Stacie I. Ringleb

Determination of thigh muscle stiffness using magnetic resonance elastography.

To measure the elastic properties of the vastus lateralis (VL), vastus medialis (VM), and sartorius (Sr) muscles using magnetic resonance elastography (MRE).

Applications of magnetic resonance elastography to healthy and pathologic skeletal muscle.

Magnetic resonance elastography (MRE) is capable of noninvasively quantifying the mechanical properties of skeletal muscles in vivo. This information can be clinically useful to understand the effects of pathologies on the mechanical properties of muscle and to quantify the effects of treatment. Advances in inversion algorithms quantify muscle anisotropy in two‐dimensional (2D) and three‐dimensional (3D) imaging. Databases of the shear stiffness of skeletal muscle have been presented in the relaxed and contracted states in the upper extremity (biceps brachii, flexor digitorum profundus, and upper trapezius), distal leg muscles (tibialis anterior, medial gastrocnemius, lateral gastrocnemius, and trapezius), and proximal leg muscles (vastus lateralis, vastus medialis, and sartorius). MRE measurements have successfully validated a mathematical model of skeletal muscle behavior in the biceps brachii, correlated to electromyographic data in the distal leg muscles and quantified the effects of pathologies on the distal and proximal leg muscles. Future research efforts should be directed toward improving one‐dimensional (1D) and 3D MRE data acquisition and image processing, tracking the effects of treatment on pathologic muscle and correlating the shear stiffness with clinical measurements. J. Magn. Reson. Imaging 2007.

Real-Time Intersession and Interrater Reliability of the Functional Movement Screen

Onate, JA, Dewey, T, Kollock, RO, Thomas, KS, Van Lunen, BL, DeMaio, M, and Ringleb, SI. Real-time intersession and interrater reliability of the functional movement screen. J Strength Cond Res 26(2): 408–415, 2012—The purpose of this study was to examine the real-time intersession and interrater reliability of the functional movement screen (FMS). The overall study consisted of 19 volunteer civilians (12 male, 7 female). The intersession reliability consisted of 12 men and 7 women, whereas 10 men and 6 women participated in the interrater reliability test session. Two raters (A and B) were involved in the interrater reliability aspect of this study. The FMS includes 7 tests: deep squat (DS), hurdle step (HS), in-line lunge (IL), shoulder mobility (SM), active straight leg raise (ASLR), trunk stability push-up (TSPU), and rotary stability (RS). Researchers analyzed the data via intraclass correlation (ICC). To determine the reliability of the intersession scoring of the FMS and the intrasession interrater scoring of the FMS a 2-way mixed effects model intraclass correlation coefficient (ICC3,1) was used for the continuous data, whereas a weighted Cohens kappa (κ) was used for the categorical data. The dependent variables were FMS total score (0–21 scale) and associated tests were DS, HS, IL, SM, ASLR, TSPU, and RS. Intersession reliability (ICC, SEM) and κ were as follows: FMS total score (0.92, 0.51), DS (κ = 0.69), HS (κ = 0.16), IL (κ = 0.69), SM (κ = 0.84), ASLR (κ = 0.69), TSPU (κ = 0.77), and RS (no covariance). Interrater reliability (ICC, SEM) and κ were as follows: FMS total score (0.98, 0.25), DS (κ = 1.0), HS (κ = 0.33), IL (κ = 0.88), SM (κ = 0.90), ASLR (κ = 0.88), TSPU (κ = 0.75), and RS (no covariance). The FMS total scores displayed high intersession and interrater reliabilities. Finally, with the exception of HS, all tasks displayed moderate to high intersession reliability and good to high interrater reliability.

Thigh muscle stiffness assessed with magnetic resonance elastography in hyperthyroid patients before and after medical treatment.

To measure the stiffness of the vastus medialis (VM) in hyperthyroid patients before and after treatment.

Virtual reality-enhanced partial body weight-supported treadmill training poststroke: feasibility and effectiveness in 6 subjects.

UNLABELLED Walker ML, Ringleb SI, Maihafer GC, Walker R, Crouch JR, Van Lunen B, Morrison S. Virtual reality-enhanced partial body weight-supported treadmill training poststroke: feasibility and effectiveness in 6 subjects. OBJECTIVE To determine whether the use of a low-cost virtual reality (VR) system used in conjunction with partial body weight-supported treadmill training (BWSTT) was feasible and effective in improving the walking and balance abilities of patients poststroke. DESIGN A before-after comparison of a single group with BWSTT intervention. SETTING University research laboratory. PARTICIPANTS A convenience sample of 7 adults who were within 1 year poststroke and who had completed traditional rehabilitation but still exhibited gait deficits. Six participants completed the study. INTERVENTION Twelve treatment sessions of BWSTT with VR. The VR system generated a virtual environment that showed on a television screen in front of the treadmill to give participants the sensation of walking down a city street. A head-mounted position sensor provided postural feedback. MAIN OUTCOME MEASURES Functional Gait Assessment (FGA) score, Berg Balance Scale (BBS) score, and overground walking speed. RESULTS One subject dropped out of the study. All other participants made significant improvements in their ability to walk. FGA scores increased from mean of 13.8 to 18. BBS scores increased from mean of 43.8 to 48.8, although a ceiling effect was seen for this test. Overground walking speed increased from mean of .49m/s to .68m/s. CONCLUSIONS A low-cost VR system combined with BWSTT is feasible for improved gait and balance of patients poststroke.

Quantitative shear wave magnetic resonance elastography: Comparison to a dynamic shear material test

Magnetic resonance elastography (MRE), a phase contrast MRI technique, images the propagation of applied mechanical waves in tissue, allowing shear stiffness to be quantified in vivo. This MRE technique has been validated with static mechanical compression tests. Dynamic mechanical analysis (DMA) may be a more appropriate comparison to MRE because it directly measures the shear modulus dynamically, while compression tests convert the measured elastic modulus to shear modulus with an assumed Poisson ratio. This study compared the shear stiffness estimated with various MRE inversion algorithms (i.e., manual calculation, local frequency estimate, phase gradient, direct inversion, and matched filter) to the dynamic mechanical test. The shear stiffness of five agarose gels with concentrations ranging from 1.5 to 3.5% were measured using MRE and DMA. The phase gradient inversion algorithm overestimated the shear modulus at higher concentrations (i.e., 3–3.5% agar), while the results from the other techniques correlated well with the dynamic mechanical test. Magn Reson Med 53:1197–1201, 2005.

Two Different Fatigue Protocols and Lower Extremity Motion Patterns During a Stop-Jump Task

CONTEXT Altered neuromuscular control strategies during fatigue probably contribute to the increased incidence of noncontact anterior cruciate ligament injuries in female athletes. OBJECTIVE To determine biomechanical differences between 2 fatigue protocols (slow linear oxidative fatigue protocol [SLO-FP] and functional agility short-term fatigue protocol [FAST-FP]) when performing a running-stop-jump task. DESIGN Controlled laboratory study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A convenience sample of 15 female soccer players (age = 19.2 ± 0.8 years, height = 1.67 ± 0.05 m, mass = 61.7 ± 8.1 kg) without injury participated. INTERVENTION(S) Five successful trials of a running-stop-jump task were obtained prefatigue and postfatigue during the 2 protocols. For the SLO-FP, a peak oxygen consumption (Vo(2)peak) test was conducted before the fatigue protocol. Five minutes after the conclusion of the Vo(2)peak test, participants started the fatigue protocol by performing a 30-minute interval run. The FAST-FP consisted of 4 sets of a functional circuit. Repeated 2 (fatigue protocol) × 2 (time) analyses of variance were conducted to assess differences between the 2 protocols and time (prefatigue, postfatigue). MAIN OUTCOME MEASURE(S) Kinematic and kinetic measures of the hip and knee were obtained at different times while participants performed both protocols during prefatigue and postfatigue. RESULTS Internal adduction moment at initial contact (IC) was greater during FAST-FP (0.064 ± 0.09 Nm/kgm) than SLO-FP (0.024 ± 0.06 Nm/kgm) (F(1,14) = 5.610, P = .03). At IC, participants had less hip flexion postfatigue (44.7° ± 8.1°) than prefatigue (50.1° ± 9.5°) (F(1,14) = 16.229, P = .001). At peak vertical ground reaction force, participants had less hip flexion postfatigue (44.7° ± 8.4°) than prefatigue (50.4° ± 10.3°) (F(1,14) = 17.026, P = .001). At peak vertical ground reaction force, participants had less knee flexion postfatigue (-35.9° ± 6.5°) than prefatigue (-38.8° ± 5.03°) (F(1,14) = 11.537, P = .001). CONCLUSIONS Our results demonstrated a more erect landing posture due to a decrease in hip and knee flexion angles in the postfatigue condition. The changes were similar between protocols; however, the FAST-FP was a clinically applicable 5-minute protocol, whereas the SLO-FP lasted approximately 45 minutes.

Rapid magnetic resonance elastography of muscle using one‐dimensional projection

To demonstrate the feasibility of 1D MR elastography (MRE) to rapidly assess skeletal muscle stiffness in vivo.

Effects of lateral ligament sectioning on the stability of the ankle and subtalar joint.

Patients with subtalar joint instability are often diagnosed with ankle instability. Only after a prolonged period of time in which a patient does not improve after treatment for ankle instability is subtalar joint instability considered. To develop a clinically relevant method to diagnose subtalar joint instability, the kinematics of the simulated unstable subtalar joint were examined. A 6 degree‐of‐freedom positioning and loading device was developed. Plantarflexion/dorsiflexion, inversion/eversion, and internal/external rotation were applied individually or as coupled motions along with an anterior/posterior drawer. Kinematic data were collected from sensors attached to the calcaneus, talus, and tibia by keeping all the ligaments intact, and by serially sectioning anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), cervical ligament, and talocalceneal interosseous ligament. Kinematic results were reported using Euler angles. The ATFL and CFL contributed talocrural instability, similar to previous studies. The interosseous ligament was the greatest contributor to subtalar joint stability. The hindfoot motion (calcaneus relative to tibia) showed significant increases in motion when the ankle and/or subtalar joint was made to be unstable. Therefore, it is difficult to diagnose subtalar joint instability on physical examination alone.

Knee and hip sagittal and transverse plane changes after two fatigue protocols

UNLABELLED Fatigue has been shown to alter the biomechanics of lower extremity during landing tasks. To date, no study has examined the effects of two types of fatigue on kinetics and kinematics. OBJECTIVES This study was conducted to assess biomechanical differences between two fatigue protocols [Slow Linear Oxidative Fatigue Protocol (SLO-FP) and Functional Agility Short-Term Fatigue Protocol (FAST-FP)]. DESIGN Single-group repeated measures design. METHODS Fifteen female collegiate soccer players had to perform five successful trials of unanticipated sidestep cutting (SS) pre- and post-fatigue protocols. The SLO-FP consisted of an initial VO(2peak) test followed by 5-min rest, and a 30-min interval run. The FAST-FP consisted of 4 sets of a functional circuit. Biomechanical measures of the hip and knee were obtained at different instants while performing SS pre- and post-fatigue. Repeated 2 × 2 ANOVAs were conducted to examine task and fatigue differences. Alpha level set a priori at 0.05. RESULTS During the FAST-FP, participants had increased knee internal rotation at initial contact (IC) (12.5 ± 5.9°) when compared to the SLO-FP (7.9 ± 5.4°, p<0.001). For hip flexion at IC, pre-fatigue had increased angles (36.4 ± 8.4°) compared to post-fatigue (30.4 ± 9.3°, p=0.003), also greater knee flexion during pre-fatigue (25.6 ± 6.8°) than post-fatigue (22.4 ± 8.4°, p=0.022). CONCLUSION The results of this study showed that hip and knee mechanics were substantially altered during both fatigue conditions.