Freehand Three-Dimensional Ultrasound to Evaluate Scapular Movement

Altered scapular kinematics have been linked to increases in shoulder pain and pathology. As such, identifying normal scapular movement is integral to preventing pathology and maintaining health of the joint. Existing methods to evaluate scapular movement are invasive, expensive, require exposure to radiation, suffer skin based motion artifacts, or allow for examination only in static postures. Freehand three-dimensional ultrasound offers the unique ability to image bone while being non-invasive, relatively low cost, and free of radiation. This is a novel application of a technology that in the past has been used for needle guided injections and determining changes in organ volumes, but never for evaluating bone movement. We have developed a custom freehand-ultrasound system that shows high repeatability across trials (SEM < 2°) in evaluating scapular kinematics in static postures with the arm at rest and elevated in the sagittal, frontal and scapular planes. Among manual wheelchair users and able-bodied controls we found scapular kinematics with the arm in an elevated position were predicted by scapular and trunk position at rest. We also found BMI ≥ 25, presence of pathology on a physical exam, shoulder abnormalities on a clinical ultrasound exam, and greater than 10 years of wheelchair use resulted in scapular postures associated with shoulder pathology in previous studies. We found no significant differences between wheelchair users and age-matched controls but attribute this to a lack of difference in pathology between the groups. A learning curve was identified over time for capturing quality ultrasound images and it is suggested future studies incorporate ample training time and require raters to meet minimum performance measures set forth by this study. In a subsample of subjects we found increases in external rotation, upward rotation and posterior tilting at incremental angles of humeral elevation during dynamic trials indicating that it is feasible to apply our methods to evaluate dynamic scapular movement. Application of these methods may help to identify shoulder pathology and evaluate the efficacy of interventions to correct altered scapular kinematics

Genome sequencing reveals Zika virus diversity and spread in the Americas

Although the recent Zika virus (ZIKV) epidemic in the Americas and its link to birth defects have attracted a great deal of attention, much remains unknown about ZIKV disease epidemiology and ZIKV evolution, in part owing to a lack of genomic data. Here we address this gap in knowledge by using multiple sequencing approaches to generate 110 ZIKV genomes from clinical and mosquito samples from 10 countries and territories, greatly expanding the observed viral genetic diversity from this outbreak. We analysed the timing and patterns of introductions into distinct geographic regions; our phylogenetic evidence suggests rapid expansion of the outbreak in Brazil and multiple introductions of outbreak strains into Puerto Rico, Honduras, Colombia, other Caribbean islands, and the continental United States. We find that ZIKV circulated undetected in multiple regions for many months before the first locally transmitted cases were confirmed, highlighting the importance of surveillance of viral infections. We identify mutations with possible functional implications for ZIKV biology and pathogenesis, as well as those that might be relevant to the effectiveness of diagnostic tests

Adapting Hands-On Science Programs for Students with Disabilities

The CSIRO, Australia's National Science Agency, has recognized their current hands-on science outreach programs do not accommodate students with disabilities and seeks to make adjustments to existing programs. Present methods for teaching students with disabilities were investigated through literature review and interviews with teachers and disability practitioners. Through observations of CSIRO programs, barriers for students with disabilities were identified. This information was used to develop a framework for adapting hands-on science programs for students with disabilities. Implementation of the framework achieves program accessibility and increases awareness of the capabilities of students with disabilities, affording them the same opportunities as their peers

Effective Stiffness of Suspended Gels

In chronic wound healing there is an over-production of myofibroblasts, resulting from the stiffness of the surrounding environment. Wound healing is studied in vitro using collagen gels and stiffness is often determined using destructive methods. A device was developed to determine stiffness non-destructively by using transverse loading methods to measure force and displacement. The device was validated by comparing results with literature on transverse loading. Collagen gels were tested to demonstrate repeatability and illustrate compatibility with relevant wound healing models

Effectiveness of Group Wheelchair Skills Training for People With Spinal Cord Injury: A Randomized Controlled Trial

To assess the effectiveness of group wheelchair skills training to elicit improvements in wheelchair skills. Randomized double-blinded controlled trial. Four Spinal Cord Injury Model Systems Centers. Manual wheelchair users with spinal cord injury (N=114). Six 90-minute group Wheelchair Skills Training Program (WSTP) classes or two 1-hour active control sessions with 6 to 10 people per group. Baseline (t1) and 1-month follow-up (t2) Wheelchair Skills Test Questionnaire (WST-Q) (Version 4.2) for capacity and performance and Goal Attainment Scale (GAS) score. Follow-up was completed by 79 participants (WSTP: n=36, active control: n=43). No differences were found between missing and complete cases. Many users were highly skilled at baseline with a WST-Q capacity interquartile range of 77% to 97%. There were no differences between groups at baseline in WST-Q measures or demographics. Compared with the active control group, the WSTP group improved in WST-Q capacity advanced score (P=.02) but not in WST-Q capacity or WST-Q performance total scores (P=.068 and P=.873, respectively). The average GAS score (0% at t1) for the WSTP group at t2 was 65.6%±34.8%. Higher GAS scores and WST-Q capacity scores were found for those who attended more classes and had lower baseline skills. Group training can improve advanced wheelchair skills capacity and facilitate achievement of individually set goals. Lower skill levels at baseline and increased attendance were correlated with greater improvement

Using remote learning to teach clinicians manual wheelchair skills: a cohort study with pre- vs post-training comparisons

PURPOSE: To test the hypothesis that remote learning to teach clinicians manual wheelchair skills is efficacious. MATERIALS AND METHODS: A convenience sample of therapists (physical and occupational) and students were enrolled in pairs in a cohort study with pre- versus post-training comparisons. The intervention was a hybrid of self-study and hands-on practice paired with remote feedback for ten intermediate and advanced manual wheelchair skills. Participants practiced with self-selected frequency and duration, uploading a session log and video(s) to an online platform. A remote trainer provided asynchronous feedback prior to the next practice session. Capacity and confidence in completing the ten skills were evaluated using the Wheelchair Skills Test Questionnaire (WST-Q). Knowledge of wheelchair skills training and motor learning was assessed using a 62-item Knowledge Test. Secondary outcome measures included skill achievement, as confirmed by submitted video recordings, and participant feedback about the training. RESULTS: Across 41participants, scores were higher at follow-up compared to baseline for WST-Q capacity (73.9±19.1 vs 16.8±15.6, p<0.001), WST-Q confidence (80.1±12.2 vs 47.6±18.2, p=0.003) and knowledge (70.8±7.5 vs 67.0±5.4, p=0.004). CONCLUSIONS: Remote learning can increase wheelchair skills capacity and confidence as well as knowledge about such training and assessment. This model should be further investigated as a delivery method for training rehabilitation professionals. Clinical Trial Registration Number: NCT0180772