Could relative movement between the adductor muscles and the skin invalidate surface electromyography measurement?

The superficial hip adductor muscles are situated in close proximity to each other. Therefore, relative movement between the overlying skin and the muscle belly could lead to a shift in the position of surface electromyography (EMG) electrodes and contamination of EMG signals with activity from neighboring muscles. The aim of this study was to explore whether hip movements or isometric contraction could lead to relative movement between the overlying skin and 3 adductor muscles: adductor magnus, adductor longus, and adductor gracilis. The authors also sought to investigate isometric torque–EMG relationships for the 3 adductor muscles. Ultrasound measurement showed that EMG electrodes maintained a position which was at least 5 mm within the muscle boundary across a range of hip flexion–extension angles and across different contraction levels. The authors also observed a linear relationship between torque and EMG amplitude. This is the first study to use ultrasound to track the relative motion between skin and muscle and provides new insight into electrode positioning. The findings provide confidence that ultrasound-based positioning of EMG electrodes can be used to derive meaningful information on output from the adductor muscles and constitute a step toward recognized guidelines for surface EMG measurement of the adductors

The implementation of a haptic feedback virtual reality simulation clinic with dynamic patient interaction and communication for medical imaging students

INTRODUCTION: An immersive virtual reality (VR) simulation clinic with dynamic patient interaction and communication was developed to facilitate the training of medical radiation science students. The software "CETSOL VR Clinic" was integrated into the Medical Imaging programme at Monash University in 2016 in order to benchmark student experiences against existing simulation techniques (Shaderware™). METHODS: An iterative approach to development, based on two cycles of user feedback, was used to develop and refine the simulated clinical environment. This environment uses realistic 3D models, embedded clinical scenarios, dynamic communication, 3D hand gesture interaction, gaze and positional stereoscopic tracking and online user capabilities using the Unity™ game and physics engines. Students' perceptions of educational enhancement of their positioning skills following the use of the simulation tools were analysed via a 5-point Likert scale questionnaire. RESULTS: Student perception scores indicated a significant difference between simulation modalities in favour of the immersive CETSOL VR Clinic, χ2 (4, N = 92) = 9.5, P-value <0.001. CONCLUSION: Student perception scores on improvement of their clinical and technical skills were higher for the hand-positioning tasks performed with the CETSOL VR Clinic™ than with the comparative benchmark simulation that did not provide dynamic patient interaction and communication

Using online peer feedback in formative assessment for medical sonography students teaching: the student view

This paper reports the results of a survey of external medical sonography university students which investigated their perceptions of anonymous online peer feedback formative assessments. Peer feedback is gaining popularity among academic teachers to both promote deeper learning and reduce heavy marking loads. Methods: In a cross sectional study design, 77 postgraduate students enrolled in an externally delivered sonography course in 2009 were invited to participate in a student evaluation survey. Results: Sixteen students (21%) responded to the survey. Students registered positive perceptions on a Likert scale for items asking about the value of the learning experiences, their level of comfort in participating in peer feedback, and their acceptance of using a web based medium. Anonymity rated highly as an important element of the assessments. Two-tailed Mann-Whitney U tests demonstrated no significant differences (P < 0.05) between student perceptions of assessment items with and without peer feedback, or between the feedback provided by their peers and the feedback provided by the teacher. Conclusion: Open questions provided insight in how the students perceived the assessment could be improved. Future derivations of the described assessment process should use a more user-friendly online platform, and the breadth of course content should be expanded so that all learning objectives and content are integrated into formative assessment. As well as being more acceptable to students this approach is more likely to motivate students to meet learning objectives, and encourage active learning. Further evaluation will be required as the assessments are modified.

Prevalence, risks, underlying mechanisms, preventative guidelines, and interventions of sonographer work‐related injuries: A literature review

Work-related injuries (WRIs) in sonographers are concerning for sonographers and their employers. This review synthesised published guidelines, recommendations, and research relating to the prevalence, risks, underlying mechanisms, and preventative interventions of sonographer WRIs to improve understanding of the existing evidence and knowledge gaps in this area. Seventy articles published between 1985 and 2018 were identified and reviewed. Sonographer WRIs are very prevalent.Monitoring of prevalence should continue, preferably using a standardised, validated, and reproducible survey instrument. Risk factors for sonographer WRIs predominantly include not only ergonomic and postural factors, but also workflow, health status, mental stress, sonographer age, and patient characteristics. More case-control and cohort studies are needed to provide more accurate data for determining risk factors. More studies evaluating preventative interventions using rigorous research methods which include consultation with work, health, and safety experts, and stakeholders such as sonographers, sonographer employers/managers, equipment manufacturers, and patients are required. There is a lack of studies investigating long term, economic, and productivity outcomes of preventative interventions. The building and expansion of a cohesive and useful body of knowledge of sonographer WRIs will inform future guideline development and revision, and motivate sonographers and their managers to implement and support valid preventative interventions

The effectiveness of real time ultrasound as a biofeedback tool for muscle retraining

Background: Real time ultrasound (RTUS) is being used by physiotherapists as a tool for enhancing biofeedback. Aim: The aim of this systematic review was to summarise and evaluate the available literature on the effectiveness of RTUS as a biofeedback tool for muscle retraining. Method: A systematic review of the literature was performed to identify primary research examining the effect of RTUS muscle retraining. Studies were ranked according to the National Health and Medical Research Council hierarchy of evidence. The methodological quality of the randomised controlled trials was systematically assessed using the PEDro rating scale while a modified tool for case series studies was used. Results: Three RCTs, one case series and one case study were included. The methodological quality of the five studies was average to good, ranging from 55 to 82%. The studies used abdominal, multifidus and pelvic floor muscles to demonstrate the effects of RTUS biofeedback. The results varied depending on the purpose of the tool and the muscles re-trained. The effectiveness of RTUS as a teaching tool is moderate for multifidus, modest for abdominal muscles and weak for pelvic floor muscles. There was a paucity of available literature on the long term retention of muscle control following use of RTUS as a biofeedback tool. Conclusion: While research in this field is limited in quantity at the current time, the results warrant further investigation. However, future researchers must make an effort to ensure that their study design is of the highest quality and also demonstrate the long term effects of using RTUS to enhance muscle retraining

Accuracy of ultrasound to identify chronic liver disease

AIM: To identify and assess studies reporting the diagnostic performance of ultrasound imaging for identifying chronic liver disease (CLD) in a high risk population