• Physical Therapy Rehabilitation Science
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• v.10 no.1
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• pp.82-89
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• 2021

Purpose: This study is to investigate the muscle activity based on real-time visual feedback training methods by rehabilitative ultrasound image in elderly and correlation between Heckmatt scale grade, muscle tone and thickness. Design: Cross-sectional study: Pilot study Methods: 6 elderly participated in the study with 2 conditions. Under the condition of rehabilitation ultrasound imaging equipment, all subjects performed voluntary maximal muscle contraction of the quadriceps 3 times using visual feedback based on Rehabilitative Ultrasound Imaging 1.0 (RUSI 1.0). Under the condition of only ultrasound images, all subjects performed voluntary maximal muscle contraction of the quadriceps 3 times using ultrasound image-based visual feedback. The muscle thickness and tone of the quadriceps were measured and the grades were classified by Heckmatt scale and all variables were comparative analyzed. Results: Heckmatt scale grade showed a negative correlation with muscle thickness at relaxation (p<0.05), and a negative correlation with the difference value obtained by subtracting muscle thickness at relaxation from muscle thickness at contraction in ultrasound image condition (p<0.05). The muscle tone during relaxation showed a negative correlation with the muscle thickness during relaxation (p<0.05). Conclusion: In the case of voluntary maximum muscle contraction of the quadriceps muscle in the elderly, it can be seen that the muscle thickness is getting larger when the RUSI 1.0-based visual feedback is provided than with only ultrasound image provided. And the lower Heckmatt scale grade is, the thicker the muscle is, and the lower the muscle tone is.

• Journal of the Korean Society of Physical Medicine
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• v.16 no.2
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• pp.45-52
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• 2021

PURPOSE: This study examined the imaging procedure of pectoralis minor muscle thickness and assessed the intra- and inter-rater reliability of the muscle thickness measured by two raters using rehabilitative ultrasound imaging (RUSI) in healthy individuals. METHODS: Fifteen participants (aged 21 - 28, seven females, and eight males) were involved in the study. The primary rater palpated the coracoid process and the fourth rib, defined as the width of the index finger lateral to the sternum to avoid breast tissues, and lined the two landmarks. The second examiner checked 1 / 3 (1st point) and 1 / 2 (2nd point) of the line length as measurement points. The two raters obtained right side muscle images of the participants at a standardized sitting position using RUSI with a 7.5 MHz linear transducer at 40mm depth. For intra-rater reliability, the principal rater took three images per point and tried to take one more with an interval. For the inter-rater reliability, the other rater performed the same tasks as the principal rater on the same day. The reliability was analyzed using the intra-class correlation coefficient (ICC), the standard error of the measurement (SEM), and Bland and Altman plots. RESULTS: The reliability at all points was excellent for the same rater (ICC_3,1 = .973 - .978, SEM = .042 - .046), and between raters (ICC_2,1 = .939 - .959, SEM = .059 - .097). CONCLUSION: These findings show that the RUSI could be reliable for examining the pectoralis minor muscle thickness in healthy individuals at all measurement sites.

• Physical Therapy Rehabilitation Science
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• v.5 no.1
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• pp.47-52
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• 2016

Objective: This study surveyed the perceptions of physical therapists on muscle re-education through visual feedback obtained from rehabilitative ultrasound imaging (RUSI). Design: Survey. Methods: For this study, 500 physical therapists who participated in a refresher training held by the Seoul City Association in March 2015 were selected for a questionnaire-based survey. Subjects were randomly selected targets physiotherapists who participated in a refresher training.The questionnaire had 21 items in total. Questions 1 to 15 could be answered by everyone. However, questions 16 to 21 could be answered only by people who used RUSI. Results: The majority of respondents were aged 20 to 30 years. Respondents in their twenties, thirties, forties, and fifties accounted for 32.4%, 40.2%, 21.9%, and 5.6%respectively. Therapists with careers spanning one to 5 years accounted for 27.8%, while those with careers spanning 5 to 10 years and 10 to 15 years accounted for 34.6% and 17.0%, respectively. Those with careers over 20 years accounted for 9.2%. The types of work have not been various including work related to the nervous system (49.0%), the musculoskeletal system (41.5%), sports (0.7%), juvenile physical therapy (4.2%), and others (4.6%). Conclusions: In this study, we examined the perceptions of physical therapists on rehabilitation ultrasound imaging used in muscle re-education. We also examined how to use this technique. Many therapists who participated in the refresher training were found to be unaware of RUSI. In the future, further investigations on RUSI for muscle re-education are required through refresher training or training lectures at the national level.

• PNF and Movement
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• v.9 no.2
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• pp.9-19
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• 2011

Purpose : To provide the understanding of abdominal hollowing exercise, this study reviewed literatures related with TrA and AHE. Methods : We reviewed the prior studies related with TrA and AHE. Results : Crook lying is easier to facilitate isolated contraction of TrA from EO than the others. The contraction of the TrA is shown to be the highest muscle activity in prone lying. Additionally, wall support standing(or standing) is shown a higher contraction of entire abdominal muscle than the others. However, learning and teaching correct AHE have innate difficulties in four positions. Conclusion : We have to consider that Rehabilitative Ultrasonic Imaging(RUSI) can facilitate accurate AHE. In the country, physical therapists will be necessary more training and efforts to use ultrasound because very few use ultrasound in clinical field. It will be necessary to study the effects of RUSI feedback and examine effects of exercises in combination with AHE.

• Physical Therapy Rehabilitation Science
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• v.6 no.1
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• pp.7-13
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• 2017

Objective: The aim of this study was to investigate the inter-rater and intra-rater reliability of rehabilitative ultrasound imaging (RUSI) for measurement of muscle thickness with changes in angles of the gluteus maximus (GM) at rest and during contraction. Design: Cross-sectional study. Methods: Twenty-two healthy men volunteered for this study. GM muscle images were obtained in the resting position and during prone hip extension with knee flexion at hip abduction angles of $0^{\circ}$ and $30^{\circ}$, respectively. Two examiners randomly measured the thickness of the GM twice in three different positions. The first position was a comfortable prone position. The second position was prone hip extension with knee flexion (PHEKF) to $90^{\circ}$. The third position was achieved by hanging a 1-kg weight on the ankle of the lifted leg during PHEKF with the angle of the lifted leg the same as the second position. Intra-class correlation coefficients (ICCs), standard error measurements, and minimal detectable changes were used to estimate reliability. Results: The intra-rater reliability ICCs (95% confidence interval) of the GM were >0.870, indicating good reliability. Inter-rater reliability ICCs ranged from 0.668 to 0.913. The reliability of measurements of muscle thickness at each position was similar to the reliability of the angle change. Differences in muscle thickness and ratios for each position with $0^{\circ}$ and $30^{\circ}$ of hip abduction were not statistically significant. Conclusions: In the present study, the intra-rater reliability of muscle thickness measurements of the GM was good, and the inter-rater reliability was moderate to good. Reliable RUSI measurements of wide and large muscles, such as the GM muscle at rest and during contraction, are feasible. Further investigation is required to establish the reproducibility of the protocols presented in this study.

• Physical Therapy Rehabilitation Science
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• v.12 no.3
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• pp.259-267
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• 2023

Objective: Rehabilitative ultrasound imaging is a safe and noninvasive technique for evaluating muscle thickness. A dual probe-fixing frame (DPF) can provide visual feedback during exercises targeting specific muscles. The purpose of this research was to verify the reliability and validity of the DPF for dual-probe ultrasound (DPU)-based visual feedback exercises, allowing users to use both hands freely. Design: This cross-sectional study used repeated measures to compare muscle thickness measurements obtained using the handheld device and DPF with DPU. Methods: Twenty healthy adults participated in the study. Measurements were taken over two sessions, with a two-day interval between the sessions. The thicknesses of the rectus abdominis (RA) and transverse abdominis (TrA) muscles were measured using DPU. The DPF with DPU developed by the research team, was used along with a laptop-based muscle viewer. Bland-Altman analysis and intraclass correlation coefficients (ICCs) calculations were used in statistical analyses to evaluate agreement and reliability, respectively. Results: The results of the Bland-Altman analysis showed small average differences between the handheld and DPF methods for both RA and TrA muscle thicknesses. Inter-rater reliability analysis showed high ICC values for DPF measurements of both RA (0.908-0.912) and TrA (0.892-741) muscle thicknesses. Intra-rater reliability analysis also showed good ICC values for measurements taken by a single examiner over two days. Conclusion: The findings of this study demonstrate that the DPF provides reliable and valid measurements of muscle thickness during visual feedback exercises using the DPU.

• Physical Therapy Rehabilitation Science
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• v.9 no.4
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• pp.287-294
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• 2020

Objective: This study aimed to investigate the effects of an ultrasound-based bar graph proportional to the quadriceps muscle thickness as a real-time visual feedback training tool in the elderly. Design: Cross-sectional study. Methods: Twenty-four elderly persons participated in this study and were randomly divided into three groups: oral training group (n=8, group 1), ultrasound imaging group (n=8, group 2), and graph group (n=8, group 3). In the pre condition, all participants performed maximal voluntary isometric contraction (MVIC) of the quadriceps with knee extension three times with oral training. In the post condition, group 1 performed MVIC of the quadriceps with oral training, group 2 performed MVIC of the quadriceps with real-time visual feedback using ultrasound imaging, and group 3 performed MVIC of the quadriceps with real-time visual feedback using a bar graph proportional to the quadriceps muscle thickness, three times for all groups. Muscle thickness, activity (mean, peak), tone, stiffness, logarithmic decrement, relaxation, and creep were measured in both conditions in all participants. Results: Visual feedback with a bar graph showed significant effects on muscle thickness, mean muscle activity, and peak muscle activity compared with oral training and visual feedback with ultrasound imaging (p<0.05). Conclusions: Isometric training of the quadriceps with real-time visual feedback using a bar graph proportional to the quadriceps muscle thickness may be more effective than other methods in improving muscle thickness and muscle activity. This study presented a tool that can help increase muscle thickness in the elderly.

• Journal of the Korean Society of Physical Medicine
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• v.7 no.3
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• pp.319-327
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• 2012

Purpose : This study aimed to identify the asymmetry observed in the rehabilitative ultrasound imaging of lateral abdominal muscle thickness and performance between the affected and unaffected side during the abdominal drawing-in maneuver (ADIM), an exercise used to facilitate activation of selectively TrA to stabilize the trunk prior to limb movement. Methods : The Participants were twenty one patients with post-stroke hemiplegia in this study. Ultrasound imaging was used to measure amount of changes in thickness of the external oblique (EO), internal oblique (IO), transversus abdominis (TrA). A Paired t-test was used to compare relaxed muscle thickness to contracted muscle thickness of all 3 muscles between the affected and unaffected sides. Results : The outcome measures included side to side differences of absolute thickness, contraction ratio among the lateral abdominal muscles. There was no significantly difference in between the affected and unaffected side at rest. But, there was a significantly difference in absolute muscle thickness between the affected and unaffected side of only TrA muscle. Also contraction ratio was a significantly difference between the affected and unaffected TrA muscle. Conclusion : These findings support the asymmetrical activation of TrA muscle during abdominal muscle contraction in patients with post-stroke hemiplegia. Further studies are warranted for confirming this outcome.

• Physical Therapy Rehabilitation Science
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• v.6 no.3
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• pp.152-157
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• 2017

Objective: The aim of this study was to determine the intra-rater and inter-rater reliability of the dual rehabilitative ultrasound imaging (D-RUSI) when simultaneously measuring muscle thickness changes at rest and during co-contraction of the biceps brachii (BB) and triceps brachii (TB). Design: Cross-sectional study. Methods: This study included 36 healthy participants (23 men, 13 women). The participants sat on a chair in a comfortable position with a cushion placed under their elbow to maintain a 90-degree elbow flexion angle. The muscle thickness of the biceps brachii and triceps brachii was measured twice using the D-RUSI by two examiners during resting and co-contraction states. One week later, the same procedure was performed once again. Results: The intra-class correlation coefficients (ICCs) for intra-rater reliability ranged from 0.887 to 0.989 and the confidence interval was within an acceptable range of 0.778 to 0.994. The standard error of measurement (SEM) values ranged from 0.303 to 0.866 and the minimal detectable change (MDC) values ranged from 0.84 to 2.40. The ICCs for inter-rater reliability ranged from 0.758 to 0.925. The SEM values ranged from 0.702 to 1.486 and the MDC values ranged from 1.95 to 4.12. Conclusions: The use of the D-RUSI of the BB muscle had a very good intra-rater reliability and very good inter-rater reliability at the resting state, and a, good inter-rater reliability at the co-activation state. ICC values showed very good intra-reliability and inter-reliability for the TB muscle. the D-RUSI is a useful tool for simultaneously measuring the thickness of two muscles when the BB is an agonist and the TB is an antagonist during co-activation of the upper arm.

• Physical Therapy Korea
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• v.18 no.3
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• pp.8-15
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• 2011

Abdominal muscle plays a crucial role in postural control and respiration control. However, thickness of abdominal muscle in the paretic side of a hemiplegic patient has not been reported in previous studies. The purpose of this research was to compare lateral abdominal muscle thickness between the nonparetic and paretic side in patients with chronic stroke using rehabilitative ultrasound imaging. Twenty two patients with chronic stroke participated in this study. Absolute thickness of transversus abdominis (TrA), internal oblique (IO) and external oblique (EO) was measured at the end of inspiration and expiration during quiet breathing, and relative thickness was calculated (thickness of each muscle as a percentage of total muscle thickness). Ultrasound imaging was recorded three times and the average value was determined for statistical analysis. Differences in absolute and relative lateral abdominal muscle thickness between the nonparetic and paretic side were assessed with paired t-tests. Absolute muscle thickness of the paretic side TrA was thinner than that of the nonparetic side at the end of inspiration and expiration during quiet breathing. Relative muscle thickness of the paretic side TrA was thinner than the paretic side only at the end of expiration during quiet breathing (p>.05). Therefore, it is necessary to strength TrA in patients with chronic stroke during physical therapy intervention. Further study is needed whether physical therapy intervension will induce TrA thickness in patients with chronic stroke in prospective study design.