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Acharya A, Shrestha S, Chen A, Conte J, Avramovic S, Sikdar S, Anastasopoulos A, Das S. Clinical risk prediction using language models: benefits and considerations. J Am Med Inform Assoc 2024:ocae030. [PMID: 38412328 DOI: 10.1093/jamia/ocae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/11/2024] [Accepted: 02/03/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVE The use of electronic health records (EHRs) for clinical risk prediction is on the rise. However, in many practical settings, the limited availability of task-specific EHR data can restrict the application of standard machine learning pipelines. In this study, we investigate the potential of leveraging language models (LMs) as a means to incorporate supplementary domain knowledge for improving the performance of various EHR-based risk prediction tasks. METHODS We propose two novel LM-based methods, namely "LLaMA2-EHR" and "Sent-e-Med." Our focus is on utilizing the textual descriptions within structured EHRs to make risk predictions about future diagnoses. We conduct a comprehensive comparison with previous approaches across various data types and sizes. RESULTS Experiments across 6 different methods and 3 separate risk prediction tasks reveal that employing LMs to represent structured EHRs, such as diagnostic histories, results in significant performance improvements when evaluated using standard metrics such as area under the receiver operating characteristic (ROC) curve and precision-recall (PR) curve. Additionally, they offer benefits such as few-shot learning, the ability to handle previously unseen medical concepts, and adaptability to various medical vocabularies. However, it is noteworthy that outcomes may exhibit sensitivity to a specific prompt. CONCLUSION LMs encompass extensive embedded knowledge, making them valuable for the analysis of EHRs in the context of risk prediction. Nevertheless, it is important to exercise caution in their application, as ongoing safety concerns related to LMs persist and require continuous consideration.
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Affiliation(s)
| | | | - Anyi Chen
- Staten Island Performing Provider System, Staten Island, NY, United States
| | - Joseph Conte
- Staten Island Performing Provider System, Staten Island, NY, United States
| | | | | | | | - Sanmay Das
- George Mason University, Fairfax, VA, United States
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2
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Shenbagam M, Kamatham AT, Vijay P, Salimath S, Patwardhan S, Sikdar S, Kataria C, Mukherjee B. A Sonomyography-based Muscle Computer Interface for Individuals with Spinal Cord Injury. IEEE J Biomed Health Inform 2024; PP:1-10. [PMID: 38285571 DOI: 10.1109/jbhi.2024.3359483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Impairment of hand functions in individuals with spinal cord injury (SCI) severely disrupts activities of daily living. Recent advances have enabled rehabilitation assisted by robotic devices to augment the residual function of the muscles. Traditionally, electromyography-based muscle activity sensing interfaces have been utilized to sense volitional motor intent to drive robotic assistive devices. However, the dexterity and fidelity of control that can be achieved with electromyography-based control have been limited due to inherent limitations in signal quality. We have developed and tested a muscle-computer interface (MCI) utilizing sonomyography to provide control of a virtual cursor for individuals with motor-incomplete spinal cord injury. We demonstrate that individuals with SCI successfully gained control of a virtual cursor by utilizing contractions of muscles of the wrist joint. The sonomyography-based interface enabled control of the cursor at multiple graded levels demonstrating the ability to achieve accurate and stable endpoint control. Our sonomyography-based muscle-computer interface can enable dexterous control of upper-extremity assistive devices for individuals with motor-incomplete SCI.
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3
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Gonçalves SF, Izquierdo AM, Bates RA, Acharya A, Matto H, Sikdar S. Negative Urgency Linked to Craving and Substance Use Among Adults on Buprenorphine or Methadone. J Behav Health Serv Res 2024; 51:114-122. [PMID: 37414999 PMCID: PMC11002981 DOI: 10.1007/s11414-023-09845-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/08/2023]
Abstract
Despite the effectiveness of medication-assisted treatment (MAT), adults receiving MAT experience opioid cravings and engage in non-opioid illicit substance use that increases the risk of relapse and overdose. The current study examines whether negative urgency, defined as the tendency to act impulsively in response to intense negative emotion, is a risk factor for opioid cravings and non-opioid illicit substance use. Fifty-eight adults (predominately White cis-gender females) receiving MAT (with buprenorphine or methadone) were recruited from online substance use forums and asked to complete self-report questionnaires on negative urgency (UPPS-P Impulsive Behavior Scale), past 3-month opioid cravings (ASSIST-Alcohol, Smoking, and Substance Involvement Screening Test), and non-opioid illicit substance use (e.g., amphetamines, cocaine, benzodiazepines). Results revealed that negative urgency was associated with past 3-month opioid cravings, as well as past month illicit stimulant use (not benzodiazepine use). These results may indicate that individuals high in negative urgency would benefit from receiving extra intervention during MAT.
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Affiliation(s)
| | - Alyssa M Izquierdo
- Department of Psychology, George Mason University, Fairfax, VA, 22030, USA
| | - Rebecca A Bates
- Department of Psychology, George Mason University, Fairfax, VA, 22030, USA
| | - Angeela Acharya
- Department of Psychology, George Mason University, Fairfax, VA, 22030, USA
| | - Holly Matto
- Department of Psychology, George Mason University, Fairfax, VA, 22030, USA
| | - Siddhartha Sikdar
- Department of Psychology, George Mason University, Fairfax, VA, 22030, USA
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4
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Sikdar S, Srbely J, Shah J, Assefa Y, Stecco A, DeStefano S, Imamura M, Gerber LH. A model for personalized diagnostics for non-specific low back pain: the role of the myofascial unit. Front Pain Res (Lausanne) 2023; 4:1237802. [PMID: 37901614 PMCID: PMC10606250 DOI: 10.3389/fpain.2023.1237802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023] Open
Abstract
Low back pain (LBP) is the leading cause of disability worldwide. Most LBP is non-specific or idiopathic, which is defined as symptoms of unknown origin without a clear specific cause or pathology. Current guidelines for clinical evaluation are based on ruling out underlying serious medical conditions, but not on addressing underlying potential contributors to pain. Although efforts have been made to identify subgroups within this population based on response to treatment, a comprehensive framework to guide assessment is still lacking. In this paper, we propose a model for a personalized mechanism-based assessment based on the available evidence that seeks to identify the underlying pathologies that may initiate and perpetuate central sensitization associated with chronic non-specific low back pain (nsLBP). We propose that central sensitization can have downstream effects on the "myofascial unit", defined as an integrated anatomical and functional structure that includes muscle fibers, fascia (including endomysium, perimysium and epimysium) and its associated innervations (free nerve endings, muscle spindles), lymphatics, and blood vessels. The tissue-level abnormalities can be perpetuated through a vicious cycle of neurogenic inflammation, impaired fascial gliding, and interstitial inflammatory stasis that manifest as the clinical findings for nsLBP. We postulate that our proposed model offers biological plausibility for the complex spectrum of clinical findings, including tissue-level abnormalities, biomechanical dysfunction and postural asymmetry, ecological and psychosocial factors, associated with nsLBP. The model suggests a multi-domain evaluation that is personalized, feasible and helps rule out specific causes for back pain guiding clinically relevant management. It may also provide a roadmap for future research to elucidate mechanisms underlying this ubiquitous and complex problem.
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Affiliation(s)
- Siddhartha Sikdar
- Center for Adaptive Systems of Brain Body Interactions, George Mason University, Fairfax, VA, United States
- Department of Bioengineering, George Mason University, Fairfax, VA, United States
| | - John Srbely
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, CA, United States
| | - Jay Shah
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Yonathan Assefa
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Antonio Stecco
- Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York City, NY, United States
| | | | - Marta Imamura
- Faculty of Medicine, University of São Paolo, São Paulo, Brazil
| | - Lynn H. Gerber
- Center for Adaptive Systems of Brain Body Interactions, George Mason University, Fairfax, VA, United States
- Department of Medicine, INOVA Health System, Fairfax, VA, United States
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5
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Patwardhan S, Gladhill KA, Joiner WM, Schofield JS, Lee BS, Sikdar S. Using principles of motor control to analyze performance of human machine interfaces. Sci Rep 2023; 13:13273. [PMID: 37582852 PMCID: PMC10427694 DOI: 10.1038/s41598-023-40446-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/10/2023] [Indexed: 08/17/2023] Open
Abstract
There have been significant advances in biosignal extraction techniques to drive external biomechatronic devices or to use as inputs to sophisticated human machine interfaces. The control signals are typically derived from biological signals such as myoelectric measurements made either from the surface of the skin or subcutaneously. Other biosignal sensing modalities are emerging. With improvements in sensing modalities and control algorithms, it is becoming possible to robustly control the target position of an end-effector. It remains largely unknown to what extent these improvements can lead to naturalistic human-like movement. In this paper, we sought to answer this question. We utilized a sensing paradigm called sonomyography based on continuous ultrasound imaging of forearm muscles. Unlike myoelectric control strategies which measure electrical activation and use the extracted signals to determine the velocity of an end-effector; sonomyography measures muscle deformation directly with ultrasound and uses the extracted signals to proportionally control the position of an end-effector. Previously, we showed that users were able to accurately and precisely perform a virtual target acquisition task using sonomyography. In this work, we investigate the time course of the control trajectories derived from sonomyography. We show that the time course of the sonomyography-derived trajectories that users take to reach virtual targets reflect the trajectories shown to be typical for kinematic characteristics observed in biological limbs. Specifically, during a target acquisition task, the velocity profiles followed a minimum jerk trajectory shown for point-to-point arm reaching movements, with similar time to target. In addition, the trajectories based on ultrasound imaging result in a systematic delay and scaling of peak movement velocity as the movement distance increased. We believe this is the first evaluation of similarities in control policies in coordinated movements in jointed limbs, and those based on position control signals extracted at the individual muscle level. These results have strong implications for the future development of control paradigms for assistive technologies.
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Affiliation(s)
| | - Keri Anne Gladhill
- Department of Psychology, George Mason University, Fairfax, VA, 22030, USA
| | - Wilsaan M Joiner
- Department of Neurobiology, Physiology and Behavior, University of California, Davis, Davis, CA, 95616, USA
| | - Jonathon S Schofield
- Mechanical and Aerospace Engineering Department, University of California, Davis, Davis, CA, 95616, USA
| | - Ben Seiyon Lee
- Department of Statistics, George Mason University, Fairfax, VA, 22030, USA
| | - Siddhartha Sikdar
- Department of Bioengineering, George Mason University, Fairfax, VA, 22030, USA.
- Center for Adaptive Systems of Brain-Body Interactions, Fairfax, VA, 22030, USA.
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Jackson KL, Durić Z, Engdahl SM, Santago AC, Sikdar S, Gerber LH. A Comparison of Approaches for Segmenting the Reaching and Targeting Motion Primitives in Functional Upper Extremity Reaching Tasks. IEEE J Transl Eng Health Med 2023; 12:10-21. [PMID: 38059129 PMCID: PMC10697295 DOI: 10.1109/jtehm.2023.3300929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/12/2023] [Accepted: 07/25/2023] [Indexed: 12/08/2023]
Abstract
There is growing interest in the kinematic analysis of human functional upper extremity movement (FUEM) for applications such as health monitoring and rehabilitation. Deconstructing functional movements into activities, actions, and primitives is a necessary procedure for many of these kinematic analyses. Advances in machine learning have led to progress in human activity and action recognition. However, their utility for analyzing the FUEM primitives of reaching and targeting during reach-to-grasp and reach-to-point tasks remains limited. Domain experts use a variety of methods for segmenting the reaching and targeting motion primitives, such as kinematic thresholds, with no consensus on what methods are best to use. Additionally, current studies are small enough that segmentation results can be manually inspected for correctness. As interest in FUEM kinematic analysis expands, such as in the clinic, the amount of data needing segmentation will likely exceed the capacity of existing segmentation workflows used in research laboratories, requiring new methods and workflows for making segmentation less cumbersome. This paper investigates five reaching and targeting motion primitive segmentation methods in two different domains (haptics simulation and real world) and how to evaluate these methods. This work finds that most of the segmentation methods evaluated perform reasonably well given current limitations in our ability to evaluate segmentation results. Furthermore, we propose a method to automatically identify potentially incorrect segmentation results for further review by the human evaluator. Clinical impact: This work supports efforts to automate aspects of processing upper extremity kinematic data used to evaluate reaching and grasping, which will be necessary for more widespread usage in clinical settings.
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Affiliation(s)
- Kyle L. Jackson
- Department of Computer ScienceGeorge Mason UniversityFairfaxVA22030USA
| | - Zoran Durić
- Department of Computer ScienceGeorge Mason UniversityFairfaxVA22030USA
- Center for Adaptive Systems and Brain-Body InteractionsGeorge Mason UniversityFairfaxVA22030USA
| | - Susannah M. Engdahl
- Center for Adaptive Systems and Brain-Body InteractionsGeorge Mason UniversityFairfaxVA22030USA
- Department of BioengineeringGeorge Mason UniversityFairfaxVA22030USA
- The American Orthotic and Prosthetic AssociationAlexandriaVA22314USA
| | | | - Siddhartha Sikdar
- Center for Adaptive Systems and Brain-Body InteractionsGeorge Mason UniversityFairfaxVA22030USA
- Department of BioengineeringGeorge Mason UniversityFairfaxVA22030USA
| | - Lynn H. Gerber
- Center for Adaptive Systems and Brain-Body InteractionsGeorge Mason UniversityFairfaxVA22030USA
- College of Public HealthGeorge Mason UniversityFairfaxVA22030USA
- Inova Health SystemFalls ChurchVA22042USA
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7
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Pradeep A, Birerdinc A, Branigan T, Phan V, Morris H, Shah J, DeStefano S, Sikdar S, Srbely J, Kumbhare D, Stecco A, Paik J, Gerber LH. Evidence for an association of serum microanalytes and myofascial pain syndrome. BMC Musculoskelet Disord 2023; 24:624. [PMID: 37528404 PMCID: PMC10391753 DOI: 10.1186/s12891-023-06744-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/21/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Myofascial Pain Syndrome (MPS) is a common pain disorder. Diagnostic criteria include physical findings which are often unreliable or not universally accepted. A precise biosignature may improve diagnosis and treatment effectiveness. The purpose of this study was to assess whether microanalytic assays significantly correlate with characteristic clinical findings in people with MPS. METHODS This descriptive, prospective study included 38 participants (25 women) with greater than 3 months of myofascial pain in the upper trapezius. Assessments were performed at a university laboratory. The main outcome measures were the Beighton Index, shoulder range of motion, strength asymmetries and microanalytes: DHEA, Kynurenine, VEGF, interleukins (IL-1b, IL-2, IL-4, IL-5, IL-7, IL-8, IL-13), growth factors (IGF-1, IGF2, G-CSF, GM-CSF), MCP-1, MIP-1b, BDNF, Dopamine, Noradrenaline, NPY, and Acetylcholine. Mann-Whitney test and Spearman's multivariate correlation were applied for all variables. The Spearman's analysis results were used to generate a standard correlation matrix and heat map matrix. RESULTS Mean age of participants was 32 years (20-61). Eight (21%) had widespread pain (Widespread Pain Index ≥ 7). Thirteen (34%) had MPS for 1-3 years, 14 (37%) 3-10 years, and 11 (29%) for > 10 years. The following showed strong correlations: IL1b,2,4,5,7,8; GM-CSF and IL 2,4,5,7; between DHEA and BDNF and between BDNF and Kynurenine, NPY and acetylcholine. The heat map analysis demonstrated strong correlations between the Beighton Index and IL 5,7, GM-CSF, DHEA. Asymmetries of shoulder and cervical spine motion and strength associated with select microanalytes. CONCLUSION Cytokine levels significantly correlate with selected clinical assessments. This indirectly suggests possible biological relevance for understanding MPS. Correlations among some cytokine clusters; and DHEA, BDNF kynurenine, NPY, and acetylcholine may act together in MPS. These findings should be further investigated for confirmation that link these microanalytes with select clinical findings in people with MPS.
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Affiliation(s)
- Aishwarya Pradeep
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, 9000 Rockville Pike, , Bethesda, MD, 20892, USA
| | - Aybike Birerdinc
- College of Science, George Mason University, 4400 University Drive, Fairfax, VA, 22032, USA
| | - Travis Branigan
- Department of Human Health and Nutritional Sciences, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada
| | - Vy Phan
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, 9000 Rockville Pike, , Bethesda, MD, 20892, USA
| | - Hailey Morris
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, 9000 Rockville Pike, , Bethesda, MD, 20892, USA
| | - Jay Shah
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, 9000 Rockville Pike, , Bethesda, MD, 20892, USA
| | - Secili DeStefano
- College of Public Health, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Siddhartha Sikdar
- Volgenau School, George Mason University, 4400 University Drive, Fairfax, VA, 22032, USA
| | - John Srbely
- Department of Human Health and Nutritional Sciences, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada
| | - Dinesh Kumbhare
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Antonio Stecco
- Department of Physical Medicine and Rehabilitation, New York University Langone Medical Center, 550 First Avenue, New York, NY, 10016, USA
| | - James Paik
- Medicine Service Line, Inova Health System, 3300 Gallows Rd, Falls Church, VA, 22042, USA
| | - Lynn H Gerber
- College of Public Health, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA.
- Medicine Service Line, Inova Health System, 3300 Gallows Rd, Falls Church, VA, 22042, USA.
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8
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Patwardhan S, Gladhill KA, Joiner WM, Schofield JS, Sikdar S. Using Principles of Motor Control to Analyze Performance of Human Machine Interfaces. Res Sq 2023:rs.3.rs-2763325. [PMID: 37292730 PMCID: PMC10246101 DOI: 10.21203/rs.3.rs-2763325/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
There have been significant advances in biosignal extraction techniques to drive external biomechatronic devices or to use as inputs to sophisticated human machine interfaces. The control signals are typically derived from biological signals such as myoelectric measurements made either from the surface of the skin or subcutaneously. Other biosignal sensing modalities are emerging. With improvements in sensing modalities and control algorithms, it is becoming possible to robustly control the target position of a end effector. It remains largely unknown to what extent these improvements can lead to naturalistic human-like movement. In this paper, we sought to answer this question. We utilized a sensing paradigm called sonomyography based on continuous ultrasound imaging of forearm muscles. Unlike myoelectric control strategies which measure electrical activation and use the extracted signals to determine the velocity of an end-effector; sonomyography measures muscle deformation directly with ultrasound and uses the extracted signals to proportionally control the position of an end-effector. Previously, we showed that users were able to accurately and precisely perform a virtual target acquisition task using sonomyography. In this work, we investigate the time course of the control trajectories derived from sonomyography. We show that the time course of the sonomyography-derived trajectories that users take to reach virtual targets reflect the trajectories shown to be typical for kinematic characteristics observed in biological limbs. Specifically, during a target acquisition task, the velocity profiles followed a minimum jerk trajectory shown for point-to-point arm reaching movements, with similar time to target. In addition, the trajectories based on ultrasound imaging result in a systematic delay and scaling of peak movement velocity as the movement distance increased. We believe this is the first evaluation of similarities in control policies in coordinated movements in jointed limbs, and those based on position control signals extracted at the individual muscle level. These results have strong implications for the future development of control paradigms for assistive technologies.
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Affiliation(s)
| | - Keri Anne Gladhill
- Department of Psychology, George Mason University, Fairfax, VA, 22030, USA
| | - Wilsaan M. Joiner
- Department of Neurobiology, Physiology and Behavior, University of California, Davis, Davis, CA, 95616, USA
| | - Jonathon S. Schofield
- Mechanical and Aerospace Engineering Department, University of California, Davis, Davis, CA, 95616, USA
| | - Siddhartha Sikdar
- Department of Bioengineering, George Mason University, Fairfax VA, 22030, USA
- Center for Adaptive Systems of Brain-Body Interactions, Fairfax VA, 22030, USA
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9
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Guthrie BM, King EL, Patwardhan S, Wei Q, Sikdar S, Chitnis PV, Jones MT. Relationships between surrogate measures of mechanical and psychophysiological load, patellar tendon adaptations, and neuromuscular performance in NCAA division I men's volleyball athletes. Front Sports Act Living 2023; 5:1065470. [PMID: 36909358 PMCID: PMC9992433 DOI: 10.3389/fspor.2023.1065470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction Patellar tendon adaptations occur in response to mechanical load. Appropriate loading is necessary to elicit positive adaptations with increased risk of injury and decreased performance likely if loading exceeds the capacity of the tendon. The aim of the current study was to examine intra-individual associations between workloads and patellar tendon properties and neuromuscular performance in collegiate volleyball athletes. Methods National Collegiate Athletics Association Division I men's volleyball athletes (n = 16, age: 20.33 ± 1.15 years, height: 193.50 ± 6.50 cm, body mass: 84.32 ± 7.99 kg, bodyfat%: 13.18 ± 4.72%) competing across 9 weeks of in-season competition participated. Daily measurements of external workloads (i.e., jump count) and internal workloads [i.e., session rating of perceived exertion (sRPE)] were recorded. Weekly measurements included neuromuscular performance assessments (i.e., countermovement jump, drop jump), and ultrasound images of the patellar tendon to evaluate structural adaptations. Repeated measures correlations (r-rm) assessed intra-individual associations among performance and patellar tendon metrics. Results Workload measures exhibited significant negative small to moderate (r-rm =-0.26-0.31) associations with neuromuscular performance, negative (r-rm = -0.21-0.30), and positive (r-rm = 0.20-0.32) small to moderate associations with patellar tendon properties. Discussion Monitoring change in tendon composition and performance adaptations alongside workloads may inform evidence-based frameworks toward managing and reducing the risk of the development of patellar tendinopathy in collegiate men's volleyball athletes.
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Affiliation(s)
- Brian M Guthrie
- Patriot Performance Laboratory, Frank Pettrone Center for Sports Performance, George Mason University, Fairfax, VA, United States
| | - Erica L King
- Department of Bioengineering, George Mason University, Fairfax, VA, United States.,Center for Adaptive Systems of Brain-Body Interactions, George Mason University, Fairfax, VA, United States
| | - Shriniwas Patwardhan
- Department of Bioengineering, George Mason University, Fairfax, VA, United States.,Center for Adaptive Systems of Brain-Body Interactions, George Mason University, Fairfax, VA, United States
| | - Qi Wei
- Department of Bioengineering, George Mason University, Fairfax, VA, United States
| | - Siddhartha Sikdar
- Department of Bioengineering, George Mason University, Fairfax, VA, United States.,Center for Adaptive Systems of Brain-Body Interactions, George Mason University, Fairfax, VA, United States
| | - Parag V Chitnis
- Department of Bioengineering, George Mason University, Fairfax, VA, United States.,Center for Adaptive Systems of Brain-Body Interactions, George Mason University, Fairfax, VA, United States
| | - Margaret T Jones
- Patriot Performance Laboratory, Frank Pettrone Center for Sports Performance, George Mason University, Fairfax, VA, United States.,Sport, Recreation, and Tourism Management, George Mason University, Fairfax, VA, United States
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10
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Acharya A, Izquierdo AM, Gonçalves SF, Bates RA, Taxman FS, Slawski MP, Rangwala HS, Sikdar S. Exploring county-level spatio-temporal patterns in opioid overdose related emergency department visits. PLoS One 2022; 17:e0269509. [PMID: 36584000 PMCID: PMC9803238 DOI: 10.1371/journal.pone.0269509] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 12/13/2022] [Indexed: 12/31/2022] Open
Abstract
Opioid overdoses within the United States continue to rise and have been negatively impacting the social and economic status of the country. In order to effectively allocate resources and identify policy solutions to reduce the number of overdoses, it is important to understand the geographical differences in opioid overdose rates and their causes. In this study, we utilized data on emergency department opioid overdose (EDOOD) visits to explore the county-level spatio-temporal distribution of opioid overdose rates within the state of Virginia and their association with aggregate socio-ecological factors. The analyses were performed using a combination of techniques including Moran's I and multilevel modeling. Using data from 2016-2021, we found that Virginia counties had notable differences in their EDOOD visit rates with significant neighborhood-level associations: many counties in the southwestern region were consistently identified as the hotspots (areas with a higher concentration of EDOOD visits) whereas many counties in the northern region were consistently identified as the coldspots (areas with a lower concentration of EDOOD visits). In most Virginia counties, EDOOD visit rates declined from 2017 to 2018. In more recent years (since 2019), the visit rates showed an increasing trend. The multilevel modeling revealed that the change in clinical care factors (i.e., access to care and quality of care) and socio-economic factors (i.e., levels of education, employment, income, family and social support, and community safety) were significantly associated with the change in the EDOOD visit rates. The findings from this study have the potential to assist policymakers in proper resource planning thereby improving health outcomes.
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Affiliation(s)
- Angeela Acharya
- Department of Computer Science, George Mason University, Fairfax, VA, United States of America
- * E-mail:
| | - Alyssa M. Izquierdo
- Clinical Psychology, George Mason University, Fairfax, VA, United States of America
| | | | - Rebecca A. Bates
- School of Nursing, George Mason University, Fairfax, VA, United States of America
| | - Faye S. Taxman
- Schar School of Policy and Government, George Mason University, Fairfax, VA, United States of America
| | - Martin P. Slawski
- Department of Statistics, George Mason University, Fairfax, VA, United States of America
| | - Huzefa S. Rangwala
- Department of Computer Science, George Mason University, Fairfax, VA, United States of America
| | - Siddhartha Sikdar
- Department of Bioengineering, George Mason University, Fairfax, VA, United States of America
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11
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Majdi JA, Acuña SA, Chitnis PV, Sikdar S. Toward a wearable monitor of local muscle fatigue during electrical muscle stimulation using tissue Doppler imaging. Wearable Technol 2022; 3:e16. [PMID: 38486895 PMCID: PMC10936279 DOI: 10.1017/wtc.2022.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/26/2022] [Accepted: 06/12/2022] [Indexed: 03/17/2024]
Abstract
Electrical muscle stimulation (EMS) is widely used in rehabilitation and athletic training to generate involuntary muscle contractions. However, EMS leads to rapid muscle fatigue, limiting the force a muscle can produce during prolonged use. Currently available methods to monitor localized muscle fatigue and recovery are generally not compatible with EMS. The purpose of this study was to examine whether Doppler ultrasound imaging can assess changes in stimulated muscle twitches that are related to muscle fatigue from electrical stimulation. We stimulated five isometric muscle twitches in the medial and lateral gastrocnemius of 13 healthy subjects before and after a fatiguing EMS protocol. Tissue Doppler imaging of the medial gastrocnemius recorded muscle tissue velocities during each twitch. Features of the average muscle tissue velocity waveforms changed immediately after the fatiguing stimulation protocol (peak velocity: -38%, p = .022; time-to-zero velocity: +8%, p = .050). As the fatigued muscle recovered, the features of the average tissue velocity waveforms showed a return towards their baseline values similar to that of the normalized ankle torque. We also found that features of the average tissue velocity waveform could significantly predict the ankle twitch torque for each participant (R2 = 0.255-0.849, p < .001). Our results provide evidence that Doppler ultrasound imaging can detect changes in muscle tissue during isometric muscle twitch that are related to muscle fatigue, fatigue recovery, and the generated joint torque. Tissue Doppler imaging may be a feasible method to monitor localized muscle fatigue during EMS in a wearable device.
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Affiliation(s)
- Joseph A. Majdi
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
- Center for Adaptive Systems of Brain–Body Interactions, George Mason University, Fairfax, Virginia, USA
| | - Samuel A. Acuña
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
- Center for Adaptive Systems of Brain–Body Interactions, George Mason University, Fairfax, Virginia, USA
| | - Parag V. Chitnis
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
- Center for Adaptive Systems of Brain–Body Interactions, George Mason University, Fairfax, Virginia, USA
| | - Siddhartha Sikdar
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
- Center for Adaptive Systems of Brain–Body Interactions, George Mason University, Fairfax, Virginia, USA
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12
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Patwardhan S, Schofield J, Joiner WM, Sikdar S. Sonomyography shows feasibility as a tool to quantify joint movement at the muscle level. IEEE Int Conf Rehabil Robot 2022; 2022:1-5. [PMID: 36176162 PMCID: PMC9806856 DOI: 10.1109/icorr55369.2022.9896582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Several methods have been used to quantify human movement at different levels, from coordinated multi joint movements to those taking place at the single muscle level. These methods are developed either in order to allow us to interact with computers and machines, or to use such technologies for aiding rehabilitation among those with mobility impairments or movement disorders. Human machine interfaces typically rely on some existing human movement ability and measure it using motion tracking or inertial measurement units, while the rehabilitation applications may require us to measure human motor intent. Surface or implanted electrodes, electromyography, electroencephalography, and brain computer interfaces are beneficial in this regard, but have their own shortcomings. We have previously shown feasibility of using ultrasound imaging (Sonomyography) to infer human motor intent and allow users to control external biomechatronic devices such as prosthetics. Here, we asked users to freely move their hand in three different movement patterns, measuring their actual joint angles and passively computing their Sonomyographic output signal. We found a high correlation between these two signals, demonstrating that the Sonomyography signal is not only user-controlled and stable, but it is closely linked with the user's actual movement level. These results could help design wearable rehabilitation or human computer interaction devices based on Sonomyography to decode human motor intent.
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Affiliation(s)
| | - Jonathon Schofield
- Mechanical and Aerospace Engineering Department, University of California, Davis, USA
| | - Wilsaan M. Joiner
- Department of Neurobiology, Physiology and Behavior, University of California, Davis, CA, USA
| | - Siddhartha Sikdar
- Department of Bioengineering, George Mason University, Fairfax VA, USA,Center for Adaptive Systems of Brain-Body Interactions, Fairfax, VA
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13
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Affiliation(s)
- Thomas C. Bulea
- Neurorehabilitation and Biomechanics Research Section, Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, United States
- *Correspondence: Thomas C. Bulea,
| | - Nitin Sharma
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina-Chapel Hill, Raleigh, NC, United States
| | - Siddhartha Sikdar
- Department of Bioengineering, George Mason University, Fairfax, VA, United States
- Center for Adaptive Systems of Brain-Body Interactions, George Mason University, Fairfax, VA, United States
| | - Hao Su
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC, United States
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14
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Engdahl S, Dhawan A, Bashatah A, Diao G, Mukherjee B, Monroe B, Holley R, Sikdar S. Classification Performance and Feature Space Characteristics in Individuals With Upper Limb Loss Using Sonomyography. IEEE J Transl Eng Health Med 2022; 10:2100311. [PMID: 35070521 PMCID: PMC8763379 DOI: 10.1109/jtehm.2022.3140973] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/07/2021] [Accepted: 01/01/2022] [Indexed: 11/15/2022]
Abstract
Objective: Sonomyography, or ultrasound-based sensing of muscle deformation, is an emerging modality for upper limb prosthesis control. Although prior studies have shown that individuals with upper limb loss can achieve successful motion classification with sonomyography, it is important to better understand the time-course over which proficiency develops. In this study, we characterized user performance during their initial and subsequent exposures to sonomyography. Method: Ultrasound images corresponding to a series of hand gestures were collected from individuals with transradial limb loss under three scenarios: during their initial exposure to sonomyography (Experiment 1), during a subsequent exposure to sonomyography where they were provided biofeedback as part of a training protocol (Experiment 2), and during testing sessions held on different days (Experiment 3). User performance was characterized by offline classification accuracy, as well as metrics describing the consistency and separability of the sonomyography signal patterns in feature space. Results: Classification accuracy was high during initial exposure to sonomyography (96.2 ± 5.9%) and did not systematically change with the provision of biofeedback or on different days. Despite this stable classification performance, some of the feature space metrics changed. Conclusions: User performance was strong upon their initial exposure to sonomyography and did not improve with subsequent exposure. Clinical Impact: Prosthetists may be able to quickly assess if a patient will be successful with sonomyography without submitting them to an extensive training protocol, leading to earlier socket fabrication and delivery.
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Affiliation(s)
- Susannah Engdahl
- Department of BioengineeringGeorge Mason University Fairfax VA 20030 USA
| | - Ananya Dhawan
- Department of BioengineeringGeorge Mason University Fairfax VA 20030 USA
| | - Ahmed Bashatah
- Department of BioengineeringGeorge Mason University Fairfax VA 20030 USA
| | - Guoqing Diao
- Department of Biostatistics and BioinformaticsThe George Washington University Washington DC 20052 USA
| | - Biswarup Mukherjee
- Department of BioengineeringGeorge Mason University Fairfax VA 20030 USA
| | | | - Rahsaan Holley
- MedStar National Rehabilitation Hospital Washington DC 20010 USA
| | - Siddhartha Sikdar
- Department of BioengineeringGeorge Mason University Fairfax VA 20030 USA
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15
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Engdahl SM, Acuña SA, King EL, Bashatah A, Sikdar S. First Demonstration of Functional Task Performance Using a Sonomyographic Prosthesis: A Case Study. Front Bioeng Biotechnol 2022; 10:876836. [PMID: 35600893 PMCID: PMC9114778 DOI: 10.3389/fbioe.2022.876836] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/29/2022] [Indexed: 11/28/2022] Open
Abstract
Ultrasound-based sensing of muscle deformation, known as sonomyography, has shown promise for accurately classifying the intended hand grasps of individuals with upper limb loss in offline settings. Building upon this previous work, we present the first demonstration of real-time prosthetic hand control using sonomyography to perform functional tasks. An individual with congenital bilateral limb absence was fitted with sockets containing a low-profile ultrasound transducer placed over forearm muscle tissue in the residual limbs. A classifier was trained using linear discriminant analysis to recognize ultrasound images of muscle contractions for three discrete hand configurations (rest, tripod grasp, index finger point) under a variety of arm positions designed to cover the reachable workspace. A prosthetic hand mounted to the socket was then controlled using this classifier. Using this real-time sonomyographic control, the participant was able to complete three functional tasks that required selecting different hand grasps in order to grasp and move one-inch wooden blocks over a broad range of arm positions. Additionally, these tests were successfully repeated without retraining the classifier across 3 hours of prosthesis use and following simulated donning and doffing of the socket. This study supports the feasibility of using sonomyography to control upper limb prostheses in real-world applications.
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Affiliation(s)
- Susannah M. Engdahl
- Department of Bioengineering, George Mason University, Fairfax, VA, United States
- Center for Adaptive Systems of Brain-Body Interactions, George Mason University, Fairfax, VA, United States
| | - Samuel A. Acuña
- Department of Bioengineering, George Mason University, Fairfax, VA, United States
- Center for Adaptive Systems of Brain-Body Interactions, George Mason University, Fairfax, VA, United States
| | - Erica L. King
- Department of Bioengineering, George Mason University, Fairfax, VA, United States
- Center for Adaptive Systems of Brain-Body Interactions, George Mason University, Fairfax, VA, United States
| | - Ahmed Bashatah
- Department of Bioengineering, George Mason University, Fairfax, VA, United States
- Center for Adaptive Systems of Brain-Body Interactions, George Mason University, Fairfax, VA, United States
| | - Siddhartha Sikdar
- Department of Bioengineering, George Mason University, Fairfax, VA, United States
- Center for Adaptive Systems of Brain-Body Interactions, George Mason University, Fairfax, VA, United States
- *Correspondence: Siddhartha Sikdar,
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16
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Desikan SK, Mayorga-Carlin M, Dux MC, Gray VL, Anagnostakos J, Khan AA, Sikdar S, Barth D, Harper S, Sorkin JD, Lal BK. Lack of association between cognitive impairment and systemic inflammation in asymptomatic carotid stenosis. J Vasc Surg 2022; 75:1643-1650. [PMID: 34921963 PMCID: PMC10939009 DOI: 10.1016/j.jvs.2021.11.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 11/11/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Asymptomatic carotid atherosclerotic stenosis (ACAS) is associated with cognitive impairment. Systemic inflammation occurs in patients with systemic atherosclerosis and is also associated with cognitive impairment. The goal of this study was to determine if cognitive impairment in patients with ACAS is the result of systemic inflammation. METHODS A cross-sectional analysis of 104 patients (63 patients with ACAS, 41 controls) with cognitive function and inflammatory biomarker assessments was performed. Venous blood was assayed for proinflammatory biomarkers (IL-1β, IL-6, IL-6R, IL-8, IL-17, tumor necrosis factor-α, matrix metalloproteinase [MMP]-1, MMP-2, MMP-7, MMP-9, vascular cell adhesion molecule, and high-sensitivity C-reactive protein). The patients also underwent comprehensive cognitive testing to compute five domain-specific cognitive scores per patient. We first assessed the associations between carotid stenosis and cognitive function, and between carotid stenosis and systemic inflammation in separate regression models. We then determined whether cognitive impairments persisted in patients with carotid stenosis after accounting for inflammation by adjusting for inflammatory biomarker levels in a combined model. RESULTS Patients with ACAS and control patients differed in age, race, coronary artery disease prevalence, and education. Stenosis patients had worse cognitive scores in two domains: learning and memory (P = .05) and motor and processing speed (P = .002). Despite adjusting for inflammatory biomarker levels, patients with ACAS still demonstrated deficits in the domains of learning and memory and motor and processing speed. CONCLUSIONS Although systemic atherosclerosis-induced inflammation is a well-recognized cause for cognitive impairment, our data suggest that it is not the primary underlying mechanism behind cognitive impairments seen in ACAS. Cognitive impairments in learning and memory and motor and processing speed seen in patients with ACAS persist after adjusting for systemic inflammation. Thus, alternative mechanisms should be explored to account for the observed functional impairments.
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Affiliation(s)
- Sarasijhaa K Desikan
- Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md
| | | | - Moira C Dux
- Neuropsychology Section, Veterans Affairs Medical Center, Baltimore, Md
| | - Vicki L Gray
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, Md
| | - John Anagnostakos
- Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Amir A Khan
- Department of Bioengineering, George Mason University, Fairfax, Va
| | | | - Dawn Barth
- Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Sophie Harper
- Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - John D Sorkin
- Baltimore VA Geriatric Research, Education and Clinical Center, Baltimore, Md; Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Md
| | - Brajesh K Lal
- Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md.
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17
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Gray V, Desikan S, Khan A, Barth D, Sikdar S, Sorkin J, Lal B. Carotid Revascularization Improves Balance and Mobility, Particularly in Patients That Are Most Impaired. Innov Aging 2020. [PMCID: PMC7740901 DOI: 10.1093/geroni/igaa057.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Balance and mobility function worsen with age, and more so for those with underlying diseases. Our research has demonstrated that asymptomatic carotid artery stenosis (ACAS) is associated with worse balance and mobility, and a higher fall risk, compared to older adults with similar comorbidities, but without ACAS. Thus, ACAS, with attendant blood flow-restriction to the brain is a potentially modifiable risk factor for balance and mobility dysfunction. The purpose of this study was to evaluate the impact of restoring blood flow to the brain by carotid revascularization, on balance and mobility in patients with high-grade ACAS (≥70% diameter-reducing stenosis). Twenty adults (67.0±9.4 years) undergoing carotid revascularization for high-grade stenosis were enrolled. A balance and mobility assessment was performed before- and six weeks- after carotid revascularization and included: Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), Four Square Step Test (FSST), Dynamic Gait Index (DGI) Timed Up and Go (TUG), gait speed, MiniBESTest, and Walk While Talk (WWT) test. Paired t-tests assessed changes in outcome measures between the two-time points. Significant improvements were observed in measures that combined walking with dynamic movements, DGI (P=0.003), and MiniBESTest (P=0.021). Pearson’s correlations examined the relationship between balance and mobility before surgery and change score after surgery. Patients with lower baseline DGI and MiniBest scores demonstrated the most improvement on follow-up testing (r=-0.70, p=0.001, and r=-0.59, p=0.006, respectively). In conclusion, revascularization of a carotid artery stenosis improves balance and mobility; the greatest improvements are observed in those patients that are the most impaired.
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Affiliation(s)
- Vicki Gray
- University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Sarasijhaa Desikan
- University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Amir Khan
- George Mason University, Fairfax, Virginia, United States
| | - Dawn Barth
- University of Maryland School of Medicine, Balitmore, Maryland, United States
| | | | - John Sorkin
- University of Maryland School of Medicine, Balitmore, Maryland, United States
| | - Brajesh Lal
- University of Maryland, Baltimroe, Maryland, United States
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18
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Khan AA, Patel J, Desikan S, Chrencik M, Martinez-Delcid J, Caraballo B, Yokemick J, Gray VL, Sorkin JD, Cebral J, Sikdar S, Lal BK. Asymptomatic carotid artery stenosis is associated with cerebral hypoperfusion. J Vasc Surg 2020; 73:1611-1621.e2. [PMID: 33166609 DOI: 10.1016/j.jvs.2020.10.063] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/03/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We have shown that almost 50% of patients with asymptomatic carotid stenosis (ACS) will demonstrate cognitive impairment. Recent evidence has suggested that cerebral hypoperfusion is an important cause of cognitive impairment. Carotid stenosis can restrict blood flow to the brain, with consequent cerebral hypoperfusion. In contrast, cross-hemispheric collateral compensation through the Circle of Willis, and cerebrovascular vasodilation can also mitigate the effects of flow restriction. It is, therefore, critical to develop a clinically relevant measure of net brain perfusion in patients with ACS that could help in risk stratification and in determining the appropriate treatment. To determine whether ACS results in cerebral hypoperfusion, we developed a novel approach to quantify interhemispheric cerebral perfusion differences, measured as the time to peak (TTP) and mean transit time (MTT) delays using perfusion-weighted magnetic resonance imaging (PWI) of the whole brain. To evaluate the utility of using clinical duplex ultrasonography (DUS) to infer brain perfusion, we also assessed the relationship between the PWI findings and ultrasound-based peak systolic velocity (PSV). METHODS Structural and PWI of the brain and magnetic resonance angiography of the carotid arteries were performed in 20 patients with ≥70% ACS. DUS provided the PSV, and magnetic resonance angiography provided plaque geometric measures at the stenosis. Volumetric perfusion maps of the entire brain from PWI were analyzed to obtain the mean interhemispheric differences for the TTP and MTT delays. In addition, the proportion of brain volume that demonstrated a delay in TTP and MTT was also measured. These proportions were measured for increasing severity of perfusion delays (0.5, 1.0, and 2.0 seconds). Finally, perfusion asymmetries on PWI were correlated with the PSV and stenosis features on DUS using Pearson's correlation coefficients. RESULTS Of the 20 patients, 18 had unilateral stenosis (8 right and 10 left) and 2 had bilateral stenoses. The interhemispheric (left-right) TTP delays measured for the whole brain volume identified impaired perfusion in the hemisphere ipsilateral to the stenosis in 16 of the 18 patients. More than 45% of the patients had had ischemia in at least one half of their brain volume, with a TTP delay >0.5 second. The TTP and MTT delays showed strong correlations with PSV. In contrast, the correlations with the percentage of stenosis were weaker. The correlations for the PSV were strongest with the perfusion deficits (TTP and MTT delays) measured for the whole brain using our proposed algorithm (r = 0.80 and r = 0.74, respectively) rather than when measured on a single magnetic resonance angiography slice as performed in current clinical protocols (r = 0.31 and r = 0.58, respectively). CONCLUSIONS Interhemispheric TTP and MTT delay measured for the whole brain using PWI has provided a new tool for assessing cerebral perfusion deficits in patients with ACS. Carotid stenosis was associated with a detectable reduction in ipsilateral brain perfusion compared with the opposite hemisphere in >80% of patients. The PSV measured at the carotid stenosis using ultrasonography correlated with TTP and MTT delays and might serve as a clinically useful surrogate to brain hypoperfusion in these patients.
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Affiliation(s)
- Amir A Khan
- Department of Bioengineering, George Mason University, Fairfax, Va
| | - Jigar Patel
- Imaging Service, Veterans Affairs Maryland Health Care System, Baltimore, Md
| | - Sarasijhaa Desikan
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md
| | - Matthew Chrencik
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md
| | - Janice Martinez-Delcid
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md
| | - Brian Caraballo
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md
| | - John Yokemick
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md
| | - Vicki L Gray
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Md
| | - John D Sorkin
- Geriatric Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center, Baltimore, Md; Claude D. Pepper Older Americans Independence Center, University of Maryland School of Medicine, Baltimore, Md
| | - Juan Cebral
- Department of Bioengineering, George Mason University, Fairfax, Va
| | | | - Brajesh K Lal
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md.
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19
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Khan AA, Patel JB, Lal BK, Sikdar S. Assessment of Interhemispheric Cerebral Perfusion Deficit in Carotid Artery Stenosis. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:5810-5813. [PMID: 33019295 DOI: 10.1109/embc44109.2020.9175883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Asymptomatic carotid stenosis patients manifest compromised cognitive performance compared to controls. Cerebral perfusion deficit could be an important contributor to cognitive impairment. The relationship between carotid stenosis and cerebral perfusion deficit is not established. If established, this could lead to a more informed selection of ACS patients likely to benefit from carotid revascularization. Perfusion-weighted MR imaging (PWI) is a clinically viable non-invasive technique to quantify cerebral perfusion. However, its impact is limited due to lack of efficient clinical tools to analyze PWI data in different brain regions for characterizing interhemispheric perfusion asymmetry. Development of automated approaches to characterize clinically relevant perfusion deficits is therefore required. Moreover, there is no established evidence of association between perfusion deficit and stenosis severity. In this paper, we propose an approach to quantify interhemispheric perfusion differences in different brain regions using clinical data. Our proposed metrics, based on the PWI mean transit time, for characterizing difference between ipsilateral and contralateral hemispheres demonstrate a very strong relationship with Doppler ultrasound based peak systolic velocity measured at stenosis. Our approach also highlights dependence of perfusion asymmetry on effective collateralization through the cerebral vasculature. In future studies, we plan to extend this method to a larger cohort and refine the methods for validating novel biomarker for risk-stratification of carotid stenosis.
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20
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Patwardhan S, Mukherjee B, Dhawan A, Alzamani M, Noor A, Engdahl S, Joiner WM, Sikdar S. Sonomyography Combined with Vibrotactile Feedback Enables Precise Target Acquisition Without Visual Feedback. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:4955-4958. [PMID: 33019099 PMCID: PMC7733223 DOI: 10.1109/embc44109.2020.9176524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Upper limb prosthesis users currently lack haptic feedback from their terminal devices, which significantly limits their ability to meaningfully interact with their environment. Users therefore rely heavily on visual feedback when using terminal devices. Previously, it has been shown that force-related feedback from an end-effector or virtual environment can help the user minimize errors and improve performance. Currently, myoelectric control systems enable the user to control the velocity of terminal devices. We have developed a novel control method using ultrasound sensing, called sonomyography, that enables position control based on mechanical deformation of muscles. In this paper, we investigated whether the proprioceptive feedback from muscle deformation combined with vibrotactile haptic feedback can minimize the need for visual feedback. Able bodied subjects used sonomyography to control a virtual cursor, and performed a target acquisition task. The effect of visual and haptic feedback on performance of a target acquisition task was systematically tested. We found that subjects made large errors when they tried to reacquire a target without visual feedback, but in the presence of real-time haptic feedback, the precision of the target position improved, and were similar to when visual feedback was used for target acquisition. This result has implications for improving the performance of prosthetic control systems.
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21
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Gray VL, Goldberg AP, Rogers MW, Anthony L, Terrin ML, Guralnik JM, Blackwelder WC, Lam DFH, Sikdar S, Lal BK. Asymptomatic carotid stenosis is associated with mobility and cognitive dysfunction and heightens falls in older adults. J Vasc Surg 2020; 71:1930-1937. [PMID: 31699511 PMCID: PMC7196504 DOI: 10.1016/j.jvs.2019.09.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 09/02/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Atherosclerosis of the carotid bifurcation with plaque formation causes asymptomatic carotid artery stenosis (ACAS), which may also be associated with cerebral hypoperfusion. Cerebral hypoperfusion adversely affects multiple aspects of mobility and cognition. This study tests the hypothesis that community-dwelling older adults with a 50% or greater diameter-reducing ACAS will have mobility and cognitive impairments that heighten their risk for falls. METHODS Eighty community-dwelling adults completed a mobility assessment (Short Physical Performance Battery, Berg Balance Scale, Four Square Step Test, Dynamic Gait Index, Timed Up and Go, and gait speed), self-reported physical function (Activities-Specific Balance Confidence, SF-12 Physical Function Component), and cognitive tests (Mini-Mental State Examination). Falls were recorded for the past 6 months. Standardized carotid ultrasound examination classified participants into no stenosis (<50% diameter reduction) (n = 54), moderate stenosis (50%-69%) (n = 17), and high-grade stenosis (70%-99%) (n = 9) groups. Linear and logistic regression analyses determined the associations between these measures and the degree of stenosis (three groups). RESULTS Logistic regression analysis showed their degree of stenosis was associated with reductions in mobility (Short Physical Performance Battery [P = .008], Berg Balance Scale [P = .0008], Four Square Step Test [P = .005], DGI [P = .0001], TUG [P = .0004], gait speed [P = .02]), perceived physical function (ABC [P < .0001], SF-12 Physical Function Component [P < .0001]), and cognition (MMSE [P = .003]). Adults with moderate- and high-grade stenosis had a greater incidence of falls compared with those without stenosis (relative risk, 2.86; P = .01). Results remained unchanged after adjustment for age, sex and cardiovascular risk factors. CONCLUSIONS ACAS is associated with impaired mobility and cognition that are accompanied with increased fall risk. These impairments increased with worsening severity.
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Affiliation(s)
- Vicki L Gray
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Md
| | - Andrew P Goldberg
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, and Department of Veterans Affairs Baltimore VA Geriatric Research Education and Clinical Center, Baltimore, Md
| | - Mark W Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Md
| | - Laila Anthony
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md
| | - Michael L Terrin
- Department of Epidemiology and Public Health, and Department of Medicine, University of Maryland School of Medicine, Baltimore, Md
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Md
| | | | - Diana F H Lam
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Md
| | | | - Brajesh K Lal
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md.
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22
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Guan S, Khan AA, Sikdar S, Chitnis PV. Limited-View and Sparse Photoacoustic Tomography for Neuroimaging with Deep Learning. Sci Rep 2020; 10:8510. [PMID: 32444649 PMCID: PMC7244747 DOI: 10.1038/s41598-020-65235-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/26/2020] [Indexed: 12/15/2022] Open
Abstract
Photoacoustic tomography (PAT) is a non-ionizing imaging modality capable of acquiring high contrast and resolution images of optical absorption at depths greater than traditional optical imaging techniques. Practical considerations with instrumentation and geometry limit the number of available acoustic sensors and their "view" of the imaging target, which result in image reconstruction artifacts degrading image quality. Iterative reconstruction methods can be used to reduce artifacts but are computationally expensive. In this work, we propose a novel deep learning approach termed pixel-wise deep learning (Pixel-DL) that first employs pixel-wise interpolation governed by the physics of photoacoustic wave propagation and then uses a convolution neural network to reconstruct an image. Simulated photoacoustic data from synthetic, mouse-brain, lung, and fundus vasculature phantoms were used for training and testing. Results demonstrated that Pixel-DL achieved comparable or better performance to iterative methods and consistently outperformed other CNN-based approaches for correcting artifacts. Pixel-DL is a computationally efficient approach that enables for real-time PAT rendering and improved image reconstruction quality for limited-view and sparse PAT.
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Affiliation(s)
- Steven Guan
- Bioengineering Department, George Mason University, 4400 University Drive, Fairfax, 22030, VA, USA.
- The MITRE Corporation, McLean, VA, 22102, USA.
| | - Amir A Khan
- Bioengineering Department, George Mason University, 4400 University Drive, Fairfax, 22030, VA, USA
| | - Siddhartha Sikdar
- Bioengineering Department, George Mason University, 4400 University Drive, Fairfax, 22030, VA, USA
| | - Parag V Chitnis
- Bioengineering Department, George Mason University, 4400 University Drive, Fairfax, 22030, VA, USA.
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Patwardhan S, Dhawan AS, Mukherjee B, Alzamani M, Joiner WM, Sikdar S. Evaluation of the Role of Proprioception During Proportional Position Control Using Sonomyography: Applications in Prosthetic Control. IEEE Int Conf Rehabil Robot 2020; 2019:830-836. [PMID: 31374733 DOI: 10.1109/icorr.2019.8779559] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Prosthetics need to incorporate the users sense of proprioception into the control paradigm to provide intuitive control, and reduce training times and prosthetic rejection rates. In the absence of functional tasks with a prosthetic, virtual cursor control tasks have been used to train users to control multiple degrees of freedom. In this study, A proportional position signal was derived from the cross-sectional ultrasound images of the users forearm. We designed a virtual cursor control task with one degree of freedom to measure the users ability to repeatably and accurately acquire different levels of muscle flexion, using only their sense of proprioception. The experiment involved a target acquisition task, where the cursors height corresponded to the extent of muscle flexion. Users were asked to acquire targets on a screen. Visual feedback was disabled at certain times during the experiment, to isolate the effect of proprioception. We found that as visual feedback was taken away from the subjects, position error increased but their stability error did not change significantly. This indicates that users are not perfect at using only their proprioceptive sense to reacquire a level of muscle flexion, in the absence of haptic or visual feedback. However, they are adept at retaining an acquired flexion level without drifting. These results could help to quantify the role of proprioception in target acquisition tasks, in the absence of haptic or visual feedback.
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Phan V, Shah J, Tandon H, Srbely J, DeStefano S, Kumbhare D, Sikdar S, Clouse A, Gandhi A, Gerber L. Myofascial Pain Syndrome: A Narrative Review Identifying Inconsistencies in Nomenclature. PM R 2020; 12:916-925. [DOI: 10.1002/pmrj.12290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/04/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Vy Phan
- Rehabilitation Medicine DepartmentClinical Center, National Institutes of Health Bethesda MD
| | - Jay Shah
- Rehabilitation Medicine DepartmentClinical Center, National Institutes of Health Bethesda MD
| | - Hannah Tandon
- Rehabilitation Medicine DepartmentClinical Center, National Institutes of Health Bethesda MD
| | - John Srbely
- Department of Human Health and Nutritional SciencesUniversity of Guelph Guelph Canada
| | - Secili DeStefano
- Department of Health Administration and PolicyCollege of Health and Human Services, George Mason University Fairfax VA
| | - Dinesh Kumbhare
- Department of Medicine, Division of Physical Medicine and RehabilitationUniversity of Toronto Toronto Canada
| | - Siddhartha Sikdar
- Department of Bioengineering, Center for Adaptive Systems of Brain‐Body InteractionsGeorge Mason University Fairfax VA
| | - Allison Clouse
- Department of Human Health and Nutritional SciencesUniversity of Guelph Guelph Canada
| | - Amar Gandhi
- Department of Health Administration and PolicyCollege of Health and Human Services, George Mason University Fairfax VA
| | - Lynn Gerber
- Department of Health Administration and Policy, Center for the Study of Chronic Illness and Disability, College of Health and Human Services, Center for Adaptive Systems of Brain‐Body InteractionsGeorge Mason University Fairfax VA
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Xing Q, Chitnis P, Sikdar S, Alshiek J, Shobeiri SA, Wei Q. M3VR-A multi-stage, multi-resolution, and multi-volumes-of-interest volume registration method applied to 3D endovaginal ultrasound. PLoS One 2019; 14:e0224583. [PMID: 31751356 PMCID: PMC6872108 DOI: 10.1371/journal.pone.0224583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/16/2019] [Indexed: 11/24/2022] Open
Abstract
Heterogeneity of echo-texture and lack of sharply delineated tissue boundaries in diagnostic ultrasound images make three-dimensional (3D) registration challenging, especially when the volumes to be registered are considerably different due to local changes. We implemented a novel computational method that optimally registers volumetric ultrasound image data containing significant and local anatomical differences. It is A Multi-stage, Multi-resolution, and Multi-volumes-of-interest Volume Registration Method. A single region registration is optimized first for a close initial alignment to avoid convergence to a locally optimal solution. Multiple sub-volumes of interest can then be selected as target alignment regions to achieve confident consistency across the volume. Finally, a multi-resolution rigid registration is performed on these sub-volumes associated with different weights in the cost function. We applied the method on 3D endovaginal ultrasound image data acquired from patients during biopsy procedure of the pelvic floor muscle. Systematic assessment of our proposed method through cross validation demonstrated its accuracy and robustness. The algorithm can also be applied on medical imaging data of other modalities for which the traditional rigid registration methods would fail.
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Affiliation(s)
- Qi Xing
- Department of Computer Science, George Mason University, Fairfax, Virginia, United States of America
- The School of Information Science and Technology, Southwest Jiaotong University, Sichuan, China
| | - Parag Chitnis
- Department of Bioengineering, George Mason University, Fairfax, Virginia, United States of America
| | - Siddhartha Sikdar
- Department of Bioengineering, George Mason University, Fairfax, Virginia, United States of America
| | - Jonia Alshiek
- Department of Obstetrics & Gynecology, INOVA Health System, Falls Church, Virginia, United States of America
| | - S. Abbas Shobeiri
- Department of Bioengineering, George Mason University, Fairfax, Virginia, United States of America
- Department of Obstetrics & Gynecology, INOVA Health System, Falls Church, Virginia, United States of America
| | - Qi Wei
- Department of Bioengineering, George Mason University, Fairfax, Virginia, United States of America
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Lal BK, Khan AA, Patel J, Chrencik M, Laila A, Yokemick JY, Sorkin JD, Sikdar S. Relationship Between Interhemispheric Cerebral Perfusion Delay and Carotid Artery Stenosis. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Antoniak G, Biswas T, Cortes N, Sikdar S, Chun C, Bhandawat V. Spring-loaded inverted pendulum goes through two contraction-extension cycles during the single-support phase of walking. Biol Open 2019; 8:bio.043695. [PMID: 31097445 PMCID: PMC6602329 DOI: 10.1242/bio.043695] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Despite the overall complexity of legged locomotion, the motion of the center of mass (COM) itself is relatively simple, and can be qualitatively described by simple mechanical models. In particular, walking can be qualitatively modeled by a simple model in which each leg is described by a spring-loaded inverted pendulum (SLIP). However, SLIP has many limitations and is unlikely to serve as a quantitative model. As a first step to obtaining a quantitative model for walking, we explored the ability of SLIP to model the single-support phase of walking, and found that SLIP has two limitations. First, it predicts larger horizontal ground reaction forces (GRFs) than empirically observed. A new model – angular and radial spring-loaded inverted pendulum (ARSLIP) – can overcome this deficit. Second, although the leg spring (surprisingly) goes through contraction-extension-contraction-extensions (CECEs) during the single-support phase of walking and can produce the characteristic M-shaped vertical GRFs, modeling the single-support phase requires active elements. Despite these limitations, SLIP as a model provides important insights. It shows that the CECE cycling lengthens the stance duration allowing the COM to travel passively for longer, and decreases the velocity redirection between the beginning and end of a step. Summary: We quantitatively evaluate a simple model for human walking based on two-spring and find that this model describes many features of human walking.
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Affiliation(s)
| | - Tirthabir Biswas
- Department of Physics, Loyola University, New Orleans, LA 70118, USA
| | - Nelson Cortes
- Department of Bioengineering, George Mason University, Fairfax, VA 22030, USA
| | - Siddhartha Sikdar
- Department of Bioengineering, George Mason University, Fairfax, VA 22030, USA
| | - Chanwoo Chun
- Department of Biology, Duke University, Durham, NC 27708, USA
| | - Vikas Bhandawat
- Department of Biology, Duke University, Durham, NC 27708, USA
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Akhlaghi N, Dhawan A, Khan AA, Mukherjee B, Diao G, Truong C, Sikdar S. Sparsity Analysis of a Sonomyographic Muscle-Computer Interface. IEEE Trans Biomed Eng 2019; 67:688-696. [PMID: 31150331 DOI: 10.1109/tbme.2019.2919488] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Sonomyography has been shown to be a promising method for decoding volitional motor intent from analysis of ultrasound images of the forearm musculature. The objectives of this paper are to determine the optimal location for ultrasound transducer placement on the anterior forearm for imaging maximum muscle deformations during different hand motions, and to investigate the effect of using a sparse set of ultrasound scanlines for motion classification for ultrasound-based muscle-computer interfaces (MCIs). METHODS The optimal placement of the ultrasound transducer along the forearm was identified using freehand three-dimensional reconstructions of the muscle thickness during rest and motion completion. Based on the ultrasound images acquired from the optimally placed transducer, classification accuracy with equally spaced scanlines across the cross-sectional field of view was determined. Furthermore, the unique contribution of each scanline to class discrimination using Fisher criterion (FC) and mutual information (MI) with respect to motion discriminability was determined. RESULTS Experiments with five able-bodied subjects show that the maximum muscle deformation occurred between 40%-50% of the forearm length for multiple degrees-of-freedom. The average classification accuracy was 94% ± 6% with the entire 128-scanline image and 94% ± 5% with four equally spaced scanlines. However, no significant improvement in classification accuracy was observed with optimal scanline selection using FC and MI. CONCLUSION For an optimally placed transducer, a small subset of ultrasound scanlines can be used instead of a full imaging array without sacrificing performance in terms of classification accuracy for multiple degrees-of-freedom. SIGNIFICANCE The selection of a small subset of transducer elements can enable the reduction of computation, and simplification of the instrumentation and power consumption of wearable sonomyographic MCIs, particularly for rehabilitation and gesture recognition applications.
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Abstract
Photoacoustic imaging is an emerging imaging modality that is based upon the photoacoustic effect. In photoacoustic tomography (PAT), the induced acoustic pressure waves are measured by an array of detectors and used to reconstruct an image of the initial pressure distribution. A common challenge faced in PAT is that the measured acoustic waves can only be sparsely sampled. Reconstructing sparsely sampled data using standard methods results in severe artifacts that obscure information within the image. We propose a modified convolutional neural network (CNN) architecture termed fully dense UNet (FD-UNet) for removing artifacts from two-dimensional PAT images reconstructed from sparse data and compare the proposed CNN with the standard UNet in terms of reconstructed image quality.
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Chrencik MT, Khan AA, Luther L, Anthony L, Yokemick J, Patel J, Sorkin JD, Sikdar S, Lal BK. Quantitative assessment of carotid plaque morphology (geometry and tissue composition) using computed tomography angiography. J Vasc Surg 2019; 70:858-868. [PMID: 30850296 DOI: 10.1016/j.jvs.2018.11.050] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Quantification of carotid plaque morphology (geometry and tissue composition) may help stratify risk for future stroke and assess plaque progression or regression in response to medical risk factor modification. We assessed the feasibility and reliability of morphologic measurements of carotid plaques using computed tomography angiography (CTA) and determined the minimum detectable change in plaque features by this approach. METHODS CTA images of both carotid arteries in 50 patients were analyzed by two observers using a semiautomatic image analysis program, yielding 93 observations per user (seven arteries were excluded because of prior stenting). One observer repeated the analyses 4 weeks later. Measurements included total plaque volume; percentage stenosis (by diameter and area); and tissue composition for calcium, lipid-rich necrotic core (LRNC), and intraplaque hemorrhage (IPH). Reliability of measurements was assessed by intraclass and interclass correlation and Bland-Altman plots. Dice similarity coefficient (DSC) and modified Hausdorff distance (MHD) assessed reliability of geometric shape measurements. We additionally computed the minimum amount of change in these features detectable by our approach. RESULTS The cohort was 51% male (mean age, 70.1 years), and 56% had a prior stroke. The mean (± standard deviation) plaque volume was 837.3 ± 431.3 mm3, stenosis diameter was 44.5% ± 25.6%, and stenosis area was 58.1% ± 29.0%. These measurements showed high reliability. Intraclass correlation coefficients for plaque volume, percentage stenosis by diameter, and percentage stenosis by area were 0.96, 0.87, and 0.83, respectively; interclass correlation coefficients were 0.88, 0.84, and 0.78. Intraclass correlations for tissue composition were 0.99, 0.96, and 0.86 (calcium, LRNC, and IPH, respectively), and interclass correlations were 0.99, 0.92, and 0.92. Shape measurements showed high intraobserver (DSC, 0.95 ± 0.04; MHD, 0.16 ± 0.10 mm) and interobserver (DSC, 0.94 ± 0.05; MHD, 0.19 ± 0.12 mm) luminal agreement. This approach can detect a change of at least 3.9% in total plaque volume, 1.2 mm3 in calcium, 4.3 mm3 in LRNC, and 8.6 mm3 in IPH with the same observer repeating measurements and 9.9% in plaque volume, 1.9 mm3 in calcium, 7.9 mm3 in LRNC, and 6.8 mm3 in IPH for two different observers. CONCLUSIONS Carotid plaque geometry (total volume, diameter stenosis, and area stenosis) and tissue composition (calcium, LRNC, and IPH) are measured reliably from clinical CTA images using a semiautomatic image analysis program. The minimum change in plaque volume detectable is ∼4% if the same observer makes both measurements and ∼10% for different observers. Small changes in plaque composition can also be detected reliably. This approach can facilitate longitudinal studies for identifying high-risk plaque features and for quantifying plaque progression or regression after treatment.
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Affiliation(s)
- Matthew T Chrencik
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md
| | - Amir A Khan
- Department of Bioengineering, George Mason University, Fairfax, Va
| | - Lauren Luther
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md
| | - Laila Anthony
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md
| | - John Yokemick
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md
| | - Jigar Patel
- Imaging Service, VA Maryland Health Care System, Baltimore, Md
| | - John D Sorkin
- Baltimore VA Medical Center Geriatric Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center, Baltimore, Md; Claude D. Pepper Older Americans Independence Center, University of Maryland School of Medicine, Baltimore, Md
| | | | - Brajesh K Lal
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md.
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Lal BK, Chrencik M, Khan A, Jones M, Huston J, Sternbergh C, Rapp J, Mukherjee D, Henke P, Yokemick J, Moore W, Sikdar S, Voeks J, Howard G, Meschia JF, Brott TG. Abstract TMP96: Carotid Plaque Characteristics Correlated to Baseline Vascular Risk Factors in a Large Randomized Trial: Results from CREST-2. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.tmp96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives:
Assessment of carotid disease is most commonly performed with duplex ultrasonography (DUS). Measures of plaque area and tissue composition from DUS images may identify patients at risk for future neurologic events, and may assess the effects of vascular risk-factor modification (by measuring change in plaque area and/or tissue constituents). We quantified plaque area and tissue constituents from DUS images of CREST-2 participants at baseline and correlated them with their baseline vascular risk factors.
Methods:
CREST-2 consists of two multicenter, randomized trials in patients with asymptomatic ≥70% carotid stenosis comparing intensive medical management (IMM) plus endarterectomy or stenting vs IMM alone. Baseline B-mode DUS images from 500 patients underwent manual plaque outlining and automatic pixel brightness assessment. Plaque area, grayscale median (GSM), Gray-Weale score for heterogeneity, and areas for intraplaque hemorrhage and lipid were the output parameters. We computed the parameter estimates (95% confidence intervals) for baseline patient characteristics (age, sex, race, diabetes, smoking, BMI, blood pressure and LDL levels) versus plaque characteristics.
Results:
High-risk plaque features (larger plaque area, lower GSM , lower Gray-Weale scores, or larger areas of hemorrhage and lipid) were present in older patients, males, and those with elevated diastolic blood pressure and LDL levels (Table).
Conclusions:
In a randomized trial of asymptomatic patients with high-grade carotid stenosis, DUS-based computation of plaque geometry and tissue composition is feasible. Elevated diastolic blood pressure and LDL levels at baseline are associated with high-risk plaque characteristics. These novel findings identify potentially modifiable targets for aggressive treatment to reduce stroke-risk in patients with carotid stenosis.
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Affiliation(s)
- Brajesh K Lal
- Vascular Surgery, Univ of Maryland VA, Baltimore, MD
| | | | - Amir Khan
- Electrical Engineering, George Mason Univ, Fairfax, VA
| | | | - John Huston
- Neuroradiology, Mayo Clinic Rochester, Rochester, MN
| | | | - Joseph Rapp
- Vascular Surgery, San Francisco VA Med Cntr, San Francisco, CA
| | | | - Peter Henke
- Vascular Surgery, VA Ann Harbor Healthcare System, Ann Harbor, MI
| | | | - Wesley Moore
- Vascular Surgery, Univ of California at Los Angeles, Los Angeles, CA
| | | | | | - George Howard
- Sch of Public Health, Univ of Alabama at Birmingham, Birmingham, AL
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Cherry MG, Ablett JR, Dickson JM, Powell D, Sikdar S, Salmon P. A qualitative study of the processes by which carers of people with dementia derive meaning from caring. Aging Ment Health 2019; 23:69-76. [PMID: 29105501 DOI: 10.1080/13607863.2017.1393792] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Most individuals with dementia live in the community, receiving care from family or lay carers. Carers' wellbeing, and the quality of the care they provide, partly depends on their ability to derive meaning from caring for someone with dementia. Both carers' previous relationship with their relative and the caregiving process itself contribute to this sense of meaning. However, it remains unclear why some carers derive meaning from these sources, whereas others do not. OBJECTIVE To further explore the processes by which carers derive a sense of meaning from caring. METHODS Representative case sampling was used to recruit a purposive sample of 20 carers for individuals living with dementia. In-depth semi-structured interviews were audio-recorded and transcribed, and analysed using pluralist qualitative methodology. RESULTS A framework of three sources from which carers derived meaning from caring was identified, encompassing: carers' perceptions of how 'right' or 'symmetrical' caring felt in light of their current and previous relationship with the person with dementia; maintenance of a 'protected' sense of self within the care relationship; and carers' perceptions of their 'social connectedness' outside the relationships. CONCLUSION Holistic assessment based on this framework could help to tailor individualised provision of support, foster resilience and safeguard carers' well-being.
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Affiliation(s)
- M G Cherry
- a Department of Psychological Sciences , University of Liverpool , Liverpool , United Kingdom of Great Britain and Northern Ireland.,b Liverpool Cancer Psychology Service, Linda Mccartney Centre , Royal Liverpool University Hospital , Liverpool , United Kingdom of Great Britain and Northern Ireland
| | - J R Ablett
- b Liverpool Cancer Psychology Service, Linda Mccartney Centre , Royal Liverpool University Hospital , Liverpool , United Kingdom of Great Britain and Northern Ireland.,c Division of Clinical Psychology , University of Liverpool , Liverpool , United Kingdom of Great Britain and Northern Ireland
| | - J M Dickson
- a Department of Psychological Sciences , University of Liverpool , Liverpool , United Kingdom of Great Britain and Northern Ireland.,d Psychology Department (Building 30) , Edith Cowan University , Joondalup , Australia
| | - D Powell
- e Arise Clinical Psychology Liverpool , Liverpool , United Kingdom of Great Britain and Northern Ireland
| | - S Sikdar
- f Older Adults' Mental Health Team , South Sefton Community Resource Centre , Liverpool , United Kingdom of Great Britain and Northern Ireland
| | - P Salmon
- c Division of Clinical Psychology , University of Liverpool , Liverpool , United Kingdom of Great Britain and Northern Ireland
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Mukherjee B, Dhawan AS, Patwardhan S, Majdi J, Holley RJ, Joiner WM, Harris-Love M, Sikdar S. Ultrasound–Based Muscle Activity Sensing for Intuitive Proportional Control in Upper Extremity Amputees. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2018.07.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Sikdar S, Diao G, Turo D, Stanley CJ, Sharma A, Chambliss A, Laughrey L, Aralar A, Damiano DL. Quantification of Muscle Tissue Properties by Modeling the Statistics of Ultrasound Image Intensities Using a Mixture of Gamma Distributions in Children With and Without Cerebral Palsy. J Ultrasound Med 2018; 37:2157-2169. [PMID: 29460971 PMCID: PMC6102099 DOI: 10.1002/jum.14566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 06/19/2017] [Accepted: 12/09/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To investigate whether quantitative ultrasound (US) imaging, based on the envelope statistics of the backscattered US signal, can describe muscle properties in typically developing children and those with cerebral palsy (CP). METHODS Radiofrequency US data were acquired from the rectus femoris muscle of children with CP (n = 22) and an age-matched cohort without CP (n = 14) at rest and during maximal voluntary isometric contraction. A mixture of gamma distributions was used to model the histogram of the echo intensities within a region of interest in the muscle. RESULTS Muscle in CP had a heterogeneous echo texture that was significantly different from that in healthy controls (P < .001), with larger deviations from Rayleigh scattering. A mixture of 2 gamma distributions showed an excellent fit to the US intensity, and the shape and rate parameters were significantly different between CP and control groups (P < .05). The rate parameters for both the single gamma distribution and mixture of gamma distributions were significantly higher for contracted muscles compared to resting muscles, but there was no significant interaction between these factors (CP and muscle contraction) for a mixed-model analysis of variance. CONCLUSIONS Ultrasound tissue characterization indicates a more disorganized architecture and increased echogenicity in muscles in CP, consistent with previously documented increases in fibrous infiltration and connective tissue changes in this population. Our results indicate that quantitative US can be used to objectively differentiate muscle architecture and tissue properties.
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Affiliation(s)
- Siddhartha Sikdar
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
| | - Guoqing Diao
- Department of Statistics, George Mason University, Fairfax, Virginia, USA
| | - Diego Turo
- Department of Mechanical Engineering, Catholic University of America, Washington, DC, USA
| | - Christopher J Stanley
- Functional and Applied Biomechanics, National Institutes of Health, Bethesda, Maryland USA
| | - Abhinav Sharma
- Functional and Applied Biomechanics, National Institutes of Health, Bethesda, Maryland USA
| | - Amy Chambliss
- George Washington University School of Medicine, Washington, DC, USA
| | - Loretta Laughrey
- Department of Physics, George Mason University, Fairfax, Virginia, USA
| | - April Aralar
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
| | - Diane L Damiano
- Functional and Applied Biomechanics, National Institutes of Health, Bethesda, Maryland USA
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Dhawan A, Mukherjee B, Patwardhan S, Majdi J, Holley R, Joiner W, Harris-Love M, Sikdar S. Ultrasound sensing-based intuitive proportional control: An evaluation study with upper-extremity amputees. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.1101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Prebble M, Sikdar S, Eddo O, McCrory S, Caswell S, Azevedo AM, Cortes N. Biomechanics of Walking in Healthy Adults at Different Gait Speeds. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000535118.61829.e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Aralar A, Bird M, Graham R, Koo B, Chitnis P, Sikdar S, Shenai M. Assessment of Ventriculoperitoneal Shunt Function Using Ultrasound Characterization of Valve Interface Oscillation as a Proxy. Cureus 2018; 10:e2205. [PMID: 29682435 PMCID: PMC5908717 DOI: 10.7759/cureus.2205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Lal BK, Dux MC, Sikdar S, Goldstein C, Khan AA, Yokemick J, Zhao L. Asymptomatic carotid stenosis is associated with cognitive impairment. J Vasc Surg 2017; 66:1083-1092. [DOI: 10.1016/j.jvs.2017.04.038] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
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Abstract
Duplex ultrasonography has a well-established role in the assessment of the degree of stenosis caused by carotid atherosclerosis. This assessment is derived from Doppler velocity changes induced by the narrowing lumen of the artery. New research into the mechanisms for plaque rupture and atheroembolic stroke indicates that the degree of narrowing is an imperfect predictor of stroke risk, and that other factors, such as plaque composition and remodeling and biomechanical forces acting on the plaque, can play a role. New advances in ultrasound imaging technology have made it possible to investigate these measures of plaque vulnerability to identify pre-embolic unstable carotid plaques. Efforts have been made to quantify the morphologic appearance of the plaque in B-mode images and to correlate them with histology. Additional research has resulted in the first generation of clinically available 3-dimensional ultrasound transducers that reduce operator-dependence and variability. Finally, ultrasonography provides real-time imaging and physiologic information that can be utilized to measure disruptive forces acting on carotid plaques. We review some of these exciting developments in ultrasonography and discuss how these may impact clinical practice.
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Affiliation(s)
- Rafael S Cires-Drouet
- Center for Vascular Diagnostics, Division of Vascular Surgery, University of Maryland School of Medicine, 22 South Greene Street, S10-B00, Baltimore, MD 21201
| | - Mahvash Mozafarian
- Center for Vascular Diagnostics, Division of Vascular Surgery, University of Maryland School of Medicine, 22 South Greene Street, S10-B00, Baltimore, MD 21201
| | - Amir Ali
- Center for Vascular Diagnostics, Division of Vascular Surgery, University of Maryland School of Medicine, 22 South Greene Street, S10-B00, Baltimore, MD 21201; Department of Bioengineering, George Mason University, Fairfax, VA
| | | | - Brajesh K Lal
- Center for Vascular Diagnostics, Division of Vascular Surgery, University of Maryland School of Medicine, 22 South Greene Street, S10-B00, Baltimore, MD 21201; Vascular Service, Veterans Affairs Medical Center, Baltimore, MD.
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Aralar AJC, Bird MD, Graham RD, Shenai MB, Chitnis PV, Sikdar S. Ultrasound characterization of interface oscillation as a proxy for ventriculoperitoneal shunt function. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2016:215-218. [PMID: 28268315 DOI: 10.1109/embc.2016.7590678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Hydrocephalus, where cerebrospinal fluid (CSF) production rate is greater than reabsorption rate, leads to impaired neurological function if left untreated. Ventriculoperitoneal shunts (VPS) are implanted in the brain ventricles to route CSF. VPS systems have a high failure rate, and failure symptoms resemble symptoms of common maladies. The current gold standard for shunt diagnosis, surgical intervention, poses high risk and requires an expensive procedure for patients. Current non-invasive methods lack proper insight to assist physicians. We propose a noninvasive method of characterizing the oscillation of the shunt's pressure-relief valve to assist physicians in shunt diagnosis. Brightness-mode and motion-mode ultrasound images can be used to determine fluid flow. Blockage in the system could be detected by observing the phase change of the ultrasound signal in different flow cases with or without perturbation. Future testing and implementation can allow for the use of this method in localizing and identifying the modality of failure.
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Khan AA, Hecker JC, Lal BK, Sikdar S. Clinical viability of carotid plaque strain estimation using B-mode ultrasound image sequences. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2016:2877-2880. [PMID: 28268915 DOI: 10.1109/embc.2016.7591330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
It is estimated that approximately 30% of ischemic strokes are caused by rupture of plaque in the carotid artery. Development of techniques focusing on identifying plaques that are vulnerable to rupture is thus indispensable for stroke prevention. Recent studies have demonstrated that motion analysis of plaques from B-mode and RF ultrasound (US) image sequences can be used to estimate plaque strain. However, viability of these methods in a clinical setting, with variable acquisition protocols, has not been demonstrated yet. In this paper, we explore the viability of estimating plaque strain from B-mode US images of asymptomatic patients, acquired in a real clinical setting with different acquisition settings, frame rates, and operators. Our proposed strain measures, shear strain rate entropy and variance, combined with the recently reported maximum absolute shear strain rate, show that the plaques fall into two distinct clusters. Moreover, these clusters show good correlations with plaque echolucency and echogenicity. We conclude that B-mode US imaging is a viable tool for characterizing plaque dynamics in clinical environments. In future studies, we plan to implement this method on multi-center studies for longitudinal monitoring of plaque.
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Baker CA, Akhlaghi N, Rangwala H, Kosecka J, Sikdar S. Real-time, ultrasound-based control of a virtual hand by a trans-radial amputee. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2016:3219-3222. [PMID: 28268993 DOI: 10.1109/embc.2016.7591414] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Advancements in multiarticulate upper-limb prosthetics have outpaced the development of intuitive, non-invasive control mechanisms for implementing them. Surface electromyography is currently the most popular non-invasive control method, but presents a number of drawbacks including poor deep-muscle specificity. Previous research established the viability of ultrasound imaging as an alternative means of decoding movement intent, and demonstrated the ability to distinguish between complex grasps in able-bodied subjects via imaging of the anterior forearm musculature. In order to translate this work to clinical viability, able-bodied testing is insufficient. Amputation-induced changes in muscular geometry, dynamics, and imaging characteristics are all likely to influence the effectiveness of our existing techniques. In this work, we conducted preliminary trials with a transradial amputee participant to assess these effects, and potentially elucidate necessary refinements to our approach. Two trials were performed, the first using a set of three motion types, and the second using four. After a brief training period in each trial, the participant was able to control a virtual prosthetic hand in real-time; attempted grasps were successfully classified with a rate of 77% in trial 1, and 71% in trial 2. While the results are sub-optimal compared to our previous able-bodied testing, they are a promising step forward. More importantly, the data collected during these trials can provide valuable information for refining our image processing methods, especially via comparison to previously acquired data from able-bodied individuals. Ultimately, further work with amputees is a necessity for translation towards clinical application.
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Gerber LH, Sikdar S, Aredo JV, Armstrong K, Rosenberger WF, Shao H, Shah JP. Beneficial Effects of Dry Needling for Treatment of Chronic Myofascial Pain Persist for 6 Weeks After Treatment Completion. PM R 2017; 9:105-112. [PMID: 27297448 PMCID: PMC5149452 DOI: 10.1016/j.pmrj.2016.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/23/2016] [Accepted: 06/01/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Dry needling is an effective treatment for reducing pain associated with active myofascial trigger points (a-MTrPs) in the short term. The duration of the benefits of this treatment have not been fully assessed. OBJECTIVE To determine whether the benefits of dry needling (DN) of a-MTrPs are sustained 6 weeks posttreatment. DESIGN Follow-up of a prospective study. SETTING University. PARTICIPANTS A total of 45 patients (13 male and 32 female) with cervical pain >3 months and a-MTrPs in the upper trapezius who completed 3 DN treatments and who were evaluated 6 weeks posttreatment. INTERVENTIONS None. MAIN OUTCOME MEASURES Primary outcomes were changes from baseline to follow-up in scores for the verbal analogue scale (VAS), Brief Pain Inventory (BPI), and MTrP status. MTrPs were rated as active (spontaneously painful), latent (painful only on compression), and nonpalpable nodule. Responders were patients whose MTrP status changed from active to latent or nonpalpable nodule (resolved). Secondary outcomes were pain pressure threshold (PPT), Profile of Mood States, Oswestry Disability Index (ODI), MOS 36-Item Short-Form Health Survey (SF-36), and cervical range of motion. RESULTS Pain measures remained significantly improved 6 weeks posttreatment (P < .003), as did the SF-36 physical functioning score (0.01) and ODI (P = .002). Side bending and PPT for subjects with unilateral MTrPs had sustained improvement (P = .002). The number of subjects with sustained MTrP response at 6 weeks was significant (P < .001). Comparing responders to nonresponders, the changes in VAS and BPI were statistically significant (P = .006, P = .03) but the change in PPT was not. Patients with higher baseline VAS scores had a higher risk of not responding to DN; those with a greater drop in VAS score from baseline had a higher probability of sustained response. A 1-unit decrease in VAS at baseline resulted in a 6.3-fold increase in the odds of being a responder versus a nonresponder (P = .008). CONCLUSIONS In this study, there was sustained reduction of pain scores after completion of DN, which is more likely with a greater drop in VAS score. Patients with higher baseline VAS scores are less likely to respond to DN. Early intervention toward significant pain reduction is likely to be associated with sustained clinical response. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Lynn H Gerber
- Center for the Study of Chronic Illness and Disability, George Mason University, MSN: 2G7, 4400 University Dr., Fairfax, VA 22030(∗).
| | | | - Jacqueline V Aredo
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD(‡)
| | - Katee Armstrong
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, VA(§)
| | | | - Hui Shao
- Department of Statistics, George Mason University, Fairfax, VA(¶)
| | - Jay P Shah
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD(#)
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Shah J, Sikdar S, Gerber L. Reply. PM R 2016; 8:1226-1227. [PMID: 27989420 DOI: 10.1016/j.pmrj.2016.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/05/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Jay Shah
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD(∗)
| | | | - Lynn Gerber
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, VA(‡)
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Khan AA, Hecker JC, Hatsukami T, Sikdar S, Lal BK. Carotid Plaque Strain Characterization in Clinical B-Mode Ultrasound Image Sequences. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Eddo O, Sikdar S, Caswell S, Ambegaonkar J, Onate J, Cortes N. Evidence Supporting Biphasic Action Of Rectus Femoris During Gait Using Ultrasound Imaging. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000487665.40658.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Turo D, Otto P, Hossain M, Gebreab T, Armstrong K, Rosenberger WF, Shao H, Shah JP, Gerber LH, Sikdar S. Novel Use of Ultrasound Elastography to Quantify Muscle Tissue Changes After Dry Needling of Myofascial Trigger Points in Patients With Chronic Myofascial Pain. J Ultrasound Med 2015; 34:2149-2161. [PMID: 26491094 PMCID: PMC5555767 DOI: 10.7863/ultra.14.08033] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 03/04/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To compare a mechanical heterogeneity index derived from ultrasound vibration elastography with physical findings before and after dry-needling treatment of spontaneously painful active myofascial trigger points in the upper trapezius muscle. METHODS Forty-eight patients with chronic myofascial pain enrolled in a prospective interventional trial of 3 weekly dry-needling treatments for active myofascial trigger points. Trigger points were evaluated at baseline and at treatment completion using palpation, the pressure-pain threshold, and the mechanical heterogeneity index. Thirty patients were reevaluated at 8 weeks. Trigger points that "responded" changed to tissue that was no longer spontaneously painful, with or without the presence of a palpable nodule. Trigger points that "resolved" changed to tissue without a palpable nodule. The mechanical heterogeneity index was defined as the proportion of the upper trapezius muscle that appeared mechanically stiffer on elastography. Statistical significance for comparisons was determined at P < .05. RESULTS Following 3 dry needle treatments, the mechanical heterogeneity index decreased significantly for the 38 myofascial trigger points (79% of 48) that responded to treatment. Among these, the baseline mechanical heterogeneity index was significantly lower for the 13 trigger points (27% of 38) that resolved, but the decrease after 3 dry needle treatments did not reach significance. The pressure-pain threshold improved significantly for both groups. At 8 weeks, the mechanical heterogeneity index decreased significantly for the 22 trigger points (73% of 30) that responded and for the 10 (45% of 22) that resolved. The pressure-pain threshold improvement was significant for trigger points that responded but did not reach significance for resolved trigger points. CONCLUSIONS The mechanical heterogeneity index identifies changes in muscle tissue properties that correlate with changes in the myofascial trigger point status after dry needling.
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Affiliation(s)
- Diego Turo
- Departments of Bioengineering (D.T., T.G., S.S.), Electrical and Computer Engineering (P.O., M.H.), and Statistics (W.F.R., H.S.) and Center for the Study of Chronic Illness and Disability (K.A., L.H.G.), George Mason University, Fairfax, Virginia USA; and Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland USA (J.P.S.)
| | - Paul Otto
- Departments of Bioengineering (D.T., T.G., S.S.), Electrical and Computer Engineering (P.O., M.H.), and Statistics (W.F.R., H.S.) and Center for the Study of Chronic Illness and Disability (K.A., L.H.G.), George Mason University, Fairfax, Virginia USA; and Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland USA (J.P.S.)
| | - Murad Hossain
- Departments of Bioengineering (D.T., T.G., S.S.), Electrical and Computer Engineering (P.O., M.H.), and Statistics (W.F.R., H.S.) and Center for the Study of Chronic Illness and Disability (K.A., L.H.G.), George Mason University, Fairfax, Virginia USA; and Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland USA (J.P.S.)
| | - Tadesse Gebreab
- Departments of Bioengineering (D.T., T.G., S.S.), Electrical and Computer Engineering (P.O., M.H.), and Statistics (W.F.R., H.S.) and Center for the Study of Chronic Illness and Disability (K.A., L.H.G.), George Mason University, Fairfax, Virginia USA; and Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland USA (J.P.S.)
| | - Katherine Armstrong
- Departments of Bioengineering (D.T., T.G., S.S.), Electrical and Computer Engineering (P.O., M.H.), and Statistics (W.F.R., H.S.) and Center for the Study of Chronic Illness and Disability (K.A., L.H.G.), George Mason University, Fairfax, Virginia USA; and Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland USA (J.P.S.)
| | - William F Rosenberger
- Departments of Bioengineering (D.T., T.G., S.S.), Electrical and Computer Engineering (P.O., M.H.), and Statistics (W.F.R., H.S.) and Center for the Study of Chronic Illness and Disability (K.A., L.H.G.), George Mason University, Fairfax, Virginia USA; and Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland USA (J.P.S.)
| | - Hui Shao
- Departments of Bioengineering (D.T., T.G., S.S.), Electrical and Computer Engineering (P.O., M.H.), and Statistics (W.F.R., H.S.) and Center for the Study of Chronic Illness and Disability (K.A., L.H.G.), George Mason University, Fairfax, Virginia USA; and Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland USA (J.P.S.)
| | - Jay P Shah
- Departments of Bioengineering (D.T., T.G., S.S.), Electrical and Computer Engineering (P.O., M.H.), and Statistics (W.F.R., H.S.) and Center for the Study of Chronic Illness and Disability (K.A., L.H.G.), George Mason University, Fairfax, Virginia USA; and Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland USA (J.P.S.)
| | - Lynn H Gerber
- Departments of Bioengineering (D.T., T.G., S.S.), Electrical and Computer Engineering (P.O., M.H.), and Statistics (W.F.R., H.S.) and Center for the Study of Chronic Illness and Disability (K.A., L.H.G.), George Mason University, Fairfax, Virginia USA; and Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland USA (J.P.S.)
| | - Siddhartha Sikdar
- Departments of Bioengineering (D.T., T.G., S.S.), Electrical and Computer Engineering (P.O., M.H.), and Statistics (W.F.R., H.S.) and Center for the Study of Chronic Illness and Disability (K.A., L.H.G.), George Mason University, Fairfax, Virginia USA; and Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland USA (J.P.S.).
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Akhlaghi N, Baker CA, Lahlou M, Zafar H, Murthy KG, Rangwala HS, Kosecka J, Joiner WM, Pancrazio JJ, Sikdar S. Real-Time Classification of Hand Motions Using Ultrasound Imaging of Forearm Muscles. IEEE Trans Biomed Eng 2015; 63:1687-98. [PMID: 26560865 DOI: 10.1109/tbme.2015.2498124] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Surface electromyography (sEMG) has been the predominant method for sensing electrical activity for a number of applications involving muscle-computer interfaces, including myoelectric control of prostheses and rehabilitation robots. Ultrasound imaging for sensing mechanical deformation of functional muscle compartments can overcome several limitations of sEMG, including the inability to differentiate between deep contiguous muscle compartments, low signal-to-noise ratio, and lack of a robust graded signal. The objective of this study was to evaluate the feasibility of real-time graded control using a computationally efficient method to differentiate between complex hand motions based on ultrasound imaging of forearm muscles. Dynamic ultrasound images of the forearm muscles were obtained from six able-bodied volunteers and analyzed to map muscle activity based on the deformation of the contracting muscles during different hand motions. Each participant performed 15 different hand motions, including digit flexion, different grips (i.e., power grasp and pinch grip), and grips in combination with wrist pronation. During the training phase, we generated a database of activity patterns corresponding to different hand motions for each participant. During the testing phase, novel activity patterns were classified using a nearest neighbor classification algorithm based on that database. The average classification accuracy was 91%. Real-time image-based control of a virtual hand showed an average classification accuracy of 92%. Our results demonstrate the feasibility of using ultrasound imaging as a robust muscle-computer interface. Potential clinical applications include control of multiarticulated prosthetic hands, stroke rehabilitation, and fundamental investigations of motor control and biomechanics.
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Shah JP, Thaker N, Heimur J, Aredo JV, Sikdar S, Gerber LH. Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. PM R 2015; 7:746-761. [PMID: 25724849 PMCID: PMC4508225 DOI: 10.1016/j.pmrj.2015.01.024] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/28/2015] [Accepted: 01/31/2015] [Indexed: 10/23/2022]
Abstract
The intent of this article is to discuss the evolving role of the myofascial trigger point (MTrP) in myofascial pain syndrome (MPS) from both a historical and scientific perspective. MTrPs are hard, discrete, palpable nodules in a taut band of skeletal muscle that may be spontaneously painful (i.e., active) or painful only on compression (i.e., latent). MPS is a term used to describe a pain condition that can be acute or, more commonly, chronic and involves the muscle and its surrounding connective tissue (e.g. fascia). According to Travell and Simons, MTrPs are central to the syndrome-but are they necessary? Although the clinical study of muscle pain and MTrPs has proliferated over the past two centuries, the scientific literature often seems disjointed and confusing. Unfortunately, much of the terminology, theories, concepts, and diagnostic criteria are inconsistent, incomplete, or controversial. To address these deficiencies, investigators have recently applied clinical, imaging (of skeletal muscle and brain), and biochemical analyses to systematically and objectively study the MTrP and its role in MPS. Data suggest that the soft tissue milieu around the MTrP, neurogenic inflammation, sensitization, and limbic system dysfunction may all play a role in the initiation, amplification, and perpetuation of MPS. The authors chronicle the advances that have led to the current understanding of MTrP pathophysiology and its relationship to MPS, and review the contributions of clinicians and researchers who have influenced and expanded our contemporary level of clinical knowledge and practice.
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Affiliation(s)
- Jay P. Shah
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Nikki Thaker
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Juliana Heimur
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Jacqueline V. Aredo
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Siddhartha Sikdar
- Departments of Electrical and Computer Engineering and Bioengineering, Volgenau School of Engineering, George Mason University, Fairfax, VA
| | - Lynn H. Gerber
- Center for the Study of Chronic Illness and Disability, College of Health and Human Services, George Mason University, 4400 University Dr, Fairfax, VA 22030
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Prather H, Gerber LH, Shah J, Sikdar S. Ask the Authors. PM R 2015; 7:719-720. [DOI: 10.1016/j.pmrj.2015.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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