Rehabilitative Ultrasound Imaging Symposium

Deydre S. Teyhen

DOI: 10.2519/jospt.2006.0301

As physical therapists, we routinely evaluate and treat motor control impairments associated with neuromusculoskeletal disorders. Over the last decade, researchers have found that deep muscle activation patterns are different in those with lumbopelvic dysfunction compared to those without. Additionally, when exercises are prescribed that target motor control impairments, favorable effects on pain, disability, and recurrence are observed. However, it has proved more difficult to establish reliable and valid noninvasive clinical measurement tools to evaluate muscle and related soft tissue morphology and function during physical tasks to improve the design of therapeutic interventions.

One tool that has potential to assist with improving physical therapists’ ability to evaluate and treat motor control impairments is the use of rehabilitative ultrasound imaging (RUSI) based on its ability to provide real-time visual feedback of the underlying muscular morphology and function to both the patient and the physical therapist. Although ultrasound imaging (USI) has been used for medical purposes since the 1950s, its application for rehabilitative sciences only started in the 1980s with the work of Dr Archie Young, a physician at the University of Oxford whose research team included physiotherapists. Although the research and clinical applications of this emerging technology have steadily grown, there has not previously been an international meeting to organize a research agenda that could ultimately guide its role in clinical practice.

The US Army-Baylor University Doctoral Program in Physical Therapy hosted a RUSI Symposium in May 2006 in San Antonio, TX. The purpose of this meeting was to develop best practice guidelines for the use of RUSI for the abdominal, pelvic, and posterior spine muscles and develop an international and collaborative research agenda related to the use of USI. Participants included leading international experts from around the world in the field of RUSI and clinical research. The objectives of the symposium were to:

1. Contribute to the development of an international set of RUSI measurement standards in the assessment of muscle function
2. Identify and synchronize current and future international efforts to promote the use of RUSI in clinical practice, research, and education
3. Initiate the development of an international and collaborative research agenda
4. Develop models for the implementation of RUSI to clinical practice within the Military Healthcare System
5. Explore future applications

Delegates represented 6 countries and 13 universities around the world. Topics discussed at the symposium included:

• Role of USI in rehabilitation
• Professional, political, ethical, and legal issues
• Clinical applications
• RUSI of the pelvic floor muscles
• RUSI of the lateral abdominal muscles
• RUSI of the posterior paraspinal muscles
• RUSI of other muscles
• Technology and techniques

Abstracts from the presenters are provided. Additionally, for each of the main topics, committees were established to develop synopsis statements addressing what is known, what remains unknown, what are the future directions and research priorities, and what are the best clinical applications of this technology.

One of the outcomes of the symposium was that the delegates unanimously agreed to a ‘‘Rehabilitative Ultrasound Imaging International Consensus Statement’’ to help define this emerging tool in the field of physical therapy. In addition, a diagram was developed to present a visual representation of how the practice of RUSI fits into the larger field of USI. The consensus statement follows:

RUSI is a procedure used by physical therapists to evaluate muscle and related soft tissue morphology and function during exercise and physical tasks. RUSI is used to assist in the application of therapeutic interventions aimed at improving neuromuscular function. This includes providing feedback to the patient and physical therapist to improve clinical outcomes. Additionally, RUSI is used in basic, applied, and clinical rehabilitative research to inform clinical practice. Currently, the international community is developing education and safety guidelines in accordance with World Federation for Ultrasound in Medicine and Biology (WFUMB). Dated: 10 May, 2006.

Synopsis statements in the format of clinical commentaries are being developed by these working groups and our goal is to have them ready for publication in 2007. Additionally, it is the intention of the group to hold future international meetings, particularly for enhancing collaborative research and steering the international physical therapy community in regards to the implementation of RUSI.

J Orthop Sports Phys Ther. 2006;36(8):A1-A17. doi:10.2519/jospt.2006.0301

View Full Article