Adaptation of a MR imaging protocol into a real-time clinical biometric ultrasound protocol for persons with spinal cord injury at risk for deep tissue injury: A reliability study |
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| Institution: | 1. Faculty of Health and Medical Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia, 6009, Australia;2. Institute for Health Research, The University of Notre Dame Australia, 19 Mouat Street (PO Box 1225), Fremantle, Western Australia, 6959, Australia;3. Fiona Stanley Hospital, State Rehabilitation Service, Spinal Service, South Metropolitan Health Service Fiona Stanley Fremantle Hospitals Group, Locked Bag 100, Palmyra DC, Western Australia, 6961, Australia;4. Perth Radiological Clinic, PO Box 99, Mirrabooka, Western Australia, 6941, Australia;5. Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK;6. Biomedical Engineering Department, Eindhoven University of Technology, PO Box 513, 5600 MB, Eindhoven, The Netherlands;7. Health Evaluation Promotion Unit, School of Human Sciences, The University of Western Australia M408, 35 Stirling Highway, Crawley, Perth, Western Australia, 6009, Australia;8. Fiona Stanley Hospital, South Metropolitan Health Service Fiona Stanley Fremantle Hospitals Group, Locked Bag 100, Palmyra DC, Western Australia, 6961, Australia;9. Melbourne School of Health Sciences, University of Melbourne, Parkville, Victoria, 2010, Australia;10. Department of Surgery, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada |
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| Abstract: | BackgroundHigh strain in soft tissues that overly bony prominences are considered a risk factor for pressure ulcers (PUs) following spinal cord impairment (SCI) and have been computed using Finite Element methods (FEM). The aim of this study was to translate a MRI protocol into ultrasound (US) and determine between-operator reliability of expert sonographers measuring diameter of the inferior curvature of the ischial tuberosity (IT) and the thickness of the overlying soft tissue layers on able-bodied (AB) and SCI using real-time ultrasound.Material and methodsPart 1: Fourteen AB participants with a mean age of 36.7 ± 12.09 years with 7 males and 7 females had their 3 soft tissue layers in loaded and unloaded sitting measured independently by 2 sonographers: tendon/muscle, skin/fat and total soft tissue and the diameter of the IT in its short and long axis. Part 2: Nineteen participants with SCI were screened, three were excluded due to abnormal skin signs, and eight participants (42%) were excluded for abnormal US signs with normal skin. Eight SCI participants with a mean age of 31.6 ± 13.6 years and all male with 4 paraplegics and 4 tetraplegics were measured by the same sonographers for skin, fat, tendon, muscle and total. Skin/fat and tendon/muscle were computed.ResultsAB between-operator reliability was good (ICC = 0.81–0.90) for 3 soft tissues layers in unloaded and loaded sitting and poor for both IT short and long axis (ICC = −0.028 and −0.01). SCI between-operator reliability was good in unloaded and loaded for total, muscle, fat, skin/fat, tendon/muscle (ICC = 0.75–0.97) and poor for tendon (ICC = 0.26 unloaded and ICC = −0.71 loaded) and skin (ICC = 0.37 unloaded and ICC = 0.10).ConclusionA MRI protocol was successfully adapted for a reliable 3 soft tissue layer model and could be used in a 2-D FEM model designed to estimate soft tissue strain as a novel risk factor for the development of a PU. |
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| Keywords: | Ultrasonography Spinal cord injury Pressure ulcer Deep tissue injury Reliability |
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