Monitoring Progression of Amyotrophic Lateral Sclerosis Using Ultrasound Morpho-Textural Muscle Biomarkers: A Pilot Study.

The need is increasing for progression biomarkers that allow the loss of motor neurons in amyotrophic lateral sclerosis (ALS) to be monitored in clinical trials. In this prospective longitudinal study, muscle thickness, echointensity, echovariation and gray level co-occurrence matrix textural features are examined as possible progression ultrasound biomarkers in ALS patients during a 5-mo follow-up period. We subjected 13 patients to 3 measurements for 20 wk. They showed a significant loss of muscle, an evident tendency to loss of thickness and increased echointensity and echovariation. In regard to textural parameters, muscle heterogeneity tended to increase as a result of the neoformation of non-contractile tissue through denervation. Considering some limitations of the study, the quantitative muscle ultrasound biomarkers evaluated showed a promising ability to monitor patients affected by ALS.Universidad Caólica San Antonio de Murcia.Medicin

Quantitative muscle ultrasonography using textural analysis in amyotrophic lateral sclerosis

Background: To analyze differences in grey level co-ocurrence matrix (GLCM) parameters, as assessed by muscle ultrasound (MUS), between amyotrophic lateral sclerosis (ALS) patients and healthy controls. To compare the diagnostic accuracy of these GLCM parameters with first order MUS parameters (echointensity, EI; echovariation, EV; and muscle thickness, MTh) in different muscle groups. Methods: Twenty-six patients with ALS and twenty-six healthy subjects underwent bilateral and transverse ultrasound of the biceps/brachialis, forearm flexor, quadriceps femoris and tibialis anterior muscle groups. MTh was measured with electronic callipers and EI, EV and GLCM were obtained using Image J (v.1.48) software. Sensitivity, specificity, likelihood ratios and area under the curve (AUC) were performed by logistic regression models and ROCcurves. Results: GLCM parameters showed reduced granularity in the muscles of ALS patients compared with the controls. Regarding the discrimination capacity, the best single diagnostic parameter in forearm flexors and quadriceps was GLCM and in biceps brachialis and tibialis anterior was EV. The respective combination of these two parameters with MTh resulted in the best AUC (over 90% in all muscle groups and close to the maximum combination model). Conclusions: The use of new textural parameters (EV and GLCM) combined with usual quantitative MUS variables are a promising biomarker in ALS.Universidad Católica de Murcia.MedicinaTerapia y Rehabilitació

Muscular echovariation: a new biomarker in amyotrophic lateral sclerosis

The purpose is to assess the characteristics of echovariation in amyotrophic lateral sclerosis (ALS) compared with other MUS parameters. Twenty-six ALS patients (8 women, mean age 58.9 years, SD 12.02 yr) and 26 healthy controls (17 women; mean age 59.6 years, SD 6.41 yr) were included in this observational study. They underwent bilateral and transverse ultrasound of the biceps/brachialis, forearm flexor group, quadriceps femoris and tibialis anterior. Muscular thickness, echointensity and echovariation were analyzed. Muscles affected by ALS showed increased echointensity, decrease in thickness, and decrease echovariation. Echovariation in all muscles but quadriceps femoris, strongly correlated with muscle strength (explained variance between 21.8% in the biceps/brachialis and 37.5% in tibialis anterior) and the ALSFRS-R score (explained variance between 26% in the biceps/brachialis and 36.7% in the forearm flexor group). Echovariation is an easy to obtain QMUS parameter that could distinguish ALS from healthy controls more accurately than previous described biomarkers.UCAMMedicinaTerapia y Rehabilitació

Biomechanic and reeducation of the march after arthroscopy of knee

Una vez se ha adquirido una marcha bípeda equilibrada, ésta pasa a convertirse en un acto involuntario, lo que la hace del mismo modo arriesgada, ya que puede alterarse por diversos factores como es una lesión o la práctica de una intervención quirúrgica como es la artroscopia de rodilla. Por esta razón, hemos creído conveniente establecer unos criterios de normalidad articular durante el ciclo de la marcha y conocer la patomecánica y la efectividad de la reeducación de la misma tras una intervención mediante artroscopia de rodilla. Para la realización de este trabajo, previo consentimiento informado, hemos contado con 50 sujetos (30 dentro de un grupo control y 20 dentro de un grupo de trabajo), llegando a la conclusión que, todos los sujetos del grupo de trabajo que llevaron a cabo una específica reeducación de la marcha, en base a unos datos obtenidos en una primera fase de tratamiento, mejoraron en mayor o menor medida frente a los que no la realizaron.Terapia y Rehabilitació

Textural Analysis by Means of a Grey Level Co-Occurrence Matrix Method on Patellar Tendon Ultrasonography is Useful for the Detection of Histological Changes after Whole-Body Vibration Training

Introducción: Las matrices de co-ocurrencia del nivel de gris (GLCM) son útiles para el análisis textural de imágenes ya la discriminación de patrones pero hasta ahora no se han aplicado sobre imágenes ecográficas del tendón. Objetivo: Análisis textural ecográfico del tendón rotuliano. Método: Estudio longitudinal analítico con 16 sujetos (8 mujeres y 8 hombres) jóvenes, sanos y sedentarios entrenados con una plataforma de vibración vertical (Fitvibe Medical) 2 días x 14 semanas. Se tomaron cortes ecográficos transversales del tendón rotuliano antes y después del entrenamiento con un ecógrafo Sonosite-180 (Lineal 5-10 MHz). Mediante el algoritmo GLCM de Image J v1.38 se calcularon las variables texturales Uniformidad (ASM), Contraste, Correlación, Homogeneidad (IDM) y la Entropía para cuatro orientaciones (0º, 90º, 180º y 270º) y tres distancias (d=1, 5 y 10 px). Se aplicó la prueba de Wilcoxon (i.c.95%) para muestras relacionadas (SPSS 15.0). Resultados: la Entropía (d=5) fue la más sensible a los cambios texturales; quizá la variable ASM, pueda resultar también de interés junto con el Contraste. Conclusiones: Ante la falta de referencias con el uso de la GLCM en el análisis textural de ecografía de tendón son necesarios más análisis que estudien cómo afectan los distintos parámetros a las variables texturales, cómo se relacionan entre sí y cuáles pueden ser los mejores ajustes del algoritmo para detectar cambios en el patrón textural.Actividad Física y DeporteTerapia y RehabilitaciónMedicin

Principles of Physiotherapy in osteoporosis

La osteoporosis, considerada actualmente como una pandemia, afecta a un amplio número de personas, tanto mujeres como hombres, lo que implica elevadas consecuencias económicas y sociales, de entre las cuales destacamos el dolor, la incapacidad y el riesgo de fractura. Su etiología es diversa, pudiendo ser primaria (postmenopáusica, senil,…) y secundaria (tras inmovilización, desequilibrios endocrinos y metabólicos, o bien, enfermedades de tipo digestivo). En todas ellas, una vez instaurada la patología, la fisioterapia desempeña un papel incuestionable, pero es en la prevención de la aparición de la osteoporosis donde esta profesión debe actuar, evitando la afectación del hueso sano.Terapia y Rehabilitació

Degenerative asymtomatic processes of the long head of biceps brachii

El tendón largo del bíceps braquial es considerado el pilar de contención del complejo articular del hombro. Su correcta biomecánica dependerá, además de sí mismo, de las estructuras con las que se relaciona, en especial con el tendón del subescapular y la corredera bicipital. El sobreuso de estas estructuras, aún sin sintomatología, desencadenará compensaciones morfológicas y morfométricas en el tendón largo del bíceps braquial e inestabilidad articular. Un sobreuso del subescapular se encuentra relacionado con: (1). Una mayor angulación interna del tendón largo del bíceps, (2). Una mayor angulación, menor profundidad y mayor anchura de la corredera bicipital. Esto supone que el 35% de las luxaciones del tendón largo del bíceps se encuentren relacionadas con rotura del tendón del subescapular.Terapia y Rehabilitació

Monitoring Progression of Amyotrophic Lateral Sclerosis Using Ultrasound Morpho-Textural Muscle Biomarkers: A Pilot Study.

The need is increasing for progression biomarkers that allow the loss of motor neurons in amyotrophic lateral sclerosis (ALS) to be monitored in clinical trials. In this prospective longitudinal study, muscle thickness, echointensity, echovariation and gray level co-occurrence matrix textural features are examined as possible progression ultrasound biomarkers in ALS patients during a 5-mo follow-up period. We subjected 13 patients to 3 measurements for 20 wk. They showed a significant loss of muscle, an evident tendency to loss of thickness and increased echointensity and echovariation. In regard to textural parameters, muscle heterogeneity tended to increase as a result of the neoformation of non-contractile tissue through denervation. Considering some limitations of the study, the quantitative muscle ultrasound biomarkers evaluated showed a promising ability to monitor patients affected by ALS.Universidad Caólica San Antonio de Murcia.Medicin

Biomechanics of the Median Nerve During Stretching as Assessed by Ultrasonography

The objective of this observational cross-sectional study was to investigate the normal motion of the median nerve when stretched during a neurodynamic exercise. In recent years, ultrasonography has been increasingly accepted as an imaging technique for examining peripheral nerves in vivo, offering a reliable and noninvasive method for a precise evaluation of nerve movement. Transverse motion of the median nerve in the arm during a neurodynamic test was measured. A volunteer sample of 22 healthy subjects (11 women) participated in the study. Nerve displacement and deformation were assessed by dynamic ultrasonography. Excellent interobserver agreement was obtained, with kappa coefficient of .7–.8. Ultrasonography showed no lateral motion during wrist extension in 68% of nerves, while 73% moved dorsally, with statistically significant differences between sexes (ORlat = 6.3; 95% CI = 1.4–27.7 and ORdor = 8.3; 95% CI = 1.6–44.6). The cross-sectional area was significantly greater in men (3.6 mm2). Quantitative analysis revealed no other statistically significant differences. Our results provide evidence of substantial individual differences in median nerve transverse displacement in response to a neurodynamic exercise.Actividad Física y DeporteMedicinaTerapia y Rehabilitació

Biomechanics of the Median Nerve During Stretching as Assessed by Ultrasonography

The objective of this observational cross-sectional study was to investigate the normal motion of the median nerve when stretched during a neurodynamic exercise. In recent years, ultrasonography has been increasingly accepted as an imaging technique for examining peripheral nerves in vivo, offering a reliable and noninvasive method for a precise evaluation of nerve movement. Transverse motion of the median nerve in the arm during a neurodynamic test was measured. A volunteer sample of 22 healthy subjects (11 women) participated in the study. Nerve displacement and deformation were assessed by dynamic ultrasonography. Excellent interobserver agreement was obtained, with kappa coefficient of .7–.8. Ultrasonography showed no lateral motion during wrist extension in 68% of nerves, while 73% moved dorsally, with statistically significant differences between sexes (ORlat = 6.3; 95% CI = 1.4–27.7 and ORdor = 8.3; 95% CI = 1.6–44.6). The cross-sectional area was significantly greater in men (3.6 mm2). Quantitative analysis revealed no other statistically significant differences. Our results provide evidence of substantial individual differences in median nerve transverse displacement in response to a neurodynamic exercise.Actividad Física y DeporteMedicinaTerapia y Rehabilitació