characteristics in toddlers to teens

Machine Learning to Improve Energy Expenditure Estimation in Children With Disabilities: A Pilot Study in Duchenne Muscular Dystrophy.

BackgroundChildren with physical impairments are at a greater risk for obesity and decreased physical activity. A better understanding of physical activity pattern and energy expenditure (EE) would lead to a more targeted approach to intervention.ObjectiveThis study focuses on studying the use of machine-learning algorithms for EE estimation in children with disabilities. A pilot study was conducted on children with Duchenne muscular dystrophy (DMD) to identify important factors for determining EE and develop a novel algorithm to accurately estimate EE from wearable sensor-collected data.MethodsThere were 7 boys with DMD, 6 healthy control boys, and 22 control adults recruited. Data were collected using smartphone accelerometer and chest-worn heart rate sensors. The gold standard EE values were obtained from the COSMED K4b2 portable cardiopulmonary metabolic unit worn by boys (aged 6-10 years) with DMD and controls. Data from this sensor setup were collected simultaneously during a series of concurrent activities. Linear regression and nonlinear machine-learning-based approaches were used to analyze the relationship between accelerometer and heart rate readings and COSMED values.ResultsExisting calorimetry equations using linear regression and nonlinear machine-learning-based models, developed for healthy adults and young children, give low correlation to actual EE values in children with disabilities (14%-40%). The proposed model for boys with DMD uses ensemble machine learning techniques and gives a 91% correlation with actual measured EE values (root mean square error of 0.017).ConclusionsOur results confirm that the methods developed to determine EE using accelerometer and heart rate sensor values in normal adults are not appropriate for children with disabilities and should not be used. A much more accurate model is obtained using machine-learning-based nonlinear regression specifically developed for this target population

Longitudinal study of upper extremity reachable workspace in fascioscapulohumeral muscular dystrophy

Facioscapulohumeral Dystrophy (FSHD) results in slowly progressive strength impairment, especially the upper extremities. Recent discoveries regarding pathophysiology have led to exciting novel therapeutic strategies. To further facilitate drug development, improved FSHD outcome measures that are functionally-relevant and sensitive to longitudinal change will be critical. Recently, a motion sensor (Kinect)-based upper extremity outcome called 'reachable workspace' that provides a quantitative reconstruction of an individual's reachability was developed. In this study, changes in reachable workspace were tracked upwards for five-years in 18 FSHD subjects. Results show -1.63 %/year decline in total reachable workspace (p = 0.144); with most notable decline in the above-the-shoulder level quadrants (upper-lateral Q3: -9.5 %/year, p < 0.001 and upper-medial Q1: -6.8 %/ year, p = 0.063) with no significant changes in the lower quadrants (Q2, Q4). Reachable workspace declined more significantly if the subjects were challenged with 500 g wrist weights: total reachable workspace: -1.82 %/year, p = 0.039; Q1: -7.20 %/year, p = 0.041; Q3: -8.09 %/year, p = 0.001. Importantly, reachable workspace outcome was also able to distinguish subgroups in FSHD: mildly- and severely-affected with essentially unchanging reachability over years, and moderately-affected who demonstrate the most detectable changes longitudinally. The study demonstrates utility for measuring declines in upper quadrant reachability, and provides enrichment/stratification of FSHD populations most likely to show treatment effects in clinical trials

Reachable workspace in facioscapulohumeral muscular dystrophy (FSHD) by kinect

IntroductionA depth-ranging sensor (Kinect) based upper extremity motion analysis system was applied to determine the spectrum of reachable workspace encountered in facioscapulohumeral muscular dystrophy (FSHD).MethodsReachable workspaces were obtained from 22 individuals with FSHD and 24 age- and height-matched healthy controls. To allow comparison, total and quadrant reachable workspace relative surface areas (RSAs) were obtained by normalizing the acquired reachable workspace by each individual's arm length.ResultsSignificantly contracted reachable workspace and reduced RSAs were noted for the FSHD cohort compared with controls (0.473 ± 0.188 vs. 0.747 ± 0.082; P < 0.0001). With worsening upper extremity function as categorized by the FSHD evaluation subscale II + III, the upper quadrant RSAs decreased progressively, while the lower quadrant RSAs were relatively preserved. There were no side-to-side differences in reachable workspace based on hand-dominance.ConclusionsThis study demonstrates the feasibility and potential of using an innovative Kinect-based reachable workspace outcome measure in FSHD

Development and application of stereo camera-based upper extremity workspace evaluation in patients with neuromuscular diseases.

BackgroundThe concept of reachable workspace is closely tied to upper limb joint range of motion and functional capability. Currently, no practical and cost-effective methods are available in clinical and research settings to provide arm-function evaluation using an individual's three-dimensional (3D) reachable workspace. A method to intuitively display and effectively analyze reachable workspace would not only complement traditional upper limb functional assessments, but also provide an innovative approach to quantify and monitor upper limb function.Methodology/principal findingsA simple stereo camera-based reachable workspace acquisition system combined with customized 3D workspace analysis algorithm was developed and compared against a sub-millimeter motion capture system. The stereo camera-based system was robust, with minimal loss of data points, and with the average hand trajectory error of about 40 mm, which resulted to ~5% error of the total arm distance. As a proof-of-concept, a pilot study was undertaken with healthy individuals (n = 20) and a select group of patients with various neuromuscular diseases and varying degrees of shoulder girdle weakness (n = 9). The workspace envelope surface areas generated from the 3D hand trajectory captured by the stereo camera were compared. Normalization of acquired reachable workspace surface areas to the surface area of the unit hemi-sphere allowed comparison between subjects. The healthy group's relative surface areas were 0.618±0.09 and 0.552±0.092 (right and left), while the surface areas for the individuals with neuromuscular diseases ranged from 0.03 and 0.09 (the most severely affected individual) to 0.62 and 0.50 (very mildly affected individual). Neuromuscular patients with severe arm weakness demonstrated movement largely limited to the ipsilateral lower quadrant of their reachable workspace.Conclusions/significanceThe findings indicate that the proposed stereo camera-based reachable workspace analysis system is capable of distinguishing individuals with varying degrees of proximal upper limb functional impairments

Reachable workspace reflects dynamometer‐measured upper extremity strength in facioscapulohumeral muscular dystrophy

IntroductionIt is not known whether a reduction in reachable workspace closely reflects loss of upper extremity strength in facioscapulohumeral muscular dystrophy (FSHD). In this study we aimed to determine the relationship between reachable workspace and quantitative upper extremity strength measures.MethodsMaximal voluntary isometric contraction (MVIC) testing of bilateral elbow flexion and shoulder abduction by hand-held dynamometry was performed on 26 FSHD and 27 control subjects. In addition, Kinect sensor-based 3D reachable workspace relative surface areas (RSAs) were obtained. Loading (500-g weight) effects on reachable workspace were also evaluated.ResultsQuantitative upper extremity strength (MVIC of elbow flexion and shoulder abduction) correlated with Kinect-acquired reachable workspace RSA (R = 0.477 for FSHD, P = 0.0003; R = 0.675 for the combined study cohort, P < 0.0001). Progressive reduction in RSA reflected worsening MVIC measures. Loading impacted the moderately weak individuals the most with additional reductions in RSA.ConclusionsReachable workspace outcome measure is reflective of upper extremity strength impairment in FSHD

Upper extremity 3‐dimensional reachable workspace analysis in dystrophinopathy using Kinect

IntroductionAn innovative upper extremity 3-dimensional (3D) reachable workspace outcome measure acquired using the Kinect sensor is applied toward Duchenne/Becker muscular dystrophy (DMD/BMD). The validity, sensitivity, and clinical meaningfulness of this novel outcome measure are examined.MethodsUpper extremity function assessment (Brooke scale and NeuroQOL questionnaire) and Kinect-based reachable workspace analyses were conducted in 43 individuals with dystrophinopathy (30 DMD and 13 BMD, aged 7-60 years) and 46 controls (aged 6-68 years).ResultsThe reachable workspace measure reliably captured a wide range of upper extremity impairments encountered in both pediatric and adult, as well as ambulatory and non-ambulatory individuals with dystrophinopathy. Reduced reachable workspaces were noted for the dystrophinopathy cohort compared with controls, and they correlated with Brooke grades. In addition, progressive reduction in reachable workspace correlated directly with worsening ability to perform activities of daily living, as self-reported on the NeuroQOL.ConclusionThis study demonstrates the utility and potential of the novel sensor-acquired reachable workspace outcome measure in dystrophinopathy

Upper extremity 3‐dimensional reachable workspace assessment in amyotrophic lateral sclerosis by Kinect sensor

IntroductionReachable workspace is a measure that provides clinically meaningful information regarding arm function. In this study, a Kinect sensor was used to determine the spectrum of 3-dimensional reachable workspace encountered in a cross-sectional cohort of individuals with amyotrophic lateral sclerosis (ALS).MethodsBilateral 3D reachable workspace was recorded from 10 subjects with ALS and 17 healthy controls. The data were normalized by each individual's arm length to obtain a reachable workspace relative surface area (RSA). Concurrent validity was assessed by correlation with scoring on the ALS Functional Rating Score-revised (ALSFRSr).ResultsThe Kinect-measured reachable workspace RSA differed significantly between the ALS and control subjects (0.579 ± 0.226 vs. 0.786 ± 0.069; P < 0.001). The RSA demonstrated correlation with ALSFRSr upper extremity items (Spearman correlation ρ = 0.569; P = 0.009). With worsening upper extremity function, as categorized by the ALSFRSr, the reachable workspace also decreased progressively.ConclusionsThis study demonstrates the feasibility and potential of using a novel Kinect-based reachable workspace outcome measure in ALS