A Force Sensing Instrument Assisted Soft Tissue Mobilization Device

Instrument assisted soft tissue mobilization (IASTM) is a form of massage using rigid manufactured or cast devices. The delivered force, which is a critical parameter in massage during IASTM, has not been measured or standardized for most clinical practices. There is a strong need to characterize the delivered force to a patient. This paper proposes a novel mechatronic design for a specific instrument to apply localized pressure which is a frequently used tool to clinically deliver localize pressure to treat soft tissue. The design is based on 1-D compression load cells, where 4-load cells are used to measure the force components in three-dimensional space. Here the proposed design of the mechatronic IASTM tool is modeled, analyzed, and simulated as a mechanical structure with simplifying assumptions on the elastic behavior of the skin under a certain amount of force conditions. A finite element model of a human arm is simulated to show the relationship between the applied forces, stress and strain on the skin, and force measurements to improve the design. The relation between device’s tip and the modeled arm was assumed to be frictional contact similar to the real IASTM practice

The Indiana University Student Outreach Clinic as a Substrate for Interprofessional Education: A Physical Therapy Perspective

poster abstractPurpose The World Health Organization defines Inter-Professional Education (IPE) as “two or more professions learning about, from and with each other to enable effective collaboration &improve health outcomes.” IPE is being stressed in education to prepare students for Inter-Professional Care (IPC). IPC occurs when multiple health workers from different professional backgrounds provide comprehensive health services. Our purpose is to discuss the Indiana University Student Outreach Clinic (IU-SOC) as an exemplar in IPE/IPC in preparing PT students for clinical practice. Description The IU-SOC has implemented IPE/IPC by collaborating with partners from the schools of medicine, pharmacy, law, social work, dentistry, and most recently, physical therapy. Student leaders collaborate to provide comprehensive patient care. Different committees are in place to facilitate communication between disciplines. One PT student is designated in the IPE role to assist other partners in determining if a patient is appropriate for PT. This model has allowed PT to communicate reciprocally with medicine to ensure best patient care. Summary of Use IU-SOC is unique because it is a student-run pro bono clinic where teaching IPE/IPC is a primary purpose. Students benefit from this model by learning the importance of communication between disciplines early in their education to better prepare for IPC; making them more likely to utilize it during clinical practice. The community has increased access to services and is utilizing healthcare resources more efficiently, with less reliance on emergency services. Occupational Therapy is anticipated to join rehab services in the near future. Importance to Members IPC helps to sustain the health care system, improve outcomes, enhance organizational efficiency, and provide more comprehensive care. IPC is the future of health care; the foundation of which must be established in education. Multi-disciplinary, student-led outreach clinics, such as IU-SOC, can serve as an IPE/IPC substrate to prepare PT students for practice

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

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

Quantifiable Soft Tissue Manipulation (QSTM): A Requisite to Advance the Field of Manual Therapy

Quantifiable soft tissue manipulation (QSTM) that can characterize the motion and forces delivered during soft tissue examination and treatment of common musculoskeletal (MS) conditions in a real-time and clinically applicable manner is needed to achieve optimal outcomes. Soft tissue manipulation (STM), e.g. massage, is a type of mechanotherapy that has been used with benefit frequently by clinicians worldwide since ancient times. Instrument-assisted STM (IASTM) is a type of STM that uses rigid devices to assess and treat soft tissue abnormalities in a targeted and precise manner. Remarkably, however, the forces delivered during STM approaches have not been adequately quantified. Unlike other mechano-therapeutic approaches, e.g. ultrasound, traction, exercise, electrical stimulation, current manual therapy practice relies mostly on subjective description of STM evaluation findings and treatment parameters. This makes documentation, analysis, comparison, progression and optimization of this non-invasive intervention difficult to establish and validate. It is the authors’ strong opinion that there is need for QSTM to objectively measure, characterize and record the 3-dimensional (3D) forces and motion trajectories of STM evaluation and intervention. Innovative technology aimed to help address this void in research, educational and clinical practice has been developed by our research team and introduced in this article. The QSTM system has two components: an electronic, handheld device (applicator) for 3D characterization of force and a computer with software for data acquisition and analysis. Preliminary testing has demonstrated that the QSTM prototype can provide accurate sensed values and good intra-, inter-rater reliability. Device revisions are in progress and further testing is planned in animals and humans. QSTM is an essential technology needed for the standardization, comparison and optimization of STM therapies and a requisite to advance the field of manual therapy

Whole-Body Vibration Training Increases Stem/Progenitor Cell Circulation Levels and May Attenuate Inflammation

Introduction Whole-body vibration training (WBVT) may benefit individuals with difficulty participating in physical exercise. The objective was to explore the effects of WBVT on circulating stem/progenitor cell (CPC) and cytokine levels. Methods Healthy male subjects each performed three activities randomly on separate days: (1) standing platform vibration, (2) repetitive leg squat exercise; and (3) in combination. Pre- and post-activity blood samples were drawn. Cell populations were characterized using flow cytometry. Biomarkers were analyzed using enzyme-linked immunosorbent assays. Results CPC levels increased significantly 21% with exercise alone (1465 ± 202–1770 ± 221 cells/mL; P = 0.017) and 33% with vibration alone in younger participants (1918 ± 341–2559 ± 496; P = 0.02). Angiogenic CPCs increased 39% during combined activity in younger (633 ± 128–882 ± 181; P = 0.05). Non-angiogenic CPCs increased 42% with vibration alone in younger (1181 ± 222–1677 ± 342; P = 0.04), but 32% with exercise alone in older participants (801 ± 251–1053 ± 325; P = 0.05). With vibration alone, anti-inflammatory cytokine interleukin-10 increased significantly (P < 0.03), although inflammatory interleukin-6 decreased (P = 0.056); tumor necrosis factor-alpha (P < 0.01) and vascular endothelial growth factor levels increased (P < 0.005), which are synergistically pro-angiogenic. Conclusions WBVT may have positive vascular and anti-inflammatory effects. WBVT could augment or serve as an exercise surrogate in warfighters and others who cannot fully participate in exercise programs, having important implications in military health

Dysfunctional stem and progenitor cells impair fracture healing with age

Successful fracture healing requires the simultaneous regeneration of both the bone and vasculature; mesenchymal stem cells (MSCs) are directed to replace the bone tissue, while endothelial progenitor cells (EPCs) form the new vasculature that supplies blood to the fracture site. In the elderly, the healing process is slowed, partly due to decreased regenerative function of these stem and progenitor cells. MSCs from older individuals are impaired with regard to cell number, proliferative capacity, ability to migrate, and osteochondrogenic differentiation potential. The proliferation, migration and function of EPCs are also compromised with advanced age. Although the reasons for cellular dysfunction with age are complex and multidimensional, reduced expression of growth factors, accumulation of oxidative damage from reactive oxygen species, and altered signaling of the Sirtuin-1 pathway are contributing factors to aging at the cellular level of both MSCs and EPCs. Because of these geriatric-specific issues, effective treatment for fracture repair may require new therapeutic techniques to restore cellular function. Some suggested directions for potential treatments include cellular therapies, pharmacological agents, treatments targeting age-related molecular mechanisms, and physical therapeutics. Advanced age is the primary risk factor for a fracture, due to the low bone mass and inferior bone quality associated with aging; a better understanding of the dysfunctional behavior of the aging cell will provide a foundation for new treatments to decrease healing time and reduce the development of complications during the extended recovery from fracture healing in the elderly

Mechanical stimulation of human dermal fibroblasts regulates pro-inflammatory cytokines: potential insight into soft tissue manual therapies

Objective Soft tissue manual therapies are commonly utilized by osteopathic physicians, chiropractors, physical therapists and massage therapists. These techniques are predicated on subjecting tissues to biophysical mechanical stimulation but the cellular and molecular mechanism(s) mediating these effects are poorly understood. Previous studies established an in vitro model system for examining mechanical stimulation of dermal fibroblasts and established that cyclical strain, intended to mimic overuse injury, induces secretion of numerous pro-inflammatory cytokines. Moreover, mechanical strain intended to mimic soft tissue manual therapy reduces strain-induced secretion of pro-inflammatory cytokines. Here, we sought to partially confirm and extend these reports and provide independent corroboration of prior results. Results Using cultures of primary human dermal fibroblasts, we confirm cyclical mechanical strain increases levels of IL-6 and adding long-duration stretch, intended to mimic therapeutic soft tissue stimulation, after cyclical strain results in lower IL-6 levels. We also extend the prior work, reporting that long-duration stretch results in lower levels of IL-8. Although there are important limitations to this experimental model, these findings provide supportive evidence that therapeutic soft tissue stimulation may reduce levels of pro-inflammatory cytokines. Future work is required to address these open questions and advance the mechanistic understanding of therapeutic soft tissue stimulation

Conference Report: 6th Annual International Symposium on Regenerative Rehabilitation

The 6th International Symposium on Regenerative Rehabilitation, hosted by the Alliance for Regenerative Rehabilitation Research and Training (AR3T), included a preconference meeting of institutional representatives of the International Consortium of Regenerative Rehabilitation, keynote talks from distinguished scientists, platform and poster presentations from experts and trainees, panel discussions and postconference workshops. The following priorities were identified: increasing rigor in basic, preclinical and clinical studies, especially the use of better controls; developing better outcome measures for preclinical and clinical trials; focusing on developing more tissue-based interventions versus cell-based interventions; including regenerative rehabilitation in curricula of professional programs like occupational and physical therapy; and developing better instruments to quantify rehabilitative interventions

Development of a Force Sensing Instrument Assisted Soft Tissue Mobilization Device

Instrument assisted soft tissue mobilization (IASTM) is a form of massage using rigid manufactured or cast devices. The delivered force, which is a critical parameter in massage during IASTM, has not been measured or standardized for most clinical practices. In addition to the force, the angle of treatment and frequency play an important role during IASTM. As a result, there is a strong need to characterize the delivered force to a patient, angle of treatment, and stroke frequency. This paper proposes a novel mechatronic design for a specific instrument from Graston Technique® (Model GT-3), which is a frequently used tool to clinically deliver localize pressure to the soft tissue. The design uses a 3D load cell, which can measure all three force components force simultaneously. The overall design is implemented with an IMUduino microcontroller chip which can also measure tool orientation angles and provide computed stroke frequency. The prototype of the mechatronic IASTM tool was validated for force measurements using an electronic plate scale that provided the baseline force values to compare with the applied force magnitudes measured by the device. The load cell measurements and the scale readings were found to be in agreement within the expected degree of accuracy. The stroke frequency was computed using the force data and determining the peaks during force application. The orientation angles were obtained from the built-in sensors in the microchip