Ultrasound estimates of muscle quality in older adults: reliability and comparison of Photoshop and ImageJ for the grayscale analysis of muscle echogenicity

Background. Quantitative diagnostic ultrasound imaging has been proposed as a method of estimating muscle quality using measures of echogenicity. The Rectangular Marquee Tool (RMT) and the Free Hand Tool (FHT) are two types of editing features used in Photoshop and ImageJ for determining a region of interest (ROI) within an ultrasound image. The primary objective of this study is to determine the intrarater and interrater reliability of Photoshop and ImageJ for the estimate of muscle tissue echogenicity in older adults via grayscale histogram analysis. The secondary objective is to compare the mean grayscale values obtained using both the RMT and FHT methods across both image analysis platforms. Methods. This cross-sectional observational study features 18 community-dwelling men (age = 61.5 ± 2.32 years). Longitudinal views of the rectus femoris were captured using B-mode ultrasound. The ROI for each scan was selected by 2 examiners using the RMT and FHT methods from each software program. Their reliability is assessed using intraclass correlation coefficients (ICCs) and the standard error of the measurement (SEM). Measurement agreement for these values is depicted using Bland-Altman plots. A paired t-test is used to determine mean differences in echogenicity expressed as grayscale values using the RMT and FHT methods to select the post-image acquisition ROI. The degree of association among ROI selection methods and image analysis platforms is analyzed using the coefficient of determination (R2). Results. The raters demonstrated excellent intrarater and interrater reliability using the RMT and FHT methods across both platforms (lower bound 95% CI ICC = .97–.99, p \u3c .001). Mean differences between the echogenicity estimates obtained with the RMT and FHT methods was .87 grayscale levels (95% CI [.54–1.21], p \u3c .0001) using data obtained with both programs. The SEM for Photoshop was .97 and 1.05 grayscale levels when using the RMT and FHT ROI selection methods, respectively. Comparatively, the SEM values were .72 and .81 grayscale levels, respectively, when using the RMT and FHT ROI selection methods in ImageJ. Uniform coefficients of determination (R2 = .96–.99, p \u3c .001) indicate strong positive associations among the grayscale histogram analysis measurement conditions independent of the ROI selection methods and imaging platform. Conclusion. Our method for evaluating muscle echogenicity demonstrated a high degree of intrarater and interrater reliability using both the RMT and FHT methods across 2 common image analysis platforms. The minimal measurement error exhibited by the examiners demonstrates that the ROI selection methods used with Photoshop and ImageJ are suitable for the post-acquisition image analysis of tissue echogenicity in older adults

Using Xbox kinect motion capture technology to improve clinical rehabilitation outcomes for balance and cardiovascular health in an individual with chronic TBI

Background Motion capture virtual reality-based rehabilitation has become more common. However, therapists face challenges to the implementation of virtual reality (VR) in clinical settings. Use of motion capture technology such as the Xbox Kinect may provide a useful rehabilitation tool for the treatment of postural instability and cardiovascular deconditioning in individuals with chronic severe traumatic brain injury (TBI). The primary purpose of this study was to evaluate the effects of a Kinect-based VR intervention using commercially available motion capture games on balance outcomes for an individual with chronic TBI. The secondary purpose was to assess the feasibility of this intervention for eliciting cardiovascular adaptations. Methods A single system experimental design (n = 1) was utilized, which included baseline, intervention, and retention phases. Repeated measures were used to evaluate the effects of an 8-week supervised exercise intervention using two Xbox One Kinect games. Balance was characterized using the dynamic gait index (DGI), functional reach test (FRT), and Limits of Stability (LOS) test on the NeuroCom Balance Master. The LOS assesses end-point excursion (EPE), maximal excursion (MXE), and directional control (DCL) during weight-shifting tasks. Cardiovascular and activity measures were characterized by heart rate at the end of exercise (HRe), total gameplay time (TAT), and time spent in a therapeutic heart rate (TTR) during the Kinect intervention. Chi-square and ANOVA testing were used to analyze the data. Results Dynamic balance, characterized by the DGI, increased during the intervention phase χ 2 (1, N = 12) = 12, p = .001. Static balance, characterized by the FRT showed no significant changes. The EPE increased during the intervention phase in the backward direction χ 2 (1, N = 12) = 5.6, p = .02, and notable improvements of DCL were demonstrated in all directions. HRe (F (2,174) = 29.65, p = \u3c .001) and time in a TTR (F (2, 12) = 4.19, p = .04) decreased over the course of the intervention phase. Conclusions Use of a supervised Kinect-based program that incorporated commercial games improved dynamic balance for an individual post severe TBI. Additionally, moderate cardiovascular activity was achieved through motion capture gaming. Further studies appear warranted to determine the potential therapeutic utility of commercial VR games in this patient population. Trial registration Clinicaltrial.gov ID - NCT0288928

Use of the Adult Myopathy Assessment Tool as a predictor of functional abilities in people with multiple sclerosis

Background: People with multiple sclerosis (PwMS) are at greater risk for decreased muscle performance which may lead to decreased functional abilities. The Kurtzke Expanded Disability Status Scale (EDSS) is commonly used as a disability status rating scale in PwMS. Nevertheless, the EDSS is largely comprised of neurological tests and may not best reflect functional performance. A functional battery such as The Adult Myopathy Assessment Tool (AMAT) may better reflect functional performance. The AMAT was designed to assess both functional strength and endurance in clinical settings. However, the AMAT has not been validated for the assessment of PwMS. Objective: The purpose of the study was to determine the comparative association of the AMAT and EDSS with measures of strength, fatigability, and functional performance. Methods: Twenty-nine people (mean age 48.6 ±11.2), with a history of MS (EDSS \u3c 7.0) were recruited. Participants completed functional testing (5 times sit to stand and gait speed) and an assessment of disability and functional status using the EDSS and AMAT, respectively. Muscle performance was assessed via a 60 s maximal volitional isometric contraction (MVIC) of the knee extensors using an isokinetic dynamometer, and expressed as fatigability (exhaustion time to 60% of MVIC), peak torque, and peak torque scaled to body weight. Results:The participants exhibited moderate levels of disability (EDSS, 3.6 ±1.4) and function (AMAT total score, 36.1 ±7.6; AMAT function subscale, 18.2 ±3.3). Peak force was 70.1 kg ±22.0 kg, exhaustion time was 38.4 s ±17.4 s, gait speed was 1.3 m/s ±0.3 m/s, and five time sit to stand was 11.4 s ±4.1 s. The AMAT function subscale was associated with scaled peak torque (r=0.426, p=.021), gait speed (r=0.825, p=0.00), and 5 time sit to stand (r=-0.632, p Conclusions: The AMAT was more strongly associated with scaled peak torque and functional measures in comparison to the EDSS. This may reflect the observation that relative strength is a better predictor of functional abilities than unadjusted strength measures. Whereas, the stronger association of the EDSS with fatigability may be explained by the pyramidal systems measures within the tool and the well-known association of MS-related fatigue with disability. Based on the results of the study, we suggest clinicians administer the AMAT in addition to the EDSS, to gain insight into functional impairments and assist with formulating a comprehensive plan of care

Personalized Stroke Rehabilitation

Stroke continues to be a leading cause of disability. Many individuals who suffer a stroke will receive specialized rehabilitation designed to maximize recovery and restore independence with daily activities. Yet, recovery is still highly variable with heterogeneity in treatment response that is still poorly understood. In recent years, the growing burden of stroke has pushed for moving away from a “one size fits all” approach with the concept of precision or personalized rehabilitation to generate evidence for clinicians to provide the right care, to the right patient, at the right time. The collection of research in this dissertation addresses key areas of personalized rehabilitation related to standardized outcome measurement, identification of biomarkers, and individualized response to treatment parameters in three parts. Part I illustrates how principals of item response theory can be used to inform a personalized measurement approach through clinical applications of Rasch analysis. Part II demonstrates how muscle coordination is linked with biomechanical variables of walking performance that can be used as potential biomarkers of recovery. Lastly, Part III shows how interindividual differences in treatment response could inform individualized prescription for transcranial direct stimulation for recovery of walking post-stroke as an example of how to approach personalized rehabilitation

Using a Module-Based Analysis Framework for Investigating Muscle Coordination during Walking in Individuals Poststroke: A Literature Review and Synthesis

Factorization methods quantitatively group electromyographic signals from several muscles during dynamic tasks into multiple modules where each module consists of muscles that are coactive during the movement. Module-based analyses may provide an analytical framework for testing theories of poststroke motor control recovery based on one’s ability to move independently from mass flexion-extension muscle group coactivation. Such a framework may be useful for understanding the causality between underlying neural impairments, biomechanical function, and walking performance in individuals poststroke. Our aim is to synthesize current evidence regarding the relationships between modules, gait mechanics, and rehabilitation in individuals poststroke. We synthesized eleven studies that performed module-based analyses during walking tasks for individuals poststroke. Modules were primarily identified by nonnegative matrix factorization, and fewer modules correlated with poor walking performance on biomechanical and clinical measures. Fewer modules indicated reduced ability to control individual muscle timing during paretic leg stance. There was evidence that rehabilitation can lead to the use of more and/or better-timed modules. While future work will need to establish the ability of modules to identify impairment mechanisms, they appear to offer a promising analytical approach for evaluating motor control

Variation of body weight supported treadmill training parameters during a single session can modulate muscle activity patterns in post-stroke gait

Evidence supporting the benefits of locomotor training (LT) to improve walking ability following stroke are inconclusive and could likely be improved with a better understanding of the effects of individual parameters i.e., body weight support (BWS), speed, and therapist assistance and their interactions with walking ability and specific impairments. We evaluated changes in muscle activity of thirty-seven individuals with chronic stroke (> 6 months), in response to a single session of LT at their self-selected or fastest-comfortable speed (FS) with three levels of BWS (0%, 15%, and 30%), and at FS with 30% BWS and seven different combinations of therapist assistance at the paretic foot, non-paretic foot, and trunk. Altered Muscle Activation Pattern (AMAP), a previously developed tool in our lab was used to evaluate the effects of LT parameter variation on eight lower-extremity muscle patterns in individuals with stroke. Repeated-measures mixed-model ANOVA was used to determine the effects of speed, BWS, and their interaction on AMAP scores. The Wilcoxon-signed rank test was used to determine the effects of therapist-assisted conditions on AMAP scores. Increased BWS mostly improved lower-extremity muscle activity patterns, but increased speed resulted in worse plantar flexor activity. Abnormal early plantar flexor activity during stance decreased with assistance at trunk and both feet, exaggerated plantar flexor activity during late swing decreased with assistance to the non-paretic foot or trunk, and diminished gluteus medius activity during stance increased with assistance to paretic foot and/or trunk. Therefore, different sets of training parameters have different immediate effects on activation patterns of each muscle and gait subphases

Ultrasound estimates of muscle quality in older adults: reliability and comparison of Photoshop and ImageJ for the grayscale analysis of muscle echogenicity

Background. Quantitative diagnostic ultrasound imaging has been proposed as a method of estimating muscle quality using measures of echogenicity. The Rectangular Marquee Tool (RMT) and the Free Hand Tool (FHT) are two types of editing features used in Photoshop and ImageJ for determining a region of interest (ROI) within an ultrasound image. The primary objective of this study is to determine the intrarater and interrater reliability of Photoshop and ImageJ for the estimate of muscle tissue echogenicity in older adults via grayscale histogram analysis. The secondary objective is to compare the mean grayscale values obtained using both the RMT and FHT methods across both image analysis platforms. Methods. This cross-sectional observational study features 18 community-dwelling men (age = 61.5 ± 2.32 years). Longitudinal views of the rectus femoris were captured using B-mode ultrasound. The ROI for each scan was selected by 2 examiners using the RMT and FHT methods from each software program. Their reliability is assessed using intraclass correlation coefficients (ICCs) and the standard error of the measurement (SEM). Measurement agreement for these values is depicted using Bland-Altman plots. A paired t-test is used to determine mean differences in echogenicity expressed as grayscale values using the RMT and FHT methods to select the post-image acquisition ROI. The degree of association among ROI selection methods and image analysis platforms is analyzed using the coefficient of determination (R2). Results. The raters demonstrated excellent intrarater and interrater reliability using the RMT and FHT methods across both platforms (lower bound 95% CI ICC = .97–.99, p < .001). Mean differences between the echogenicity estimates obtained with the RMT and FHT methods was .87 grayscale levels (95% CI [.54–1.21], p < .0001) using data obtained with both programs. The SEM for Photoshop was .97 and 1.05 grayscale levels when using the RMT and FHT ROI selection methods, respectively. Comparatively, the SEM values were .72 and .81 grayscale levels, respectively, when using the RMT and FHT ROI selection methods in ImageJ. Uniform coefficients of determination (R2 = .96–.99, p < .001) indicate strong positive associations among the grayscale histogram analysis measurement conditions independent of the ROI selection methods and imaging platform. Conclusion. Our method for evaluating muscle echogenicity demonstrated a high degree of intrarater and interrater reliability using both the RMT and FHT methods across 2 common image analysis platforms. The minimal measurement error exhibited by the examiners demonstrates that the ROI selection methods used with Photoshop and ImageJ are suitable for the post-acquisition image analysis of tissue echogenicity in older adults

Ultrasound estimates of muscle quality in older adults: reliability and comparison of Photoshop and ImageJ for the grayscale analysis of muscle echogenicity.

Background. Quantitative diagnostic ultrasound imaging has been proposed as a method of estimating muscle quality using measures of echogenicity. The Rectangular Marquee Tool (RMT) and the Free Hand Tool (FHT) are two types of editing features used in Photoshop and ImageJ for determining a region of interest (ROI) within an ultrasound image. The primary objective of this study is to determine the intrarater and interrater reliability of Photoshop and ImageJ for the estimate of muscle tissue echogenicity in older adults via grayscale histogram analysis. The secondary objective is to compare the mean grayscale values obtained using both the RMT and FHT methods across both image analysis platforms. Methods. This cross-sectional observational study features 18 community-dwelling men (age = 61.5 ± 2.32 years). Longitudinal views of the rectus femoris were captured using B-mode ultrasound. The ROI for each scan was selected by 2 examiners using the RMT and FHT methods from each software program. Their reliability is assessed using intraclass correlation coefficients (ICCs) and the standard error of the measurement (SEM). Measurement agreement for these values is depicted using Bland-Altman plots. A paired t-test is used to determine mean differences in echogenicity expressed as grayscale values using the RMT and FHT methods to select the post-image acquisition ROI. The degree of association among ROI selection methods and image analysis platforms is analyzed using the coefficient of determination (R (2)). Results. The raters demonstrated excellent intrarater and interrater reliability using the RMT and FHT methods across both platforms (lower bound 95% CI ICC = .97-.99, p \u3c .001). Mean differences between the echogenicity estimates obtained with the RMT and FHT methods was .87 grayscale levels (95% CI [.54-1.21], p \u3c .0001) using data obtained with both programs. The SEM for Photoshop was .97 and 1.05 grayscale levels when using the RMT and FHT ROI selection methods, respectively. Comparatively, the SEM values were .72 and .81 grayscale levels, respectively, when using the RMT and FHT ROI selection methods in ImageJ. Uniform coefficients of determination (R (2) = .96-.99, p \u3c .001) indicate strong positive associations among the grayscale histogram analysis measurement conditions independent of the ROI selection methods and imaging platform. Conclusion. Our method for evaluating muscle echogenicity demonstrated a high degree of intrarater and interrater reliability using both the RMT and FHT methods across 2 common image analysis platforms. The minimal measurement error exhibited by the examiners demonstrates that the ROI selection methods used with Photoshop and ImageJ are suitable for the post-acquisition image analysis of tissue echogenicity in older adults