Ultrasound imaging for diagnostics of functional muscle status in spinal cord injury
Lead Research Organisation:
University of Glasgow
Department Name: School of Engineering
Abstract
A wide range of conditions or pathologies can lead to neuromuscular disorders which affect communication and mobility, e.g. spinal cord injury (SCI). The neuromuscular status in these conditions is typically clinically assessed using visual-manual tests. A number of additional tests have been proposed, based on a combination of sensory and motor tests with measurements of evoked potentials. These tests don't address the challenges of differentiating between different synergistic muscles, or detecting very small contractions. Ultrasound imaging (USI) is safe, relatively inexpensive and can measure static and dynamic muscle parameters in vivo. Static parameters relate to muscle morphology, such as muscle size, shape and structure. Automatic analysis of ultrasound (US) B-mode video recorded during muscle activity allows dynamic measurements of changes in these parameters, and therefore provides an indication of muscle activity with high spatial and temporal resolution. It is a potential tool that could provide objective and highly sensitive measures of the functional status of the muscle and its changes during and after acute rehabilitation for individuals with SCI. Since USI can describe muscle contractions in vivo, it can also be used to understand the changes in contraction characteristics of muscle following paralysis, and its response to neuromuscular stimulation (NMS).
The potential impact of the research is to (i) improve our understanding of muscle contraction following neuromusclar disease, (ii) provide a novel, highly sensitive method to diagnose and characterise the functional status of muscle.
Aims and objectives
The project aims to evaluate the suitability of ultrasound imaging (USI) for characterising the functional status of paralysed muscles in SCI, describing muscle changes during and after rehabilitation, and quantifying muscle behaviour during NMS. The objectives are:
1) Evaluate USI in SCI patients to detect muscle contractions at different stages post-injury;
2) Develop methods to assess the functional status of muscle from USI and predict recovery patterns based on this;
3) Quantitatively describe the effect of NMS training on paralysed muscle in SCI;
4) Evaluate various NMS stimulation conditions with respect to muscle contraction.
Novelty of the research methodology
The use of USI to describe muscle contractions is relatively new. With the development of advanced image analysis techniques, the automatic characterisation of muscle from USI video recordings is now possible. This opens the possibility to apply this technique, for the first time, in the spinal cord injured population, potentially allowing a more detailed clincial description of the injury and a better understanding of the recovery patterns.
Alignment to EPSRC's strategies and research areas
This project aligns with the Healthcare technologies theme, contributing to the challenge Optimising Treatment (Optimising care through effective diagnosis, patient-specific prediction and evidence-based intervention). It also aims to develop Future Therapies
Potential applications and benefits
The aim of this project is to evaluate the techniques in a clinical setting. Potential applications are identified in the treatment of spinal cord injury, and in neuromuscular disease in general. Beneficiaries are patients and health care professionals.
Collaborators
This clinical research within this project is conducted in close collaboration with the Queen Elizabeth National Spinal Injuries Unit in Glasgow (Dr M. Purcell).
The technological development regarding ultrasound image analysis is based on a collaboration with Prof Ian Loram (Manchester Metropolitan University).
The potential impact of the research is to (i) improve our understanding of muscle contraction following neuromusclar disease, (ii) provide a novel, highly sensitive method to diagnose and characterise the functional status of muscle.
Aims and objectives
The project aims to evaluate the suitability of ultrasound imaging (USI) for characterising the functional status of paralysed muscles in SCI, describing muscle changes during and after rehabilitation, and quantifying muscle behaviour during NMS. The objectives are:
1) Evaluate USI in SCI patients to detect muscle contractions at different stages post-injury;
2) Develop methods to assess the functional status of muscle from USI and predict recovery patterns based on this;
3) Quantitatively describe the effect of NMS training on paralysed muscle in SCI;
4) Evaluate various NMS stimulation conditions with respect to muscle contraction.
Novelty of the research methodology
The use of USI to describe muscle contractions is relatively new. With the development of advanced image analysis techniques, the automatic characterisation of muscle from USI video recordings is now possible. This opens the possibility to apply this technique, for the first time, in the spinal cord injured population, potentially allowing a more detailed clincial description of the injury and a better understanding of the recovery patterns.
Alignment to EPSRC's strategies and research areas
This project aligns with the Healthcare technologies theme, contributing to the challenge Optimising Treatment (Optimising care through effective diagnosis, patient-specific prediction and evidence-based intervention). It also aims to develop Future Therapies
Potential applications and benefits
The aim of this project is to evaluate the techniques in a clinical setting. Potential applications are identified in the treatment of spinal cord injury, and in neuromuscular disease in general. Beneficiaries are patients and health care professionals.
Collaborators
This clinical research within this project is conducted in close collaboration with the Queen Elizabeth National Spinal Injuries Unit in Glasgow (Dr M. Purcell).
The technological development regarding ultrasound image analysis is based on a collaboration with Prof Ian Loram (Manchester Metropolitan University).
People |
ORCID iD |
Henrik Gollee (Primary Supervisor) | |
Jennifer Miller (Student) |
Publications
Ruslee R
(2019)
Investigation of different stimulation patterns with doublet pulses to reduce muscle fatigue.
in Journal of rehabilitation and assistive technologies engineering
Miller J
(2021)
Ultrasound Imaging as a Diagnostic Tool to Assess the Functional Status of Muscles after a Spinal Cord Injury.
in Ultrasound in medicine & biology
Studentship Projects
Project Reference | Relationship | Related To | Start | End | Student Name |
---|---|---|---|---|---|
EP/N509668/1 | 30/09/2016 | 29/09/2021 | |||
1804964 | Studentship | EP/N509668/1 | 02/10/2016 | 30/03/2020 | Jennifer Miller |
Description | Ultrasound imaging (USI) can provide information about the behaviour of muscles during functional electrical stimulation, a technique commonly used in rehabilitation where low amplitude current is used to artificially elicit a muscle contraction through electrodes on the skin. USI is capable of differentiating between different levels of stimulation and electrode patterns, and could therefore be used to help optimise the technique. USI is also able to detect differences between healthy muscles and those affected by a spinal cord injury. Changes in muscle structure, including the thickness and the echogenicity (i.e. how bright/white the muscle appears), can be seen with time since the injury occurred. This suggests USI is capable of detecting and monitoring changes in the muscle as a result of atrophy. It can also detect decreased muscle movement as a result of partial paralysis. The ability of USI to distinguish between different levels of muscle activity indicates a potential for quantitatively describing muscle function. Analysis of this data is ongoing. |
Exploitation Route | The use of ultrasound imaging as a technique to better understand muscle behaviour during functional electrical stimulation (FES) could be further developed to optimise the use of FES in rehabilitation applications. There is also potential for ultrasound imaging to be included as a diagnostic tool for assessing muscle function following a spinal cord injury by monitoring changes in the structure of the muscle and measuring the amount of movement the muscle is able to produce. |
Sectors | Healthcare |
Description | Analysis of USI (MMU) |
Organisation | Manchester Metropolitan University |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Our use of the tracking software to analyse ultrasound videos demonstrates the use of the software for rehabilitation and clinical applications. |
Collaborator Contribution | The tracking software used to analyse the ultrasound videos was originally developed at Manchester Metropolitan University. |
Impact | Publication: Ultrasound imaging analysis for the optimisation of functional electrical stimulation. |
Start Year | 2016 |
Description | Clinical Research at QENSIU |
Organisation | Queen Elizabeth University Hospital |
Department | The Queen Elizabeth National Spinal Injury Unit |
Country | United Kingdom |
Sector | Hospitals |
PI Contribution | A clinical research study investigating the use of ultrasound imaging as a potential additional tool to assess the functional status of muscles following a spinal cord injury. This involved the development and design of a suitable protocol, data collection and data analysis. |
Collaborator Contribution | Clinical research was carried out within the premises of the Queen Elizabeth National Spinal Injuries Unit. Participants were inpatients from the unit who were initially screened by Dr M. Purcell, a consultant within the unit. Dr Purcell also contributed her expertise as a consultant in the field of spinal cord injury during the initial development of the protocol. |
Impact | No research outcomes yet. |
Start Year | 2016 |
Description | Applicants Visit |
Form Of Engagement Activity | Participation in an open day or visit at my research institution |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Schools |
Results and Impact | A brief presentation about current research and demonstration of equipment used was given to school children who would potentially apply to the University to do an undergraduate course in a relevant field to our research group. Pupils expressed interest in the undergraduate course. |
Year(s) Of Engagement Activity | 2017,2018,2019,2020 |
Description | Poster Presentation at 22nd Annual IFESS Conference |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Other audiences |
Results and Impact | A poster was displayed at the 22nd Annual International Functional Electrical Stimulation Society (IFESS) conference with a presentation to an audience of approximately 60 people. The majority of the audience were academics in the field of functional electrical stimulation or rehabilitation in spinal cord injury. There were also post graduate research students and professionals who work with spinal cord injury patients (e.g. physiotherapists). Interest was expressed in the use of ultrasound imaging to optimise the use of electrical stimulation. |
Year(s) Of Engagement Activity | 2018 |
Description | Presentation to Physiotherapists |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Professional Practitioners |
Results and Impact | A presentation about ongoing research into the use of ultrasound imaging for assessing muscle function in spinal cord injury was given to approximately 10 physiotherapists who work within the unit where the research was taking place (Queen Elizabeth National Spinal Injury Unit, Queen Elizabeth University Hospital, Glasgow). This gave the physiotherapists an insight into the work research being done within the unit and an interest was expressed in the potential for ultrasound imaging to be used as a diagnostic tool. |
Year(s) Of Engagement Activity | 2018 |
Description | Undergraduates Visit Spinal Injuries Unit |
Form Of Engagement Activity | Participation in an open day or visit at my research institution |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Undergraduate students |
Results and Impact | Undergraduate students from the University of Glasgow visited the Queen Elizabeth National Spinal Injuries Unit and were given demonstrations of equipment used in current research. Interest was expressed in the research being done by our group. |
Year(s) Of Engagement Activity | 2017,2018,2019 |