Ultrasound imaging for diagnostics of functional muscle status in spinal cord injury

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).