Achilles tendon assessment on quantitative MRI: Sources of variability and relationships to tendinopathy.

Quantitative MRI (qMRI) measures are useful in assessing musculoskeletal tissues, but application to tendon has been limited. The purposes of this study were to optimize, identify sources of variability, and establish reproducibility of qMRI to assess Achilles tendon. Additionally, preliminarily estimates of effect of tendon pathology on qMRI metrics and structure-function relationships between qMRI measures and ankle performance were examined. T1, T1ρ, T2, and T2* maps of the Achilles tendon were obtained using a 3T MRI scanner. In participants with asymptomatic tendons (n = 21), MRI procedures were repeated twice, and region of interest selection was performed by three raters. Variance decomposition and reproducibility statistics were completed. To estimate the effect of pathology, qMRI measures from individuals with asymptomatic tendons were compared to qMRI measures from a pilot group of individuals with Achilles tendinopathy (n = 7). Relationships between qMRI and ankle performance measures were assessed. Between-participant variation accounted for the majority of variability (46.7%-64.0%) in all qMRI measures except T2*. ICCs met or exceeded 0.7 for all qMRI measures when averaged across raters or scans. Relaxation times were significantly longer in tendinopathic tendons (mean (SD) T1: 977.8 (208.6) ms, T1ρ: 35.4 (7.1) ms, T2: 42.8 (7.9) ms, T2*: 14.1 (7.6) ms, n = 7) compared to asymptomatic control tendons (T1: 691.7 (32.4) ms, T1ρ: 24.0 (3.6) ms, T2: 24.4 (7.5) ms, T2*: 9.5 (3.4) ms, n = 21) (p < 0.011 for all comparisons). T1 related to functional performance measures in symptomatic and asymptomatic groups. Study findings suggest that qMRI is reliable to assess the Achilles tendon. qMRI quantitatively assesses the presence of tendon pathology and relates to functional performance outcomes, supporting the utility of incorporating qMRI in research and clinic.

Quantative MRI predicts tendon mechanical behavior, collagen composition, and organization.

Quantitative magnetic resonance imaging (qMRI) measures have provided insights into the composition, quality, and structure-function of musculoskeletal tissues. Low signal-to-noise ratio has limited application to tendon. Advances in scanning sequences and sample positioning have improved signal from tendon allowing for evaluation of structure and function. The purpose of this study was to elucidate relationships between tendon qMRI metrics (T1, T2, T1ρ and diffusion tensor imaging [DTI] metrics) with tendon tissue mechanics, collagen concentration and organization. Sixteen human Achilles tendon specimens were collected, imaged with qMRI, and subjected to mechanical testing with quantitative polarized light imaging. T2 values were related to tendon mechanics [peak stress (rsp = 0.51, p = 0.044), equilibrium stress (rsp = 0.54, p = 0.033), percent relaxation (rsp = -0.55, p = 0.027), hysteresis (rsp = -0.64, p = 0.007), linear modulus (rsp = 0.67, p = 0.009)]. T1ρ had a statistically significant relationship with percent relaxation (r = 0.50, p = 0.048). Collagen content was significantly related to DTI measures (range of r = 0.56-0.62). T2 values from a single slice of the midportion of human Achilles tendons were strongest predictors of tendon tensile mechanical metrics. DTI diffusivity indices (mean diffusivity, axial diffusivity, radial diffusivity) were strongly correlated with collagen content. These findings build on a growing body of literature supporting the feasibility of qMRI to characterize tendon tissue and noninvasively measure tendon structure and function. Statement of Clinical Significance: Quantitative MRI can be applied to characterize tendon tissue and is a noninvasive measure that relates to tendon composition and mechanical behavior.

Rehabilitation for Children With Dystonic Cerebral Palsy Using Haptic Feedback in Virtual Reality: Protocol for a Randomized Controlled Trial.

BACKGROUND: Cerebral palsy (CP) is the most common developmental motor disorder in children. Individuals with CP demonstrate abnormal muscle tone and motor control. Within the population of children with CP, between 4% and 17% present dystonic symptoms that may manifest as large errors in movement tasks, high variability in movement trajectories, and undesired movements at rest. These symptoms of dystonia typically worsen with physical intervention exercises. OBJECTIVE: The aim of this study is to establish the effect of haptic feedback in a virtual reality (VR) game intervention on movement outcomes of children with dystonic CP. METHODS: The protocol describes a randomized controlled trial that uses a VR game-based intervention incorporating fully automated robotic haptic feedback. The study consists of face-to-face assessments of movement before, after, and 1 month following the completion of the 6-session game-based intervention. Children with dystonic CP, aged between 7 and 17 years, will be recruited for this study through posted fliers and laboratory websites along with a group of typically developing (TD) children in the same age range. We anticipate to recruit a total of 68 participants, 34 each with CP and TD. Both groups of children will be randomly allocated into an intervention or control group using a blocked randomization method. The primary outcome measure will be the smoothness index of the interaction force with the robot and of the accelerometry signals of sensors placed on the upper limb segments. Secondary outcomes include a battery of clinical tests and a quantitative measure of spasticity. Assessors administering clinical measures will be blinded. All sessions will be administered on-site by research personnel. RESULTS: The trial has not started and is pending local institutional review board approval. CONCLUSIONS: Movement outcomes will be examined for changes in muscle activation and clinical measures in children with dystonic CP and TD children. Paired t tests will be conducted on movement outcomes for both groups of children independently. Positive and negative results will be reported and addressed. TRIAL REGISTRATION: ClinicalTrials.gov NCT03744884; https://clinicaltrials.gov/ct2/show/NCT03744884 (Archived by WebCite at http://www.webcitation.org/74RSvmbZP). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/11470.

Dance and rehabilitation in cerebral palsy: a systematic search and review.

AIM: To conduct a review of research literature on the use of dance and movement with music (rhythmic auditory stimulation [RAS]) in the neurorehabilitation of children and adults with cerebral palsy (CP). METHOD: We conducted a systematic search and quality appraisal of the research literature on dance and RAS in CP. Additionally, we linked the research outcomes to the International Classification of Functioning, Disability and Health (ICF) framework. RESULTS: Studies showed preliminary evidence of the benefits of dance and RAS on body functions, particularly balance, gait, walking, and cardiorespiratory fitness for individuals with CP. Research gaps are evident across all domains of the ICF, particularly in the participation and environment domains. INTERPRETATION: To facilitate translation of quantitative research outcomes to the clinical classification of the ICF, a table was constructed that links traditional areas of quantitative rehabilitation research with the ICF categories highlighting areas of research strengths and areas where increased rigor is desirable. The potential for dance and RAS to have positive impacts on body functions, emotional expression, social participation, and attitudinal change are indicated areas for consideration in future research. WHAT THIS PAPER ADDS: The potential for dance and movement to music help balance, gait, and walking in children and adults with cerebral palsy. Research gaps are evident across International Classification of Functioning, Disability and Health domains, particularly participation and environment domains.

LA DANZA Y LA REHABILITACIÓN EN LA PARÁLISIS CEREBRAL: UNA BÚSQUEDA SISTEMÁTICA Y REVISIÓN: OBJETIVO: Realizar una revisión de la literatura de investigación sobre el uso de la danza y el movimiento con la música (estimulación auditiva rítmica [RAS]) en la neurorrehabilitación de niños y adultos con parálisis cerebral (PC). MÉTODO: Llevamos a cabo una búsqueda sistemática y una evaluación de calidad de la literatura de investigación sobre danza y RAS en PC. Además, vinculamos los resultados de la investigación al marco teórico de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF), RESULTADOS: Los estudios mostraron evidencia preliminar de los beneficios de la danza y el RAS en las funciones corporales, particularmente el equilibrio, la marcha, la marcha y la capacidad cardiorrespiratoria para las personas con PC. Las brechas de investigación son evidentes en todos los dominios de la CIF, particularmente en los ámbitos de participación y medio ambiente. INTERPRETACIÓN: Para facilitar la traducción de los resultados de la investigación cuantitativa a la clasificación clínica de la CIF, se construyó una tabla que vincula las áreas tradicionales de investigación de rehabilitación cuantitativa con las categorías CIF. destacando áreas de fortalezas de investigación y áreas donde es deseable un mayor rigor. El potencial de la danza y el RAS para tener un impacto positivo en las funciones corporales, la expresión emocional, la participación social y el cambio de actitud son áreas identificadas para tener en consideración en investigaciones futuras.

DANÇA E REABILITAÇÃO EM PARALISIA CEREBRAL: UMA PESQUISA E REVISÃO SISTEMÁTICA: OBJETIVO: Conduzir uma revisão da literaturs sobre o uso da dança e movimento com música (estimulação auditiva rítmica [EAR]) na neuroreabilitação de crianças e adolescentes com paralisia cerebral (PC). MÉTODO: Conduzimos uma busca sistemática e avaliação de qualidade da literatura sobre dança e EAR em PC. Adicionalmente, relacionamos os resultados da pesquisa com a estrutura da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). RESULTADOS: Os estudos mostraram evidência preliminar dos benefícios e EAR nas funções do corpo, particularmente equilíbrio, marcha, caminhar e aptidão cárdio-respiratória em indivíduos com PC. Lacunas nas pesquisas são evidentes em todos os domínios da Classificação Internacional de Funcionalidade, Incapacidade e Saúde , particularmente nos domínios de participação e ambiente. INTERPRETAÇÃO: Para facilitar a transição de resultados de pesquisas quantitativas para a classificação clínica da CIF, uma tabela foi elaborada para relacionar áreas tradicionais de pesquisas quantitativas em reabilitação com as categorias da CIF. Foram realçadas áreas de em que pesquisas estão fortes e áreas onde maior rigor é necessário. O potencial da dança e EAR para proporcionar impactos positivos nas funções do corpo, expressão emocional, participação social, e mudança atitudinal são indicados como áreas para consideração em futuras pesquisas.