- Email: [email protected]
Quantitative ultrasound using texture analysis of myofascial pain syndrome in the trapezius
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Y.G. Yi et al. / Annals of Physical and Rehabilitation Medicine 61S (2018) e309–e433
ISPR8-0827
Differentiating varying degrees of central sensitization in chronic widespread pain using quantitative ultrasound S. Ahmed 1,∗ , M. Behr 1 , D. Kumbhare 2 University Health Network, Toronto Rehabilitation Institute, Toronto, Canada 2 University of Toronto, Medicine, Toronto, Canada ∗ Corresponding author. E-mail address: [email protected] (S. Ahmed)
1
Introduction/Background Chronic widespread pain affects almost 11.4–24% of the general population. Central sensitization (CS) is thought to be the mechanism underlying chronic pain. The goal of this study was to determine whether ultrasound texture features (statistical measure of echointensity patterns) can differentiate chronic pain patients with varying degrees of CS, as our previous work has shown that texture features can differentiate patients with myofascial pain. Material and method Thirty patients with chronic widespread pain that fulfilled the 2016 fibromyalgia diagnostic criteria were included in the study. Patients completed the CS inventory, a Table 1 MANOVA results that differentiate between the groups.
questionnaire that indicates the degree of CS—mild, moderate, severe, and extreme. Patients’ upper trapezius muscle was then imaged using B-mode ultrasound. Ninety-one texture features were extracted from the acquired images, and a principal components analysis (PCA) was performed to reduce the features into components that accounted for a large proportion of the variability among the images. A MANOVA and post-hoc analyses were then performed on the features with the top three loading factors to determine whether they could differentiate patients with mild, moderate, severe, or extreme central sensitization. Results The PCA identified eight components that account for 95% of the variability among the images. The MANOVA and posthoc analyses revealed that all extracted features could differentiate between two or more of the groups, and twelve variables could specify group membership (Table 1 & a visual representation in Fig. 1). Conclusion Texture feature analysis of the upper trapezius muscle can differentiate varying degrees of CS using a clinical classification system. Texture feature analysis of muscle should be further explored as a diagnostic marker of chronic widespread pain severity and development. Keywords Musculoskeletal conditions; Diagnosis of neurological; Musculoskeletal and movement related functions Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.1002 ISPR8-0828
Quantitative ultrasound using texture analysis of myofascial pain syndrome in the trapezius S. Ahmed 1,∗ , M. Behr 1 , M. Noseworthy 2 , D. Kumbhare 3 University Health Network, Toronto Rehabilitation Institute, Toronto, Canada 2 McMaster University, Biomedical Engineering, Hamilton, Canada 3 University of Toronto, Medicine, Toronto, Canada ∗ Corresponding author. E-mail address: [email protected] (S. Ahmed)
1
Fig. 1 Visual representation of blob area and mean echo intensity in (A) mild, (B) moderate, (C) severe, (D) extreme groups.
Introduction/Background Myofascial pain syndrome (MPS) is a prevalent pain disorder characterized by myofascial trigger points (MTrP), which are stiff contracted regions within a taut band of muscle. Clinically MTrPs can be differentiated in two groups, latent and active. Active MTrPs induce spontaneous pain whereas latent MTrPs do not. Clinicians disagree on the criteria that differentiate active and latent MTrPs, necessitating an objective method for their differentiation. Our previous work has shown that ultrasound texture features can differentiate between patients with MPS and healthy individuals in the upper trapezius muscle. The objective of this study was to determine whether ultrasound texture features can differentiate between active MTrPs, latent MTrPs, and healthy individuals in the upper trapezius muscle. Material and method We collected B-mode ultrasound images of the upper trapezius muscle from 18 latent, 19 active, and 24 healthy participants. Ninety-two Haralick, Galloway, and histogram related texture features were extracted from the images. A principal components analysis (PCA) was performed to reduce the features into components that accounted for the most variability among the images (Table 1). A MANOVA and post-hoc analyses were then performed to determine whether healthy, latent, or active group membership could be differentiated by the reduced factors (Table 2). Results The PCA identified eight components that explain 95% of the variability in the images. The features with the three highest loading factors in each component were included in the MANOVA, for a total of 23 features. All features could differentiate between at least two of the latent, active, or healthy groups.
Y.G. Yi et al. / Annals of Physical and Rehabilitation Medicine 61S (2018) e309–e433
Table 1 A summary of the components and the highest ranked three features.
Table 2 Texture features that differentiate between the clinical groups as listed above.
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Introduction/Background Analyze the integrity of sacral area sensory pathways in all its components (A, A␦ and C fibers). We evaluated the relative activation state of each single fiber and correlated these data with the clinical conditions, especially the AIS (American spinal cord injury association Injury Score), to define the grade of SCI completeness. Material and method We examined 25 patients affected by acute post-traumatic SCI and admitted between June 2015 and 2016. Lesion level: 10 quadriplegic (all incomplete) and 15 paraplegic patients (8 complete, 7 incomplete); average age 36.2 y (12–71); time between traumatic event and evaluation < 1 y. Examination: AIS grading; evaluation of sensory fibres with the technological ® device Neurometer ; we analysed the pudendal nerve (Penis Dorsal nerve in male and Superficial Perineal nerve in female). Results In 3 of the 8 AIS A patients we found out a residual activity of sensory fibres (normal activity of C fibres and inactivity of A fibres) showing a discrepancy in AIS score between clinical and instrumental findings (discomplete lesions). Accidentally we found out that this typical sensory fibres activation pattern (observed in 13 of 25 patients) was also associated with non-responder, highgrade neuropathic pain (NRS 8–10/10). Conclusion The presence of a discomplete lesion could lead to a different rehabilitation programme; early identification of patients presenting a typical fibers activation pattern associated with neuropathic pain could give us the opportunity to design a tailored therapy before the onset of chronic pain and overactivities; could the neuromodulation of inactive A fibers be a new therapeutic target? Keywords Sensory; Pain; Fibers Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.1004
C1.04 Physical and rehabilitation medicine diagnostics as related to organ systems and body functions – Diagnosis and assessment of functions of the cardiovascular, haematological, immunological, and respiratory systems ISPR8-0799 Conclusion Ultrasound texture features can differentiate between upper trapezius tissue in patients with active and latent MTrPs, and can differentiate these clinical groups from healthy tissue. Ultrasound should be further explored as a clinical diagnostic modality for differentiating MPS patients. Keywords Musculoskeletal conditions; Diagnosis of neurological; Musculoskeletal and movement related functions Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.1003 ISPR8-0628
Preliminary data of a neuroselective study of sensory pathways in spinal cord injured (SCI) patients
M. Zarbo ∗ , M. Spinelli , A. Leo , M.G. Ricchiuti , L. Frediani ASST Grande Ospedale Metropolitano Niguarda, Unità Spinale Unipolare, Milan, Italy ∗ Corresponding author. E-mail address: [email protected] (M. Zarbo), [email protected] (M. Spinelli)
The distribution of lung ventilation of healthy subjects placed in various positions, by the method of impedance tomography K. Grigoriadis 1,∗ , M. Micha 2 , G. Konstantopoulou 1 , A. Grigoriadou 3 , A. Armaganidis 1 1 ATTIKON University General Hospital, Second Department of Critical Care Medicine, Athens, Greece 2 ATTIKON University General Hospital, Physical Medicine and Rehabilitation, Athens, Greece 3 TEI of Central Greece, Physiotherapy, Lamia, Greece ∗ Corresponding author. E-mail address: [email protected] (K. Grigoriadis) Introduction/Background Impedance tomography is a modern method for real time monitoring of the air distribution during lung ventilation, as it can record the changes of lung impedance during breathing and via a mathematical processing creates a visual image representing the changes of lung ventilation. The aim of this study is to record the percentage distribution of lung ventilation in healthy subjects, in several positions. The results of this study can be used for explaining the fluctuations of oxygenation in cases
Y.G. Yi et al. / Annals of Physical and Rehabilitation Medicine 61S (2018) e309–e433
ISPR8-0827
Differentiating varying degrees of central sensitization in chronic widespread pain using quantitative ultrasound S. Ahmed 1,∗ , M. Behr 1 , D. Kumbhare 2 University Health Network, Toronto Rehabilitation Institute, Toronto, Canada 2 University of Toronto, Medicine, Toronto, Canada ∗ Corresponding author. E-mail address: [email protected] (S. Ahmed)
1
Introduction/Background Chronic widespread pain affects almost 11.4–24% of the general population. Central sensitization (CS) is thought to be the mechanism underlying chronic pain. The goal of this study was to determine whether ultrasound texture features (statistical measure of echointensity patterns) can differentiate chronic pain patients with varying degrees of CS, as our previous work has shown that texture features can differentiate patients with myofascial pain. Material and method Thirty patients with chronic widespread pain that fulfilled the 2016 fibromyalgia diagnostic criteria were included in the study. Patients completed the CS inventory, a Table 1 MANOVA results that differentiate between the groups.
questionnaire that indicates the degree of CS—mild, moderate, severe, and extreme. Patients’ upper trapezius muscle was then imaged using B-mode ultrasound. Ninety-one texture features were extracted from the acquired images, and a principal components analysis (PCA) was performed to reduce the features into components that accounted for a large proportion of the variability among the images. A MANOVA and post-hoc analyses were then performed on the features with the top three loading factors to determine whether they could differentiate patients with mild, moderate, severe, or extreme central sensitization. Results The PCA identified eight components that account for 95% of the variability among the images. The MANOVA and posthoc analyses revealed that all extracted features could differentiate between two or more of the groups, and twelve variables could specify group membership (Table 1 & a visual representation in Fig. 1). Conclusion Texture feature analysis of the upper trapezius muscle can differentiate varying degrees of CS using a clinical classification system. Texture feature analysis of muscle should be further explored as a diagnostic marker of chronic widespread pain severity and development. Keywords Musculoskeletal conditions; Diagnosis of neurological; Musculoskeletal and movement related functions Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.1002 ISPR8-0828
Quantitative ultrasound using texture analysis of myofascial pain syndrome in the trapezius S. Ahmed 1,∗ , M. Behr 1 , M. Noseworthy 2 , D. Kumbhare 3 University Health Network, Toronto Rehabilitation Institute, Toronto, Canada 2 McMaster University, Biomedical Engineering, Hamilton, Canada 3 University of Toronto, Medicine, Toronto, Canada ∗ Corresponding author. E-mail address: [email protected] (S. Ahmed)
1
Fig. 1 Visual representation of blob area and mean echo intensity in (A) mild, (B) moderate, (C) severe, (D) extreme groups.
Introduction/Background Myofascial pain syndrome (MPS) is a prevalent pain disorder characterized by myofascial trigger points (MTrP), which are stiff contracted regions within a taut band of muscle. Clinically MTrPs can be differentiated in two groups, latent and active. Active MTrPs induce spontaneous pain whereas latent MTrPs do not. Clinicians disagree on the criteria that differentiate active and latent MTrPs, necessitating an objective method for their differentiation. Our previous work has shown that ultrasound texture features can differentiate between patients with MPS and healthy individuals in the upper trapezius muscle. The objective of this study was to determine whether ultrasound texture features can differentiate between active MTrPs, latent MTrPs, and healthy individuals in the upper trapezius muscle. Material and method We collected B-mode ultrasound images of the upper trapezius muscle from 18 latent, 19 active, and 24 healthy participants. Ninety-two Haralick, Galloway, and histogram related texture features were extracted from the images. A principal components analysis (PCA) was performed to reduce the features into components that accounted for the most variability among the images (Table 1). A MANOVA and post-hoc analyses were then performed to determine whether healthy, latent, or active group membership could be differentiated by the reduced factors (Table 2). Results The PCA identified eight components that explain 95% of the variability in the images. The features with the three highest loading factors in each component were included in the MANOVA, for a total of 23 features. All features could differentiate between at least two of the latent, active, or healthy groups.
Y.G. Yi et al. / Annals of Physical and Rehabilitation Medicine 61S (2018) e309–e433
Table 1 A summary of the components and the highest ranked three features.
Table 2 Texture features that differentiate between the clinical groups as listed above.
e431
Introduction/Background Analyze the integrity of sacral area sensory pathways in all its components (A, A␦ and C fibers). We evaluated the relative activation state of each single fiber and correlated these data with the clinical conditions, especially the AIS (American spinal cord injury association Injury Score), to define the grade of SCI completeness. Material and method We examined 25 patients affected by acute post-traumatic SCI and admitted between June 2015 and 2016. Lesion level: 10 quadriplegic (all incomplete) and 15 paraplegic patients (8 complete, 7 incomplete); average age 36.2 y (12–71); time between traumatic event and evaluation < 1 y. Examination: AIS grading; evaluation of sensory fibres with the technological ® device Neurometer ; we analysed the pudendal nerve (Penis Dorsal nerve in male and Superficial Perineal nerve in female). Results In 3 of the 8 AIS A patients we found out a residual activity of sensory fibres (normal activity of C fibres and inactivity of A fibres) showing a discrepancy in AIS score between clinical and instrumental findings (discomplete lesions). Accidentally we found out that this typical sensory fibres activation pattern (observed in 13 of 25 patients) was also associated with non-responder, highgrade neuropathic pain (NRS 8–10/10). Conclusion The presence of a discomplete lesion could lead to a different rehabilitation programme; early identification of patients presenting a typical fibers activation pattern associated with neuropathic pain could give us the opportunity to design a tailored therapy before the onset of chronic pain and overactivities; could the neuromodulation of inactive A fibers be a new therapeutic target? Keywords Sensory; Pain; Fibers Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.1004
C1.04 Physical and rehabilitation medicine diagnostics as related to organ systems and body functions – Diagnosis and assessment of functions of the cardiovascular, haematological, immunological, and respiratory systems ISPR8-0799 Conclusion Ultrasound texture features can differentiate between upper trapezius tissue in patients with active and latent MTrPs, and can differentiate these clinical groups from healthy tissue. Ultrasound should be further explored as a clinical diagnostic modality for differentiating MPS patients. Keywords Musculoskeletal conditions; Diagnosis of neurological; Musculoskeletal and movement related functions Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.1003 ISPR8-0628
Preliminary data of a neuroselective study of sensory pathways in spinal cord injured (SCI) patients
M. Zarbo ∗ , M. Spinelli , A. Leo , M.G. Ricchiuti , L. Frediani ASST Grande Ospedale Metropolitano Niguarda, Unità Spinale Unipolare, Milan, Italy ∗ Corresponding author. E-mail address: [email protected] (M. Zarbo), [email protected] (M. Spinelli)
The distribution of lung ventilation of healthy subjects placed in various positions, by the method of impedance tomography K. Grigoriadis 1,∗ , M. Micha 2 , G. Konstantopoulou 1 , A. Grigoriadou 3 , A. Armaganidis 1 1 ATTIKON University General Hospital, Second Department of Critical Care Medicine, Athens, Greece 2 ATTIKON University General Hospital, Physical Medicine and Rehabilitation, Athens, Greece 3 TEI of Central Greece, Physiotherapy, Lamia, Greece ∗ Corresponding author. E-mail address: [email protected] (K. Grigoriadis) Introduction/Background Impedance tomography is a modern method for real time monitoring of the air distribution during lung ventilation, as it can record the changes of lung impedance during breathing and via a mathematical processing creates a visual image representing the changes of lung ventilation. The aim of this study is to record the percentage distribution of lung ventilation in healthy subjects, in several positions. The results of this study can be used for explaining the fluctuations of oxygenation in cases