Journal of Orthopaedic & Sports Physical Therapy - Maria Stokes, MCSP, PhD

December 2011 Letters to the Editor-in-Chief

Tue, 29 Nov 2011 00:00:00 EST

Robert Ferrari, David M. Walton, Douglas M. White, Jackie L. Whittaker, Maria Stokes, Damien Howell, Kim H�bert-Losier, Anthony G. Schneiders, S. John Sullivan

Letters to the Editor-in-Chief of JOSPT as follows:

"Early Prognostic Factors in Patients With Whiplash" and Author's Response
"Staying Current in the Use of Ultrasound Imaging" and Author's Response
"Differentiating the Soleus From the Gastrocnemius With the Heel Raise Test" and Author's Response

J Orthop Sports Phys Ther 2011;41(12):983-987. doi:10.2519/jospt.2011.0202

Ultrasound Imaging and Muscle Function

Tue, 07 Jun 2011 00:00:00 EST

Jackie L. Whittaker, Maria Stokes

SYNOPSIS: There is a growing trend in the physical therapy profession to use conventional grayscale brightness (B-mode) ultrasound imaging (USI) as a tool to assess the morphological (form and structure) and morphometric (measures of form) characteristics of muscle, and to use these findings to draw conclusions regarding muscle function. This trend is reflected in numerous published investigations. As many physical therapists may lack training in the principles and instrumentation underlying USI use, it is critical that therapists gain a clear understanding of the information that USI can, and cannot, provide about muscle function before employing the technique for either research or clinical applications. Failure to do so may result in the propagation of inaccurate terminology and beliefs. This paper aims to clarify the role that USI has in the assessment of muscle function, first, by briefly reviewing how conventional grayscale B-mode ultrasound images and clips are generated, and second, by summarizing the types of information that these images can provide. It also discusses the various factors that need to be considered when interpreting a dynamic USI assessment of muscle specifically as it relates to the assessment of muscle function.

J Orthop Sports Phys Ther 2011;41(8):572-580, Epub 7 June 2011. doi:10.2519/jospt.2011.3682

KEY WORDS: morphology, morphometry, sonography

Rehabilitative Ultrasound Imaging of the Posterior Paraspinal Muscles

Wed, 29 Aug 2007 00:00:00 EST

Maria Stokes, Kyle B. Kiesel, James M. Elliott, Paul W. Hodges, Julie A. Hides

SYNOPSIS: Interest in rehabilitative ultrasound imaging (RUSI) of the posterior paraspinal muscles is growing, along with the body of literature to support integration of this technique into routine physical therapy practice. This clinical commentary reviews how RUSI can be used as an evaluative and treatment tool, and proposes guidelines for its use for the posterior muscles of the lumbar and cervical regions. Both quantitative and qualitative applications are described, as well as measurement reliability and validity. Measurement of morphological characteristics of the muscles (morphometry) in healthy populations and people with spinal pathology are described. Preliminary normal reference data exist for measurements of cross-sectional area (CSA), linear dimensions (muscle depth/thickness and width), and shape ratios. Compared to individuals without low back pain, changes in muscles' size at rest and during the contracted state have been observed using RUSI in people with spinal pathology. Visual observation of the image during contraction indicates that RUSI may be a valuable biofeedback tool. Further investigation of many of these observations is required using controlled studies to provide conclusive evidence that RUSI enhances clinical practice.

J Orthop Sports Phys Ther. 2007;37(10):581-595, published online 29 August 2007. doi: 10.2519/jospt.2007.2599

KEY WORDS: cervical muscles, lumbar muscles, lumbar spine, neck, morphometry, sonography

Rehabilitative Ultrasound Imaging: Understanding the Technology and Its Applications

Wed, 30 May 2007 00:00:00 EST

Jackie L. Whittaker, James M. Elliott, Katy Cook, Helene M. Langevin, Haldis H. Dahl, Maria Stokes, Deydre S. Teyhen

The use of ultrasound imaging by physical therapists is growing in popularity. This commentary has 2 aims. The first is to introduce the concept of rehabilitative ultrasound imaging (RUSI), provide a definition of the scope of this emerging tool in regard to the physical therapy profession, and describe how this relates to the larger field of medical ultrasound imaging. The second aim is to provide an overview of basic ultrasound imaging and instrumentation principles, including an understanding of the various modes and applications of the technology with respect to neuromusculoskeletal rehabilitation and in relation to other common imaging modalities.

J Orthop Sports Phys Ther. 2007:37(8):434-449; published online 30 May 2007. doi:10.2519/jospt.2007.2530

KEY WORDS: elastography, magnetic resonance imaging, rehabilitation, sonography

Rehabilitative Ultrasound Imaging of the Lower Trapezius Muscle: Technical Description and Reliability

Tue, 29 May 2007 00:00:00 EST

Cliona O'Sullivan, Susanna Bentman, Kathleen Bennett, Maria Stokes
STUDY DESIGN: Exploratory and reliability study. BACKGROUND: Shoulder dysfunction is common and often difficult to diagnose and treat. The trapezius muscle is an important stabilizer and primary mover of the scapula. The potential use of rehabilitative ultrasound imaging (RUSI) to evaluate scapular muscle function warrants investigation. OBJECTIVES: To establish a procedure for imaging the thickness of the lower trapezius muscle and to examine reliability within and among investigators. METHODS: In 16 asymptomatic subjects (12 female, 4 male), aged 20 to 41 years, 3 investigators used RUSI to measure the thickness of the left lower trapezius muscle with the subject at rest in prone. Investigator 1 took 3 images on each of 2 days, while the other 2 investigators took 2 images each on the second day. All measurements of lower trapezius muscle thickness were made off-line, at a point 3 cm lateral to the lateral edge of the spinous processes. To also obtain within-scan reliability, 1 image taken by investigator 1, once displayed on the scanner's screen, was measured 3 times. Investigator 1 also measured lower trapezius muscle thickness 1 cm medial to this site. Reliability was examined using intraclass correlation coefficients (ICC) and the Bland and Altman plot. RESULTS: The intrarater within-scan reliability at the lateral site was ICC_3,3= 0.99, (95% CI: 0.98 to 1.0).The intrarater between-scan reliability (within-day) at the lateral site, medial site, and combined sites (mean of medial and lateral) were ICC_3,3= 0.96; (95% CI: 0.90 to 0.98); ICC_3,2= 0.90 (95% CI: 0.78 to 0.96); and ICC_3,2= 0.99 (95% CI: 0.99 to 1.0), respectively. Intrarater (between-day) reliability was good for the lateral site and combined sites (ICC_3,3= 0.91; 95% CI: 0.74 to 0.96 and ICC_3,3 = 0.90; 95% CI: 0.70 to 0.96, respectively) and moderate for the medial site (ICC_3,3= 0.89; 95% CI: 0.68 to 0.96). Interrater reliability (among investigators) was also moderate (ICC_{2, 2}= 0.88; 95% CI: 0.73 to 0.96). Mean lower trapezius muscle thickness was approximately 3.1 mm (SD, 0.8mm). CONCLUSION: Thickness of the lower trapezius muscle can be measured reliably with RUSI.

J Orthop Sports Phys Ther. 2007;37(10):620-626, published online 29 May 2007. doi:10.2519/jospt.2007.2446

KEY WORDS: morphology, morphometry, muscle size, scapular muscles, ultrasonography