Artificial Neural Network-Based Activities Classification, Gait Phase Estimation, and Prediction

Gait patterns are critical to health monitoring, gait impairment assessment, and wearable device control. Unrhythmic gait pattern detection under community-based conditions is a new frontier in this area. The present paper describes a high-accuracy gait phase estimation and prediction algorithm built on a two-stage artificial neural network. This work targets to develop an algorithm that can estimate and predict the gait cycle in real time using a portable controller with only two IMU sensors (one on each thigh) in the community setting. Our algorithm can detect the gait phase in unrhythmic conditions during walking, stair ascending, and stair descending, and classify these activities with standing. Moreover, our algorithm is able to predict both future intra- and inter-stride gait phases, offering a potential means to improve wearable device controller performance. The proposed data-driven algorithm is based on a dataset consisting of 5 able-bodied subjects and validated on 3 different able-bodied subjects. Under unrhythmic activity situations, validation shows that the algorithm can accurately identify multiple activities with 99.55% accuracy, and estimate ([Formula: see text]: 6.3%) and predict 200-ms-ahead ([Formula: see text]: 8.6%) the gait phase percentage in real time, which are on average 57.7 and 54.0% smaller than the error from the event-based method in the same conditions. This study showcases a solution to estimate and predict gait status for multiple unrhythmic activities, which may be deployed to controllers for wearable robots or health monitoring devices.

Diagnosis and treatment of phrenic nerve hourglass constriction in patients with Parsonage-Turner syndrome

Phrenic nerve injury can occur anywhere along its course and clinically results in diaphragm paralysis. Although most patients with Parsonage-Turner syndrome and phrenic nerve dysfunction improve without treatment, some patients do not recover spontaneously. In these cases, an initial autoimmune response produces scarring along the affected nerve(s). This scar, known as an hourglass constriction, causes focal compression of the nerve at the site of the scar, which prevents the nerve from spontaneously recovering. Thus, the authors present a unique case of phrenic nerve injury secondary to Parsonage-Turner syndrome that improved with internal neurolysis. The video can be found here: https://stream.cadmore.media/r10.3171/2022.10.FOCVID22105.

Toward Development of a Diabetic Synovium Culture Model

Osteoarthritis (OA) is a degenerative joint disease characterized by articular cartilage degradation and inflammation of synovium, the specialized connective tissue that envelops the diarthrodial joint. Type 2 diabetes mellitus (DM) is often found in OA patients, with nearly double the incidence of arthritis reported in patients with diabetes (52%) than those without it (27%). The correlation between OA and DM has been attributed to similar risk factors, namely increasing age and joint loading due to obesity. However, a potential causative link is not well understood due to comorbidities involved with treating diabetic patients, such as high infection rates and poor healing response caused by hyperglycemia and insulin resistance. The purpose of this study was to investigate the effect of hyperglycemic and insulin culture conditions on synovium properties. It was hypothesized that modeling hyperglycemia-induced insulin resistance in synovium would provide novel insights of OA pathogenesis in DM patients. To simulate DM in the synovial joint, healthy synovium was preconditioned in either euglycemic (EG) or hyperglycemic (HG) glucose concentrations with insulin in order to induce the biological response of the diseased phenotype. Synovium biochemical composition was evaluated to determine ECM remodeling under hyperglycemic culture conditions. Concurrent changes in AKT phosphorylation, a signaling pathway implicated in insulin resistance, were measured along with gene expression data for insulin receptors, glucose transporters, and specific glycolysis markers involved in glucose regulation. Since fluid shear stress arising during joint articulation is a relevant upstream stimulus for fibroblast-like synoviocytes (FLS), the predominant cell type in synovium, FLS mechanotransduction was evaluated via intracellular calcium ([Ca²⁺]_i). Incidence and length of primary cilia, a critical effector of cell mechanosensing, were measured as potential mechanisms to support differences in [Ca²⁺]_i responses. Hyperglycemic culture conditions decreased collagen and GAG content compared to EG groups, while insulin recovered ECM constituents. FLS mechanosensitivity was significantly greater in EG and insulin conditions compared to HG and non-insulin treated groups. Hyperglycemic treatment led to decreased incidence and length of primary cilia and decreased AKT phosphorylation, providing possible links to the mechanosensing response and suggesting a potential correlation between glycemic culture conditions, diabetic insulin resistance, and OA development.

Diagnostic Musculoskeletal Ultrasound for the Acute Evaluation and Management of Soccer Players

ABSTRACT

Musculoskeletal ultrasound (US) has many applications in the care of athletes. This article reviews the current literature and identifies research gaps regarding musculoskeletal US in the athletic training room setting to evaluate and manage soccer players. The best evidence for US in the training room setting is for diagnosis and prognosis of muscle injuries, where studies show that it is equivalent to other imaging modalities. US also has been used for injury risk prediction, although the data are mixed. Many applications of US are described in other sport settings and may have crossover applications to soccer.

Rehabilitation Medicine Response to the COVID-19 Pandemic

The COVID-19 pandemic has spread across the globe at a rapid rate, affecting large numbers of individuals in different countries with varying healthcare systems and infrastructure. In the United States, New York City has been the epicenter of the COVID-19 outbreak, and the peak impact in this region has come earlier in this location than most other parts of the country. We report our experience preparing for this pandemic in a New York City academic medical center and its regional healthcare system, the issues confronted during the rise and peak of the number of cases, and the plans for the postpeak recovery and adjustment to the new reality of providing rehabilitation in an environment where COVID-19 remains prevalent.

Diagnostic and therapeutic musculoskeletal ultrasound applications of the shoulder

High frequency ultrasound is a valuable tool for assessing soft tissue injuries about the shoulder. It has advantages over other imaging modalities including relatively low cost, portability, and dynamic real-time visualization. It has a high sensitivity for identifying tendon degeneration, bursitis, and rotator cuff tears. Ultrasound is also an excellent modality for diagnostic and therapeutic needle-guided procedures. A detailed knowledge of shoulder anatomy and transducer positioning is required for obtaining adequate diagnostic value from ultrasound. This Monograph is designed to help develop scanning protocols for optimizing image acquisition for musculoskeletal assessment of the shoulder. Muscle Nerve, 2019.

Resident Accuracy of Musculoskeletal Palpation With Ultrasound Verification

OBJECTIVES

The purpose of this observational study was to determine the accuracy of musculoskeletal palpation of the medial joint line of the knee, medial patellar tendon, and posterior tibialis tendon verified by ultrasound imaging among physical medicine and rehabilitation residents.

METHODS

Eighteen physical medicine and rehabilitation resident physicians at a single specialized institution were asked to identify the medial joint line of the knee, medial patellar tendon, and posterior tibialis tendon on 2 separate standardized patient models during a single data collection. They were asked to place a paper clip flat on the surface of the skin parallel to the specified anatomic structure. A high-frequency linear array transducer was used to identify whether the paper clip was correctly placed over the structures and to measure the distance from the intended structure.

RESULTS

The accuracy rates for palpation of the medial joint line, medial patellar tendon, and posterior tibialis tendon in both models were 14%, 36%, and 28%, respectively, for all levels of residents. Accuracy rates for all of the structures by level of education were 19%, 29%, and 31% for postgraduate years 2, 3, and 4. Median confidence scores were 3.75, 3.5, and 2 for the medial joint line, medial patellar tendon, and posterior tibialis tendon.

CONCLUSIONS

This study highlights the level of inaccuracy of musculoskeletal palpation skills and draws further attention to an area of much-needed improvement in our musculoskeletal residency training programs. Ultrasound imaging is an effective noninvasive method for providing swift feedback to medical students and residents and thereby reduce the instances of inaccurate musculoskeletal palpation.

Fundamental Considerations for Ultrasound-Guided Musculoskeletal Interventions

Ultrasound can be used to guide joint and soft tissue interventions to improve accuracy, efficacy, patient satisfaction, and to minimize complications. This article summarizes the rationale supporting ultrasound-guided injections and explains how to safely and effectively set up and perform these procedures.

Supinator Cyst in a Young Female Softball Player Successfully Treated With Aspiration

Ganglion cysts around the elbow joint are rare, with fewer than 25 citations in the English-language literature, most of them case reports. Among the many causes of elbow pain, cysts are primarily a diagnosis that depends on advanced imaging. When an elbow ganglion or perineural cyst is symptomatic, treatment has ranged from nonoperative to surgical intervention. Our case is unique because it is the first documented ultrasound-guided aspiration and cortisone injection that successfully alleviated a patient's symptoms. The procedures and outcomes of minimally invasive ultrasound-guided aspiration and steroid injections have not been described for cysts around the elbow.

Pharmaceutical therapy for osteoarthritis

There are a variety of oral and topical pharmaceutical agents for the treatment of osteoarthritis. To date there is no pharmacologic agent proved to prevent disease progression. This article focuses primarily on the medications used for symptomatic relief and palliation of pain. The article reviews the medications' mechanisms of action and the available efficacy literature, as well as indications, contraindications, and common adverse effects.

Current concepts for shoulder training in the overhead athlete

Nontraumatic shoulder pain in the adult overhead athlete is a common problem. The exact biomechanical adaptations that predispose the overhead athlete to injury can be multifactorial in nature, including range of motion deficits, muscular imbalances, and scapular dyskinesis. It is imperative that the rehabilitation professional not only correctly identify and treat the direct cause of the pain, but also initiate a rehabilitation program aimed at improvement of the underlying biomechanical deficits that predispose the overhead athlete to shoulder injury. This only can be accomplished through a better understanding of the most common biomechanical deficits that the overhead athlete develops and how to treat them. This article focuses primarily upon shoulder training in the adult baseball pitcher as a classic example of an overhead athlete.