Ultrasound imaging for measuring the material and mechanical properties of the Achilles tendon: inter-day reliability and correlation with a functional calf length test

poster abstractPurpose/Hypothesis: The ability to objectively assess Achilles tendon length and mechanical properties can be challenging because other factors such as muscle and joint mechanics can complicate standard clinical tests. Ultrasound imaging has the ability to provide isolated objective measures of the material and mechanical properties of the Achilles tendon. The primary aim of this study was to assess the inter-day reliability of the material and mechanical properties of the Achilles tendon in a single rater. A secondary aim was to investigate whether there was any relationship between measured tendon properties and calf muscle length measured with a lunge test. Number of subjects: Ten Achilles tendons in 5 subjects (all subjects were 24 years old; 80% female). Material/Methods: Healthy subjects attended 2 identical measurement sessions, 2 days apart. Subjects were measured at the same time of day and were encouraged to perform the same pre-test activities. Immediately prior to the ultrasound imaging, functional calf length was measured in standing with a lunge test. Subjects were then positioned prone with the knee extended and ankle held at 0 degrees of dorsiflexion, and measurements of the resting tendon length and tendon cross-sectional area were obtained from static ultrasound images. Tendon elongation was measured during isometric dynamometry through imaging the proximal movement of the musculotendinous junction of the medial gastrocnemius. Tendon strain was measured at maximum isometric torque. Intra-class correlation coefficients (ICCs) were calculated to determine the reliability of the ultrasound measures. The correlation between tendon properties and the lunge test were examined using a Pearson correlation coefficient, with the level of significance set at 0.05. Results: Reliability analysis demonstrated high inter-day test-retest reliability for resting Achilles tendon length (ICC = 0.95), cross-sectional area (ICC = 0.96) and strain (ICC = 0.95). Tendon elongation measured with ultrasound imaging during peak isometric force had good reliability (ICC = 0.81). A moderate correlation was found between resting tendon length and the lunge test on each day of testing; Day 1 (r=0.67, r2=0.45, p=0.034) and Day 2 (r=0.66, r2=0.44, p=0.038). Conclusion: Ultrasound imaging measurements of the material and mechanical properties of the Achilles tendon has good-to-high inter-day reliability in a single rater. It was also determined that Achilles tendon resting length accounted for ~45% of the variance in the lunge test, indicating other factors contribute to lunge test performance. The later may include talocrural and subtalar joint motion, and length of the gastrocnemius and soleus muscles. Clinical relevance: Ultrasound imaging can be used as a reliable, safe and cost-effective tool to measure isolated Achilles tendon properties. This may allow future studies to explore intervention effects on the material and mechanical characteristics of the tendon

Successful treatment of a guitarist with a finger joint injury using instrument-assisted soft tissue mobilization: a case report

Finger injuries are common and can greatly affect a musician's quality of life. A 55-year-old man, who had injured the proximal interphalangeal joint of the left index finger 6 months prior to any intervention, was treated with a manual therapy approach incorporating instrument-assisted soft tissue mobilization (IASTM). Initial examination findings included self-reported pain and functional limitations and physical impairments that significantly impeded his ability to play the acoustic guitar. He was treated once a week for 6 weeks with IASTM, joint mobilization, therapeutic exercise, and ice massage. Additionally, a home exercise program and self-care instructions were provided. The patient gained positive outcomes with improvements in pain (Numerical Pain Rating Scale while playing the guitar: initial 5/10, discharge 1/10) and function (Disability Arm Shoulder Hand Sports-Performing Arts Optional Module: initial 75; discharge 6·25), each reaching a minimum clinically important difference. Importantly, he was able to play the guitar with minimal to no pain as desired. Physical measures also improved, including an immediate gain in finger range of motion with IASTM alone. Manual therapy approaches integrating IASTM may provide an effective conservative treatment strategy for patients with finger/hand conditions in the performing arts and other patient populations

ULTRASOUND IMAGING AS A DIAGNOSTIC TOOL FOR MUSCLE, TENDON AND FASCIA PATHOLOGIES: AN EMERGING PHYSICAL THERAPY PRACTICE

poster abstractObjective: Ultrasonography (US) is a front-runner for diagnostic imaging in musculoskeletal pathologies associated with muscle, tendon and fascia. The objective of this review was to systematically identify and summarize the literature on current trends of diagnostic ultrasonography in physical therapy. In addition, we expect to establish the merit, validity, and reliabil-ity of diagnostic ultrasonography. Method: A literature search was conducted using: PubMed, ProQuest, Science Direct, Thompson, EMBASE, OVID, CINAHL, and MEDLINE data-bases. Keywords that were used: diagnostic ultrasound, musculoskeletal conditions, rehabilitation, physical therapy. Findings: The current applications for US involving muscle, includes identifying superficial muscles, such as transversus abdominis and multifidus, to provide biofeedback for muscle re-education and measuring cross-sectional area to predict force generation. For tendons, US provides high-resolution images of inflammation, blood flow, and tendon width that assists in diagnosing pathologies such as Achilles tendonitis. US yields clear visualization of fascial thickness and is used to help determine potential eti-ology, confirm clinical diagnosis, and gauge the efficacy of intervention in plantar fasciitis. Research shows that the overall accuracy of US in musculoskeletal medi-cine is significantly similar to the gold standard of diagnostic imaging- MRI. Compared to MRI, US is safer, more convenient, less expensive, non-invasive, and dynamic. Limiting aspects of US include being restricted to su-perficial structures and a lack of minimum clinically important difference val-ues (MCID). Conclusion: Overall, there is a convincing body of evidence supporting the use of US in diagnosis and assessment of muscle, tendon and fascia conditions. Taking into consideration the surplus of clinical applications and advantages over other imaging tools, US is becoming a promising primary instrument for diagnosing and assessing musculoskeletal disorders in physi-cal rehabilitation. The results from this literature review will be used to sup-port the design of clinical trials investigating the effectiveness of manual therapy techniques

Achilles tendon material properties are greater in the jump leg of jumping athletes

Purpose: The Achilles tendon (AT) must adapt to meet changes in demands. This study explored AT adaptation by comparing properties within the jump and non-jump legs of jumping athletes. Non-jumping control athletes were included to control limb dominance effects. Methods: AT properties were assessed in the preferred (jump) and non-preferred (lead) jumping legs of male collegiate-level long and/or high jump (jumpers; n=10) and cross-country (controls; n=10) athletes. Cross-sectional area (CSA), elongation, and force during isometric contractions were used to estimate the morphological, mechanical and material properties of the ATs bilaterally. Results: Jumpers exposed their ATs to more force and stress than controls (all p≤0.03). AT force and stress were also greater in the jump leg of both jumpers and controls than in the lead leg (all p0.05). Conclusion: ATs chronically exposed to elevated mechanical loading were found to exhibit greater mechanical (stiffness) and material (Young’s modulus) properties

Mutations in KDSR Cause Recessive Progressive Symmetric Erythrokeratoderma

Supplemental Data Supplemental Data include five figures and three tables and can be found with this article online at http://dx.doi.org/10.1016/j.ajhg.2017.05.003. Supplemental Data Document S1. Figures S1–S5 and Tables S1–S3 Download Document S2. Article plus Supplemental Data Download Web Resources 1000 Genomes, http://www.internationalgenome.org/ ANNOVAR, http://annovar.openbioinformatics.org/en/latest/ BWA-MEM, http://bio-bwa.sourceforge.net/index.shtml Database of Genomic Variants, http://dgv.tcag.ca/dgv/app/home dbSNP, https://www.ncbi.nlm.nih.gov/projects/SNP/ Exome Aggregation Consortium (ExAC) Browser, http://exac.broadinstitute.org/ ExonPrimer, https://ihg.helmholtz-muenchen.de/ihg/ExonPrimer.html GenBank, https://www.ncbi.nlm.nih.gov/genbank/ Genome Analysis Toolkit (GATK), https://software.broadinstitute.org/gatk/ Integrative Genomics Viewer (IGV), http://software.broadinstitute.org/software/igv/ OMIM, https://www.omim.org/ SNPmasker, http://bioinfo.ebc.ee/snpmasker/ UCSC Genome Browser, https://genome.ucsc.edu/index.html Variant Effect Predictor, http://useast.ensembl.org/info/docs/tools/vep/index.html The discovery of new genetic determinants of inherited skin disorders has been instrumental to the understanding of epidermal function, differentiation, and renewal. Here, we show that mutations in KDSR (3-ketodihydrosphingosine reductase), encoding an enzyme in the ceramide synthesis pathway, lead to a previously undescribed recessive Mendelian disorder in the progressive symmetric erythrokeratoderma spectrum. This disorder is characterized by severe lesions of thick scaly skin on the face and genitals and thickened, red, and scaly skin on the hands and feet. Although exome sequencing revealed several of the KDSR mutations, we employed genome sequencing to discover a pathogenic 346 kb inversion in multiple probands, and cDNA sequencing and a splicing assay established that two mutations, including a recurrent silent third base change, cause exon skipping. Immunohistochemistry and yeast complementation studies demonstrated that the mutations cause defects in KDSR function. Systemic isotretinoin therapy has achieved nearly complete resolution in the two probands in whom it has been applied, consistent with the effects of retinoic acid on alternative pathways for ceramide generation

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

The Changing Face of Neolithic and Bronze Age Ireland: A Big Data Approach to the Settlement and Burial Records

This paper synthesizes and analyses the spatial and temporal patterns of archaeological sites in Ireland spanning the Neolithic period and the Bronze Age transition (4300-1900 cal BC). Included are a large number of unpublished, newly discovered sites excavated through development-led projects. Data were also sourced from national archives, published excavation reports and on-line databases. Software tools were developed to deal with the varying nature and resolution of these datasets, allowing chronology to be considered in the analysis to a degree that is usually not possible in prehistoric studies. Summed radiocarbon probabilities are used to examine the dataset using context- and sample-sensitive approaches. Visualisations of spatial and chronological data illustrate the expansion of Early Neolithic settlement, followed by an apparent attenuation of all settlement activity. The Late Neolithic and Chalcolithic periods are characterised by a resurgence and diversification of activity. To assess the significance of these observations, Irish radiocarbon data are compared to an idealized model derived from North American data. Even after taking various considerations into account, human population increases can be suggested to have occurred during the Early and Late Neolithic periods. Gaps and biases in the data are discussed and priorities for future work are identified

Comparison of active treatments for impaired glucose regulation : a Salford Royal Foundation Trust and Hitachi collaboration (CATFISH): study protocol for a randomized controlled trial

BACKGROUND: Diabetes is highly prevalent and contributes to significant morbidity and mortality worldwide. Behaviour change interventions that target health and lifestyle factors associated with the onset of diabetes can delay progression to diabetes, but many approaches rely on intensive one-to-one contact by specialists. Health coaching is an approach based on motivational interviewing that can potentially deliver behaviour change interventions by non-specialists at a larger scale. This trial protocol describes a randomized controlled trial (CATFISH) that tests whether a web-enhanced telephone health coaching intervention (IGR3) is more acceptable and efficient than a telephone-only health coaching intervention (IGR2) for people with prediabetes (impaired glucose regulation). METHODS: CATFISH is a two-parallel group, single-centre individually randomized controlled trial. Eligible participants are patients aged ≥18 years with impaired glucose regulation (HbA1c concentration between 42 and 47 mmol/mol), have access to a telephone and home internet and have been referred to an existing telephone health coaching service at Salford Royal NHS Foundation Trust, Salford, UK. Participants who give written informed consent will be randomized remotely (via a clinical trials unit) to either the existing pathway (IGR2) or the new web-enhanced pathway (IGR3) for 9 months. The primary outcome measure is patient acceptability at 9 months, determined using the Client Satisfaction Questionnaire. Secondary outcome measures at 9 months are: cost of delivery of IGR2 and IGR3, mental health, quality of life, patient activation, self-management, weight (kg), HbA1c concentration, and body mass index. All outcome measures will be analyzed on an intention-to-treat basis. A qualitative process evaluation will explore the experiences of participants and providers with a focus on understanding usability of interventions, mechanisms of behaviour change, and impact of context on delivery and user acceptability. Qualitative data will be analyzed using Framework. DISCUSSION: The CATFISH trial will provide a pragmatic assessment of whether a web-based information technology platform can enhance acceptability of a telephone health coaching intervention for people with prediabetes. The data will prove critical in understanding the role of web applications to improve engagement with evidence-based approaches to preventing diabetes. TRIAL REGISTRATION: ISRCTN16534814 . Registered on 7 February 2016

Facial mimcry and emotion consistency : Influences of memory and context.

This study investigates whether mimicry of facial emotions is a stable response or can instead be modulated and influenced by memory of the context in which the emotion was initially observed, and therefore the meaning of the expression. The study manipulated emotion consistency implicitly, where a face expressing smiles or frowns was irrelevant and to be ignored while participants categorised target scenes. Some face identities always expressed emotions consistent with the scene (e.g., smiling with a positive scene), whilst others were always inconsistent (e.g., frowning with a positive scene). During this implicit learning of face identity and emotion consistency there was evidence for encoding of face-scene emotion consistency, with slower RTs, a reduction in trust, and inhibited facial EMG for faces expressing incompatible emotions. However, in a later task where the faces were subsequently viewed expressing emotions with no additional context, there was no evidence for retrieval of prior emotion consistency, as mimicry of emotion was similar for consistent and inconsistent individuals. We conclude that facial mimicry can be influenced by current emotion context, but there is little evidence of learning, as subsequent mimicry of emotionally consistent and inconsistent faces is similar