The role of 3D digital applications in Manual Therapy Education – A scoping review

Background: Currently, teaching methods for developing complex physical assessment and palpation skills in manual therapy is challenging for both learners and educators. 3D digital technologies such as virtual reality (VR), augmented reality (AR) and mixed reality may facilitate and/or address these challenges. However, their current usage and/or role in improving learning outcomes in manual therapy education is still largely unknown. Methods: The following electronic databases were searched from Jan 2005 to April 2021: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), Science Direct and Google Scholar. Two independent reviewers reviewed the articles retrieved from the databases to assess for eligibility. Studies of any methodology (quantitative, qualitative and mixed methods) that investigated the use or application of the 3D digital applications were included in the review. Primary outcomes included any outcome related to learning based on the updated Blooms taxonomy. Narrative synthesis was used to synthesise data from the included studies.Results: A total of 4 articles were included in the final review. The main findings were classified into the following key concepts: (1) perception of tissue stiffness, (2) improved student self-efficacy in performing MT techniques, and (3) barriers and facilitators for utilizing 3D technologies. All included outcomes met understanding, applying, analysing and evaluating levels of Blooms taxonomy; however, no outcomes met the ‘creating’ level of Bloom’s taxonomy.Discussion: Our review found that there are no AR, VR or mixed applications that specifically serve the needs of MT education in relation to joint motion assessment, but applications are available that can be readily used or potentially adapted to train skills of tissue palpation. . Therefore, future studies are required to investigate the sophisticated requirements to teach/learn complex manual techniques for which palpation skills may be mandatory.

Spontaneous changes of skull morphology in premature babies: A preliminary study using plagiocephalometric analysis

Aim — to develop a reliable protocol to study the spontaneous changes in te skull morphology, specifically plagiocephaly in premature infants.Materials and methods. Evaluation of the degree of asymmetry using a plagiocephalometric tool and passive motion assessment for axial rotation and clinical examination of the neck muscles in six preterm infants. All measures are taken four times over a two months period.Results. About the placement of thermoplastic bands, a maximal variability of 3 % and 5 % was found for intra-and inter- observations respectively for the indices of interest (ODDI, CPI, CVAI). The variability of measures taken on photocopies was less than 1 %. 67 % of children had a preferential position on the third measure (T3) and 83 % on the fourth measure (T4). The prevalence of plagiocephaly was 17, 67, 33 and 50 % at T1, T2, T3 and T4 respectively considering a threshold of oblique diameters difference (ODDI) of 104 % . No influence of gender, gestational age, primiparity or asymmetry in muscle tension and/or rotation has been highlighted. In comparison with previous data, a very highly significant difference (p=0,001) was found for the index head values.Conclusion. This study has demonstrated the feasibility of the method. More consistent data should be considered, with a broader sample in order to provide a relevant analysis of the morphometric changes of the skull base. According to the criteria of the literature, three premature infants out of six had a plagiocephaly at T4 and we observed a normalization of morphometric values was observed in two infants.

A REAL TIME SPEED MODULATION SYSTEM TO IMPROVE OPERATIONAL ABILITY OF AUTONOMOUS PLANING CRAFT IN A SEAWAY

This study focuses on developing a control system to enhance the seaworthiness of Autonomous high-speed Planing Crafts (APCs). APCs operating at high-speed in a seaway encounter very high vertical accelerations which pose a hazard to payload and crafts' structural integrity. Therefore, for safety operation of APCs in a seaway it is proposed to employ a system termed vision-aided speed modulation system (VSMS). The proposed VSMS employs an embedded analytical tool termed Motion Assessment of Planing Craft in a Seaway (MAPCS) for the prediction of vertical accelerations and angular velocities, the APC might encounter in the incoming waves. As a response to the MAPCS predicted values the VSMS speed setting module modulates the craft's forward speed. All modules of the VSMS are presented together with their validation and system's preliminary operational results. It is concluded that VSMS might be an essential tool to considerably enhance the operational ability of APCs.

Ultrasound-based sensors for respiratory motion assessment in multimodality PET imaging

Breathing motion can displace internal organs by up to several cm; as such, it is a primary factor limiting image quality in medical imaging. Motion can also complicate matters when trying to fuse images from different modalities, acquired at different locations and/or on different days. Currently available devices for monitoring breathing motion often do so indirectly, by detecting changes in the outline of the torso rather than the internal motion itself, and these devices are often fixed to floors, ceilings or walls, and thus cannot accompany patients from one location to another. We have developed small ultrasound-based sensors, referred to as ‘organ configuration motion’ (OCM) sensors, that attach to the skin and provide rich motion-sensitive information. In the present work we tested the ability of OCM sensors to enable respiratory gating during in vivo PET imaging. A motion phantom involving an FDG solution was assembled, and two cancer patients scheduled for a clinical PET/CT exam were recruited for this study. OCM signals were used to help reconstruct phantom and in vivo data into time series of motion-resolved images. As expected, the motion-resolved images captured the underlying motion. In Patient #1, a single large lesion proved to be mostly stationary through the breathing cycle. However, in Patient #2, several small lesions were mobile during breathing, and our proposed new approach captured their breathing-related displacements. In summary, a relatively inexpensive hardware solution was developed here for respiration monitoring. Because the proposed sensors attach to the skin, as opposed to walls or ceilings, they can accompany patients from one procedure to the next, potentially allowing data gathered in different places and at different times to be combined and compared in ways that account for breathing motion.

Analyzing Head Pose in Remotely Collected Videos of People with Parkinson’s Disease

We developed an intelligent web interface that guides users to perform several Parkinson’s disease (PD) motion assessment tests in front of their webcam. After gathering data from 329 participants (N = 199 with PD, N = 130 without PD), we developed a methodology for measuring head motion randomness based on the frequency distribution of the motion. We found PD is associated with significantly higher randomness in side-to-side head motion as measured by the variance and number of large frequency components compared to the age-matched non-PD control group (p = 0.001, d = 0.13). Additionally, in participants taking levodopa (N = 151), the most common drug to treat Parkinson’s, the degree of random side-to-side head motion was found to follow an exponential-decay activity model following the time of the last dose taken (r = −0.404, p = 6e-5). A logistic regression model for classifying PD vs. non-PD groups identified that higher frequency components are more associated with PD. Our findings could potentially be useful toward objectively quantifying differences in head motions that may be due to either PD or PD medications.

Rest contrast echocardiography unmasks hidden wall motion abnormalities in patients with chest pain. A case series and review of pertinent literature.

We present a case series of three patients that underwent myocardial contrast echocardiography (MCE) in the setting of recent chest pain, as paradigmatic examples of the usefulness of contrast-echocardiography with very-low mechanical index imaging in the context of rest wall motion assessment. Moreover, we analysed the pertinent literature about the use of rest MCE in the context of chest pain of unknown origin, showing its diagnostic and prognostic impact. We think that MCE could play a key role in detecting chest pain subtended by previously unknown CAD. For example, in pts without significant ECG modifications or in whom high sensitivity troponins show only borderline increase (still below the upper limit) or have no clearly significant delta. In such cases the more sensitive evaluation of WM powered by MCE could add diagnostic information, above all in pts with severe CAD but apparently normal WM at standard echocardiography.

Segmental Strain for Myocardial Scar Detection in Acute Infarcts and Follow-Up CMR Using Non-Contrast Cine Images

Aims Scar tissue from myocardial infarction is best visualized with cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE). Gadolinium-free alternatives for detection of myocardial scars are limited. This study investigated the feasibility of myocardial scar detection in acute infarcts and follow-up CMR using non-contrast cine images. Methods Fifty-seven patients with acute infarcts (15 female, mean age 61 ± 12 years, CMR 2.8 ± 2 days after infarction) were retrospectively evaluated with follow-up CMR exams available in thirty-two patients (9 female, 35 ± 14 days after infarction). Twenty-eight patients with normal CMR scans (2 female, mean age 47 ± 8 years) served as controls. Global and segmental strain parameters (global peak circumferential [GPCS], global peak longitudinal [GPLS], global peak radial strain [GPRS], segmental peak circumferential [SPCS], segmental peak longitudinal [SPLS], and segmental peak radial strain [SPRS]) were calculated from standard non-contrast balanced SSFP cine sequences using commercially available software (Segment CMR, Medviso, Sweden). Visual assessment of wall motion abnormalities on short axis cine images, as well as segmental circumferential strain calculations (endo-/epicardially contoured short axis cine and resulting polar plot strain map) of every patient (acute imaging and follow-up CMR) and control were presented for two blinded readers in random order, who were advised to localize potentially infarcted segments, blinded to LGE images and clinical information.Results While global strain values were impaired in patients with acute infarcts compared to controls (GPCS p= 0.01; GPLS p= 0.04; GPRS p= 0.01), global strain was similar between first CMR and follow-up imaging in the subgroup of 32 patients (GPCS p= 0.7; GPLS p=0.8; GPRS p=0.2). In acute infarcts and in follow-up CMR, patients had reduced mean SPCS in infarcted segments compared to remote myocardium (acute p= 0.03, follow-up exams p= 0.02). SPCS values in infarcted areas were similar in acute infarcts and in follow-up exams (p=0.8). In acute infarcts 74.6% of all in LGE infarcted segments (141/189) were correctly localized in polar plot strain maps compared to 44.4% (84/189) of infarcted segments detected by visual wall motion assessment only (p < 0.01). In follow-up exams, 81.5% of all in LGE infarcted segments (93/114 segments) were correctly localized in polar plot strain maps compared to 51.8% (59/114) of infarcted segments detected by visual wall motion assessment (p < 0.01).Conclusion Segmental circumferential strain derived from routinely acquired cine sequences detects nearly 75% acute infarcts and about 80% of infarcts in follow-up CMR and can potentially be used for scar identification based on non-contrast cine images, when gadolinium cant not be applied or LGE images are not available.