Reliability of ultrasound to measure morphology of the toe flexor muscles

Measuring the strength of individual foot muscles is very challenging; however, measuring muscle morphology has been shown to be associated with strength [1]. A reliable method of assessing foot muscle atrophy and hypertrophy would therefore be beneficial to researchers and clinicians. Real-time ultrasound (US) is a non-invasive, objective and inexpensive method of assessing muscle morphology and has been employed widely to quantify cross-sectional area (CSA) and linear dimensions of larger muscles (e.g. quadriceps, triceps surae). Few studies, however, have determined its ability to measure the small muscles of the foot and ankle. This study aimed to determine whether US is a reliable tool to measure the morphology of the toe flexor muscles

Effects of age on strength and morphology of toe flexor muscles

Study Design: Cross-sectional. 27 Objective: To compare the strength and size of the toe flexor muscles of older adults relative 28 to their younger counterparts. 29 Background: Age related muscle atrophy is common in lower limb muscles and we therefore 30 speculated that foot muscles also diminish with age. However, there is a paucity of literature 31 characterizing foot muscle strength and morphology, and any relationship between these two, 32 in older people. 33 Methods: Seventeen young adults with a normal foot type were matched by gender and BMI 34 to 17 older adults with a normal foot type, from an available sample of 41 young (18-50 35 years) and 44 older (60+ years) adults. Among the matched groups (n=34), muscle thickness 36 and cross-sectional area (CSA) for five intrinsic and two extrinsic toe flexor muscles were 37 obtained using ultrasound. Toe strength was assessed using a pressure platform. Differences 38 in toe flexor strength and muscle size between the young and older matched groups were 39 determined using ANCOVA (controlling for height). Correlations between strength and size 40 of the toe flexor muscles of the pooled group (n=34) were also calculated. 41 Results: Toe strength and the thickness and CSA of most foot muscles and were significantly 42 reduced in the older adults (P<0.05). Hallux and toe flexor strength were strongly correlated 43 with the size of the intrinsic muscles toe flexor muscles. 44 Conclusion: The smaller foot muscles appear to be affected by sarcopenia in older adults. 45 This could contribute to reduced toe flexion force production and affect the ability of older 46 people to walk safely. Interventions aimed at reversing foot muscle atrophy in older people 47 require further investigation

Plantar fascia segmentation and thickness estimation in ultrasound images

Ultrasound (US) imaging offers significant potential in diagnosis of plantar fascia (PF) injury and monitoring treatment. In particular US imaging has been shown to be reliable in foot and ankle assessment and offers a real-time effective imaging technique that is able to reliably confirm structural changes, such as thickening, and identify changes in the internal echo structure associated with diseased or damaged tissue. Despite the advantages of US imaging, images are difficult to interpret during medical assessment. This is partly due to the size and position of the PF in relation to the adjacent tissues. It is therefore a requirement to devise a system that allows better and easier interpretation of PF ultrasound images during diagnosis. This study proposes an automatic segmentation approach which for the first time extracts ultrasound data to estimate size across three sections of the PF (rearfoot, midfoot and forefoot). This segmentation method uses artificial neural network module (ANN) in order to classify small overlapping patches as belonging or not-belonging to the region of interest (ROI) of the PF tissue. Features ranking and selection techniques were performed as a post-processing step for features extraction to reduce the dimension and number of the extracted features. The trained ANN classifies the image overlapping patches into PF and non-PF tissue, and then it is used to segment the desired PF region. The PF thickness was calculated using two different methods: distance transformation and area-length calculation algorithms. This new approach is capable of accurately segmenting the PF region, differentiating it from surrounding tissues and estimating its thickness

A framework for guiding the learning of ultrasound scanning

Ultrasound scanning is provided by a range of health professionals who need to be trained to a proficient level. In respect of education and training in ultrasound scanning, little attention has been given to how scanning skills are acquired and what assists and hinders the learning process. This study aims to develop a framework for guiding learning in ultrasound scanning. Overt participant observation and semi-structured interviews generated data on four learners undertaking a 12-month postgraduate ultrasound programme. Narrative analysis of the interview data was used to reveal dominant themes related to stages in learning to scan. Dominant themes associated with learning to scan were; communication with the patient, navigation skills, image interpretation skills, observation of practice, feedback on performance, random practise. Detailed interpretation of the themes through narrative analysis provided characteristics of learning for each stage of a four staged process. This study provides an insight into the key features of scan performance and how scanning skills are acquired over a four staged approach. These themes and characteristics are presented in a framework for guiding learning in ultrasound scanning

Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial

Background Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects. Methods FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762. Findings Between Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839–1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26–6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38–2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months. Interpretation Fluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function. Funding UK Stroke Association and NIHR Health Technology Assessment Programme

A framework of learning experiences in ultrasound scanning

This thesis explores learning experiences in ultrasound scanning by examining the ways that sonographers, at various stages in their professional development, scan patients. The qualitative study developed a framework, the themed content of which emerged from the sonographers' own narratives of their learning experiences. The focus on, and the consequent analysis of the sonographers' narratives at different points in their learning led to the construction of a staged framework. The study's sample was designed to cover a broad spectrum of experience and was divided into two groups, differentiated by their qualification status. Purposive sampling was used, recruiting ten participants who recounted their learning experiences to the researcher. The researcher took the role of participant observer. Data was generated via direct observation of sonographers in their working context and the use of semi-structured interviews facilitated the telling of narratives of the individual's learning experiences. These narratives were then formally analysed to seek a better understanding of why the subject performed in the way that they did. The resulting framework was constructed from the analyses of the narratives; it comprises seven stages ranging from 'starting to scan' to 'excellence in scanning'. This Framework of Learning Experiences in Ultrasound Scanning is the first experiential framework of its kind which shows how progress in scanning develops over time. Its focus on process also adds empirical evidence to the sparse literature concerning scanning performance. The framework is foundational in the sense that it has potential implications for curricula, training, and service delivery related to the Sonographers' profession and role. However, the intent of the framework is to understand better the experience of learning to scan and therefore it is a necessary precursor to any future work that seeks to apply that understanding to practice.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Plantar fascia segmentation and thickness estimation in ultrasound images

Ultrasound (US) imaging offers significant potential in diagnosis of plantar fascia (PF) injury and monitoring treatment. In particular US imaging has been shown to be reliable in foot and ankle assessment and offers a real-time effective imaging technique that is able to reliably confirm structural changes, such as thickening, and identify changes in the internal echo structure associated with diseased or damaged tissue. Despite the advantages of US imaging, images are difficult to interpret during medical assessment. This is partly due to the size and position of the PF in relation to the adjacent tissues. It is therefore a requirement to devise a system that allows better and easier interpretation of PF ultrasound images during diagnosis. This study proposes an automatic segmentation approach which for the first time extracts ultrasound data to estimate size across three sections of the PF (rearfoot, midfoot and forefoot). This segmentation method uses artificial neural network module (ANN) in order to classify small overlapping patches as belonging or not-belonging to the region of interest (ROI) of the PF tissue. Features ranking and selection techniques were performed as a post-processing step for features extraction to reduce the dimension and number of the extracted features. The trained ANN classifies the image overlapping patches into PF and non-PF tissue, and then it is used to segment the desired PF region. The PF thickness was calculated using two different methods: distance transformation and area-length calculation algorithms. This new approach is capable of accurately segmenting the PF region, differentiating it from surrounding tissues and estimating its thickness

Effects of age on strength of the toe flexor muscles

Abstract of paper that presented at the Eleventh Footwear Biomechanics Symposium, Natal, Brazil, 2013