This research was supported by the National Research Foundation of Korea (NRF-2015M3A9E3052338).

The procedures presented below were approved by the Institutional Review Board of Korea University, Seoul, Republic of Korea.
1. Constructing Phantom Acupoints
Note: The creation of a phantom acupoint with a similar torque amplitude as that of a human acupoint is important in applying this method because practicing acupuncture manipulation on a phantom acupoint must not feel different in quality from practicing on a human acupoint. Thus, a thorough development and validation process is required to qualify a phantom acupoint as a predefined human acupoint. A 5% agarose gel was shown to have a similar torque amplitude (59.2 &#177; 4.5 and 58.7 &#177; 4.6 &#181;Nm, respectively) to the LI4 acupoint, which is located between the thumb and index finger13.
<ol>
	<li>Add 0.75 g agarose to 15 ml distilled water and dissolve the agarose gel; warm the solution in a microwave oven for 20 sec until the agarose becomes transparent. Use a concentration of 5% (0.75 g) to make phantom acupoints with torque amplitudes similar to those of human acupoints (e.g., the LI4 acupoint; Figure 1).</li>
	<li>Divide the agarose gel into 2 ml portions and seal them in five tubes. Make sure to wear gloves to avoid burns. Be careful to position the tubes perpendicularly at room temperature (25 &#176;C) for 2 hr.</li>
	<li>Evaluate the degree of stimulation and biomechanical force of newly created phantom acupoints using an acupuncture needle and motion sensor specifically designed to measure acupuncture manipulation10. Position an acupuncture needle within a hole located at the center of the sensor before starting the evaluation. Evaluate the frequency using power in frequency domain calculated by Fourier transformation.</li>
	<li>Apply acupuncture to the phantom acupoint. When the needle is 15 mm deeper than the gel surface, rotate the needle for 15 sec while rotating one full circle clockwise and counter-clockwise in 1 sec (1 Hz). If possible, verify the velocity of rotation with a motion sensor real-time graph. Pull the needle from the gel after acupuncture manipulation.</li>
</ol>
2. Implementation of the Acupuncture Manipulation Education System
<ol>
	<li>Prepare a 5% agarose gel phantom acupoint (process explained in step 1.1) that shows a torque amplitude similar to that of a real human arm, such as acupoint LI4, which is an acupoint located between the thumb and index finger.</li>
	<li>Sanitize hands using an alcohol-based hand sanitizer before acupuncture manipulation to avoid possible wounds or infection while practicing acupuncture manipulation.</li>
	<li>Practice acupuncture using this program. Download this program from the website: http://cmslab.khu.ac.kr/downloads/ames and install the program. Start the program on the computer and prepare the motion sensor. Position an acupuncture needle through the hole located at the center of the sensor before starting the evaluation. Because the acupuncture needle is not attached to the sensor, be prepared to move the needle through the hole while the sensor measures the motion of the needle. Prepare the phantom acupoint to insert and manipulate the needle.</li>
	<li>Choose from various templates of acupuncture manipulation, including various frequencies and asymmetric movements. Before starting the manipulation, choose from lifting/thrusting or the rotating manipulation technique by pressing one of the two radio buttons displayed on the graphic user interface (GUI) software and decide whether the intended movement for practice follows the pattern of a 1:1 ratio, a 1:2 ratio, or a 2:1 ratio sine graph.</li>
	<li>Position the acupuncture needle (0.25 &#215; 40 mm) in the motion sensor so that it is ready to be manipulated. Place the phantom acupoint under the needle and the sensor.</li>
	<li>Calibrate the motion sensor using a two-axis actuator. Position the acupuncture needle with the participant&#39;s finger and press Calibrate on the screen. Through the calibration, the two-axis actuator will recognize and adjust the current position as a zero value in depth.</li>
	<li>Manipulate an acupuncture needle on the phantom acupoint for about 1 min while the actual movement of acupuncture manipulation is being measured. Have the participant look at the screen as they manipulate the needle to view the actual movement of his or her acupuncture manipulation concurrently, along with the intended movement. Transmitted actual movement is displayed as the green line, and the template of the intended motion is concurrently overlapped as the red line.</li>
	<li>Acquire real-time motion wave data (80.3 Hz sampling rate) of the lifting/thrusting method of acupuncture manipulation using the motion sensor by clicking the button presented in the software. The real-time motion wave data can also be acquired using the rotation method.</li>
	<li>Repeat this at least eight times to enhance acupuncture manipulation skills.</li>
</ol>
3. Data Processing
<ol>
	<li>Filter out the fluctuating low-frequency signals (&#60; 0.2 Hz) and high-frequency noise signals (&#62; 5 Hz) by applying the infinite impulse response (IIR). Use the Butterworth filter, which allows for filtering of information in a frequency signal that is either lower than 0.2 Hz or higher than 5 Hz.</li>
	<li>Separate the filtered signals of the participants into repeated motion units by detecting local maximum and minimum points.</li>
	<li>To generate a pattern template for each participant, normalize the duration (length of sampled motion unit) and amplitude (magnitude of lifting/thrusting or rotation) in every sampled unit.</li>
	<li>Calculate the average amplitude and duration of a sampled motion unit for each participant.</li>
	<li>Extract the main frequency from the actual movement using a Fourier transformation, so that the error between the main frequency and frequency of the intended movement is shown on the program screen after the participant finishes a 1-minute training session.</li>
	<li>Analyze the normalized motion units for each participant using a generalized additive mixed model (GAMM) method9. 
	Note: In GAMM, model a single manipulation movement (M) for a participant as the sum of smooth function in time (t) and random intercepts for individual units (u). In other words, model M = s(t) + b(u), where M is the motion for a participant, s(t) is a smooth function in time, and b(u) is random intercepts for individual units. Our previous study explained the GAMM model and the calculation of the mean square error (MSE) in detail9.</li>
	<li>Calculate the mean square error (MSE) between the intended movement and the extracted motion pattern of the actual movement by the participant between the first and the last trial of acupuncture manipulation9.</li>
	<li>Analyze data from the first and the last trial using a two-sample t-test to identify changes in acupuncture manipulation after visual feedback.</li>
</ol>

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	<li>Thompson, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+a+clinical-practice+guideline+and+practice-based+education+on+detection+and+outcome+of+depression+in+primary+care:+Hampshire+Depression+Project+randomised+controlled+trial.">Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire Depression Project randomised controlled trial.</a> Lancet. 355 (9199), 185-191 (2000).</li><li>Moore, D. J., Drisko, C. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dental+teaching+model.">Dental teaching model.</a> U.S. Patent No. , (1992).</li><li>Heng, P. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intelligent+inferencing+and+haptic+simulation+for+Chinese+acupuncture+learning+and+training.">Intelligent inferencing and haptic simulation for Chinese acupuncture learning and training.</a> IEEE Trans Inf Technol Biomed. 10, 28-41 (2006).</li><li>Leung, K. M., Heng, P. A., Sun, H., Wong, T. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+haptic+needle+manipulation+simulator+for+Chinese+acupuncture.">A haptic needle manipulation simulator for Chinese acupuncture.</a> Stud Health Technol Inform. 94, 187-189 (2003).</li><li>Wang, H. S., Yan, Z. G., Cheng, Z., Shao, S. J., Zhuang, T. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Study+on+force+feedback+of+acupuncture+manipulation+at+Jianliao+(TE+14)+based+on+VOXEL-MAN.">Study on force feedback of acupuncture manipulation at Jianliao (TE 14) based on VOXEL-MAN.</a> Zhongguo Zhen Jiu. 29, 745-748 (2009).</li><li>Li, J., Grierson, L. E., Wu, M. X., Breuer, R., Carnahan, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Perceptual+motor+features+of+expert+acupuncture+lifting-thrusting+skills.">Perceptual motor features of expert acupuncture lifting-thrusting skills.</a> Acupunct Med. 31, 172-177 (2013).</li><li>Dumoulin, C. L., Darrow, R. D., Adams, W. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Display+system+for+enhancing+visualization+of+body+structures+during+medical+procedures.">Display system for enhancing visualization of body structures during medical procedures.</a> U.S. Patent. , (1996).</li><li>Vesely, I., Smith, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Method+for+carrying+out+a+medical+procedure+using+a+three-dimensional+tracking+and+imaging+system.">Method for carrying out a medical procedure using a three-dimensional tracking and imaging system.</a> U.S. Patent. , (1998).</li><li>Seo, Y. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Motion+patterns+in+acupuncture+manipulation.">Motion patterns in acupuncture manipulation.</a> Acupunct Med. 32 (5), 394-399 (2014).</li><li>Davis, R. T., Churchill, D. L., Badger, G. J., Dunn, J., Langevin, H. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+new+method+for+quantifying+the+needling+component+of+acupuncture+treatments.">A new method for quantifying the needling component of acupuncture treatments.</a> Acupunct Med. 30 (2), 113-119 (2012).</li><li>Lee, I. S., Lee, Y. S., Park, H. J., Lee, H., Chae, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+phantom-based+education+system+for+acupuncture+manipulation.">Evaluation of phantom-based education system for acupuncture manipulation.</a> PLoS One. 10 (2), e0117992 (2015).</li><li>Jung, W. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sensorimotor+learning+of+acupuncture+needle+manipulation+using+visual+feedback.">Sensorimotor learning of acupuncture needle manipulation using visual feedback.</a> PLoS One. 10 (9), e0139340 (2015).</li><li>Lee, I. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Haptic+Simulation+for+Acupuncture+Needle+Manipulation.">Haptic Simulation for Acupuncture Needle Manipulation.</a> J Altern Complement Med. 20 (8), 654-660 (2014).</li><li>Dang, T., Annaswamy, T. M., Srinivasan, M. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+and+evaluation+of+an+epidural+injection+simulator+with+force+feedback+for+medical+training.">Development and evaluation of an epidural injection simulator with force feedback for medical training.</a> Stud Health Technol Inform. 81, 97-102 (2001).</li></ol>

The authors declared that no competing conflicts of interest exist.

The present procedure tracks the process of acupuncture manipulation education from the creation of phantom acupoints and the application of the AMES program to the analysis of data acquired from participants&#39; trials. Phantom acupoints are generated from agarose gel, and the solution needs to be carefully adjusted to resemble the motion and torque amplitudes of human acupoints. We developed different types of phantom acupoints with torque amplitudes that were similar to those of other acupoints; these can be applied to a more comprehensive acupuncture manipulation training protocol, such as one using acupoints with different anatomical characteristics13. In addition, use of a motion sensor allows the quantification of needle manipulation in terms of motion and force patterns10. Using phantom acupoints and acupuncture needles, this program can be applied to training different types of acupuncture manipulation by changing its modes from the rotating or lifting/thrusting method and by changing the frequency and the pattern. In addition, by extracting the sample motion of the participant through data processing, the participant can see their acupuncture manipulation movement and instantly compare the difference between the actual and intended movements. Furthermore, GAMM, based on the generalized additive model (GAM) method, allows for the specification of smooth functions within a mixed model framework. By comparing the motion patterns before and after training, the participants can receive information about improvements in acupuncture manipulation as a result of training.
There are different methods and tools for educating and regulating medical procedures. One is a detailed, written instruction set, such as a standard operating procedure (SOP). The goal of this approach is to achieve uniformity in the performance of a specific function to meet the goals of Good Clinical Practices1. Another approach, similar to our phantom acupoint method, is found in dental models, which include flexible molds2. A previous study used force feedback for training with an epidural injection simulator to obtain cerebrospinal fluid14. A phantom acupoint is useful in a phantom-based educational program that trains students to perform acupuncture manipulations. This is an important advance in educational programs related to medical procedures, including acupuncture. On the other hand, due to the lack of quantitative and objective information concerning needle manipulation motion parameters, it is difficult to learn the sophisticated movements of acupuncture manipulation. To solve this problem, Davis et al. developed a motion and force sensor to quantify different needling motion and force patterns for two different acupuncture techniques10.
Sensorimotor learning is based on sensory feedback, which seeks to reduce discrepancies between desired and actual movements. Humans can estimate the error gradients of each component of their movement and improve their performance through iterative corrections based on movement error. Visual feedback during an isometric target-acquisition task was shown to improve performance in two different ways: concurrent visual feedback enhanced motor performance through automatic recalibration of visuo-motor mapping, whereas post-trial visual feedback induced improvements using a cognitive strategy. AMES presents acupuncture manipulation in the form of an oscillation that constantly moves according to the participant&#39;s movement, allowing the participant to obtain feedback and modify his or her manipulation technique.
The critical step in this protocol is to adjust the position of acupuncture needle so it is neither too deep nor too shallow within the phantom acupoint so that the program will recognize the position of the needle as the baseline and show movement on the same level as the template on the screen. The participant must check the screen and the position of the acupoint carefully before starting the manipulation movement.
By modulating the frequency, amplitude, and ratio of the sine wave, the visualizations of the intended movement and the actual movement of the acupuncture manipulation provide feedback to the participant. This real-time feedback to the participant allows minimization of manipulation error. The visualization in this program allows depiction of changes in the time interval or in the velocity of the rotation and lifting/thrusting movement of acupuncture manipulation, as well as in the pattern of the movement. For example, the mode of lifting/thrusting can be in the ratio of 1:1, 2:1, or 1:2, and the mode of rotating clockwise/counterclockwise can be at 0.5, 1, or 2 Hz. To enhance the effect of real-time visual feedback and enable students to grasp the movement error, this program provides information on the difference between the intended and actual movements enacted by the participant after the trial using the error feedback based on a quantified measurement12.
Standardization of acupuncture education is difficult due to the complicated manipulations of acupuncture needles involved in this practice. Different forms of movement are required to visualize different methods of acupuncture, such as the tonifying and reducing methods in the lifting/thrusting movement. Recent studies have focused on display systems for enhancing visualization of body structures during medical procedures as well as on simulations of the tools and methods used in medical procedures, such as phantom models10-11. By visually presenting the motion patterns of the hand movements performed during acupuncture manipulation, this system helps students and young doctors improve their performance of the sophisticated hand movements required for acupuncture needle manipulation. Therefore, our program proposes a novel form of acupuncture training that can yield standardized acupuncture practice with easy and efficient preparation. In addition, this program provides ample data on the acupuncture needling performed by participants, which can be used to provide visuo-motor learning in acupuncture education.
The limitations of the technique presented here are as follows. First, the template curve for manipulation is artificially generated, which means that it can differ from the manipulation movement in an actual setting. Second, the information about the rotation methods provided by oscillation is not intuitively obvious, as the direction of clockwise and counter-clockwise movement is not well-represented in the visualization. Finally, our protocol does not include programs that provide training in the combination skills of rotating and lifting/thrusting together, which is another acupuncture manipulation skill. In our future study, we will provide templates from skilled clinicians that include the combination skills of rotating and lifting/thrusting to overcome some of these limitations.
In summary, our newly developed program for acupuncture training uses visual feedback and provides a new method for acupuncture education, employing a device that enables easy handling of acupuncture needles and precise measurement of acupuncture movement. It is also a cost-effective tool with which to practice acupuncture needling. Moving beyond a visualization system of body parts during medical procedures, this program uses graphs to provide a visualization of the medical procedure itself. Our program proposes a novel method for acupuncture training that is simple and efficient and results in standardized practices and data on acupuncture needling.

The Acupuncture Manipulation Education System (AMES) was developed to enhance students&#39; acupuncture manipulation skills, with the goal of teaching acupuncture manipulation through visuo-motor learning. This program is a novel approach to acupuncture training that uses a graphic user interface (GUI) software. This system allows students to concurrently observe their own actual movement and the intended movement. This visual feedback helps students to improve their acupuncture manipulation skills.
Different methods and tools, such as detailed, written instructions or flexible molds for dentistry, have been developed to educate students about medical procedures1-2. In acupuncture, classical medical texts have included instructions on various methods of acupuncture manipulation that have different effects on patients. Recently, several studies proposed a virtual-reality system for acupuncture training using a 3D stereo display and realistic haptic feedback in real time3-4. Whereas many of the past developments focused on the anatomical structures involved in medical procedures5-6, recent developments in acupuncture training have focused on the sensation of needling or a virtual-reality system using artificial skin pads to provide a setting similar to that in which the actual clinical practice of acupuncture needling occurs7-8. As explained in previous studies, the new system provides a display system for visualization of acupuncture manipulation that enables easy handling of the acupuncture needle using inexpensive and portable tools with which to practice needling9. Using a motion sensor designed for acupuncture10, this system helps students and young doctors improve their acupuncture manipulation performance using visual feedback and visuo-motor learning11-12.

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	<colgroup>
		<col />
		<col />
		<col />
		<col />
	</colgroup>
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:204px;">Agarose</td>
			<td style="width:79px;">Lonza</td>
			<td style="width:141px;">50002</td>
			<td style="width:152px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Safe-Lock Tube</td>
			<td>Eppendorf</td>
			<td>T2795-1000EA</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">motion and force sensor</td>
			<td>Stromatec</td>
			<td>Acusensor</td>
			<td>www.stromatec.com</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">acupuncture needle</td>
			<td>Seirin</td>
			<td></td>
			<td>J Type Japanese needle</td>
		</tr>
	</tbody>
</table>

visualizing motion patterns in acupuncture manipulation

Acupuncture manipulation varies widely among practitioners in clinical settings, and it is difficult to teach novice students how to perform acupuncture manipulation techniques skillfully. The Acupuncture Manipulation Education System (AMES) is an open source software system designed to enhance acupuncture manipulation skills using visual feedback. Using a phantom acupoint and motion sensor, our method for acupuncture manipulation training provides visual feedback regarding the actual movement of the student's acupuncture manipulation in addition to the optimal or intended movement, regardless of whether the manipulation skill is lifting, thrusting, or rotating. Our results show that students could enhance their manipulation skills by training using this method. This video shows the process of manufacturing phantom acupoints and discusses several issues that may require the attention of individuals interested in creating phantom acupoints or operating this system.

The Acupuncture Manipulation Education System (AMES) is an educational system that visualizes the rotating manipulation or lifting/thrusting method of acupuncture treatment. Here, we show an example of waveform raw data of motion and torque amplitude during a 1-Hz rotating manipulation (Figure 1). As shown in Figure 2A, the program concurrently visualizes the actual movement and the intended movement using different color lines, allowing for a visuo-motor learning. In addition, there are various templates for rotating and lifting/thrusting movements according to the symmetry and frequency of different movements (Figure 2B). After the participants complete the acupuncture manipulation, the raw data of the real-time motion are processed to produce an extracted sample motion of each participant&#39;s actual acupuncture manipulation. The sampled motion is used to calculate the error between the intended movement and the actual movement after processing (Figure 3). Upon analysis, the motion patterns of acupuncture manipulation during the complex lifting/thrusting session are improved. The estimated motion pattern regression curves are closer to the motion template in the post-training test compared with the pre-training test (Figure 4A). In addition, there is a significant shape error reduction in the complex lifting/thrusting session following training (Figure 4B).
<img alt="Figure 1" src="/files/ftp_upload/54213/54213fig1.jpg" /> 
Figure 1. Examples of Waveform Raw Data of Motion Amplitude and Torque during a 1 Hz Rotating Manipulation (Left: Human Acupoint, Right: Phantom Acupoint). A concentration of 5% (0.75 g) agarose was used to create phantom acupoints with torque amplitudes similar to those of human acupoints (e.g., the LI4 acupoint). <a href="https://www.jove.com/files/ftp_upload/54213/54213fig1large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 2" src="/files/ftp_upload/54213/54213fig2.jpg" /> 
Figure 2. Overview of the Program. A) A screenshot of the program. Transmitted actual movement from the motion sensor is displayed as the green line, and the template of the intended motion is concurrently overlapped, appearing as the red line. B) Various templates of acupuncture manipulation movement. This educational program for acupuncture supports training for both the rotating and the lifting/thrusting movements of the acupuncture needle. Various templates are provided to learn various frequencies and asymmetric movements. <a href="https://www.jove.com/files/ftp_upload/54213/54213fig2large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 3" src="/files/ftp_upload/54213/54213fig3.jpg" /> 
Figure 3. Extraction of the Sample Motion of the Participant through Data Processing and Error Calculations. (a) Raw motion data in a trial, (b) identified sampled motion unit, (c) normalization with resampled of the number of observed data to a specific number (50), (d) normalization with rescaling of the lifting/thrusting amplitude between 0 and 1, and (e) calculating mean squared error between individual motion and template shape. <a href="https://www.jove.com/files/ftp_upload/54213/54213fig3large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 4" src="/files/ftp_upload/54213/54213fig4.jpg" /> 
Figure 4. Data Analysis Before and After the Training. A) Comparison of motion patterns between pre-training and post-training trials. Eight training trials were performed between the pre- and post-training. Single motion units (blue dotted line), the fitted model (red line) through a generalized additive mixed model (GAMM), and the template of the intended motion (black line) pre- and post-training are displayed. B) Box and whisker plot of MSE values. The mean square error (MSE) was compared between the pre-training and the post-training trial. It can be seen that this participant showed a significantly lower MSE value in the post-training trial than in the pre-training trial after using this program. <a href="https://www.jove.com/files/ftp_upload/54213/54213fig4large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>

Watch this Scientific Journal Video about Visualizing Motion Patterns in Acupuncture Manipulation at JoVE.com

Visualizing Motion Patterns in Acupuncture Manipulation

Here, we present a protocol for using the Acupuncture Manipulation Education System (AMES) in the training of acupuncture manipulation skills using phantom acupoints.

Acupuncture manipulation varies widely among practitioners in clinical settings, and it is difficult to teach novice students how to perform acupuncture ...

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8.6K Views.  Kyung Hee University. Here, we present a protocol for using the Acupuncture Manipulation Education System (AMES) in the training of acupuncture manipulation skills using phantom acupoints.

Video: Visualizing Motion Patterns in Acupuncture Manipulation

Mindfulness in Motion (MIM): An Onsite Mindfulness Based Intervention (MBI) for Chronically High Stress Work Environments to Increase Resiliency and Work Engagement

A pragmatic mindfulness intervention to benefit personnel working in chronically high-stress environments, delivered onsite during the workday, is timely and valuable to employee and employer alike. Mindfulness in Motion (MIM) is a Mindfulness Based Intervention (MBI) offered as a modified, less time intensive method (compared to Mindfulness-Based Stress Reduction), delivered onsite, during work, and intends to enable busy working adults to experience the benefits of mindfulness. It teaches mindful awareness principles, rehearses mindfulness as a group, emphasizes the use of gentle yoga stretches, and utilizes relaxing music in the background of both the group sessions and individual mindfulness practice. MIM is delivered in a group format, for 1 hr/week/8 weeks. CDs and a DVD are provided to facilitate individual practice. The yoga movement is emphasized in the protocol to facilitate a quieting of the mind. The music is included for participants to associate the relaxed state experienced in the group session with their individual practice. To determine the intervention feasibility/efficacy we conducted a randomized wait-list control group in Intensive Care Units (ICUs). ICUs represent a high-stress work environment where personnel experience chronic exposure to catastrophic situations as they care for seriously injured/ill patients. Despite high levels of work-related stress, few interventions have been developed and delivered onsite for such environments. The intervention is delivered on site in the ICU, during work hours, with participants receiving time release to attend sessions. The intervention is well received with 97% retention rate. Work engagement and resiliency increase significantly in the intervention group, compared to the wait-list control group, while participant respiration rates decrease significantly pre-post in 6/8 of the weekly sessions. Participants value institutional support, relaxing music, and the instructor as pivotal to program success. This provides evidence that MIM is feasible, well accepted, and can be effectively implemented in a chronically high-stress work environment.

Mindfulness in Motion MIM: An Onsite Mindfulness Based Intervention MBI for Chronically High Stress Work Environments to Increase Resiliency and Work Engagement

The Mindfulness in Motion (MIM) protocol offers a pragmatic Mindfulness Based Intervention (MBI) on-site, for persons working in chronically high-stress work environments that significantly increases resiliency and work engagement. The protocol has proven feasible, beneficial, and is easily adaptable to other high-stress workplaces.

A pragmatic mindfulness intervention to benefit personnel working in chronically high-stress environments, delivered onsite during the workday, is timely ...

How to Study Placebo Responses in Motion Sickness with a Rotation Chair Paradigm in Healthy Participants

Placebo responses occur in every medical intervention when patients or participants expect to receive an effective treatment to relieve symptoms. However, underlying mechanisms of placebo responses are not fully understood. It has repeatedly been shown that placebo responses are associated with changes in neural activity but for many conditions it is unclear whether they also affect the target organ, such as the stomach in motion sickness. Therefore, we present a methodology for the multivariate assessment of placebo responses by subjective, behavioral and objective measures in motion sickness with a rotation chair paradigm. The physiological correlate of motion sickness is a shift in gastric myoelectrical activity towards tachygastria that can be recorded with electrogastrography. The presented study applied the so-called balanced placebo design (BPD) to investigate the effects of ginger compared to placebo and the effects of expectations by verbal information. However, the study revealed no significant main or interactional effects of ginger (as a drug) or information on outcome measures but showed interactions when sex of participants and experimenters are taken into considerations. We discuss limitations of the presented study and report modifications that were used in subsequent studies demonstrating placebo responses when rotation speed was lowered. In general, future placebo studies have to identify the appropriate target organ for the studied placebo responses and to apply the specific methods to assess the physiological correlates.

An experimental rotation chair paradigm is used to investigate whether a placebo intervention on motion sickness affects subjective outcome measures only or also affects behavioral and objective measures in a balanced placebo design.

Placebo responses occur in every medical intervention when patients or participants expect to receive an effective treatment to relieve symptoms. However, ...

Multifunctional Setup for Studying Human Motor Control Using Transcranial Magnetic Stimulation, Electromyography, Motion Capture, and Virtual Reality

The study of neuromuscular control of movement in humans is accomplished with numerous technologies. Non-invasive methods for investigating neuromuscular function include transcranial magnetic stimulation, electromyography, and three-dimensional motion capture. The advent of readily available and cost-effective virtual reality solutions has expanded the capabilities of researchers in recreating &#8220;real-world&#8221; environments and movements in a laboratory setting. Naturalistic movement analysis will not only garner a greater understanding of motor control in healthy individuals, but also permit the design of experiments and rehabilitation strategies that target specific motor impairments (e.g. stroke). The combined use of these tools will lead to increasingly deeper understanding of neural mechanisms of motor control. A key requirement when combining these data acquisition systems is fine temporal correspondence between the various data streams. This protocol describes a multifunctional system&#8217;s overall connectivity, intersystem signaling, and the temporal synchronization of recorded data. Synchronization of the component systems is primarily accomplished through the use of a customizable circuit, readily made with off the shelf components and minimal electronics assembly skills.

Transcranial magnetic stimulation, electromyography, and 3D motion capture are commonly used non-invasive techniques for investigating neuromuscular function in humans. In this paper, we describe a protocol that synchronously samples data generated by all three of these tools along with the unique addition of virtual reality stimulus presentation and feedback.

The study of neuromuscular control of movement in humans is accomplished with numerous technologies. Non-invasive methods for investigating neuromuscular ...

Substantiating Appropriate Motion Capture Techniques for the Assessment of Nordic Walking Gait and Posture in Older Adults

Nordic walking (NW) has become a safe and simple form of exercise in recent years, and in studying this gait pattern, various data collection techniques have been employed, each with positives and negatives. The aim was to determine the effect of NW on older adult gait and posture and to determine optimal use of different data collection systems in both short and long duration analysis. Gait and posture during NW and normal walking were assessed in 17 healthy older adults (age: 69 &#177; 7.3). Participants performed two trials of 6 Minute Walk Tests (6MWT) (1 with poles (WP) and 1 without poles (NP)) and 6 trials of a 5m walk (3 WP and 3 NP). Motion was recorded using two systems, a 6-sensor accelerometry system and an 8-camera 3-dimensional motion capture system, in order to quantify spatial-temporal, kinematic, and kinetic parameters.
With both systems, participants demonstrated increased stride length and double support and decreased gait speed and cadence WP compared to NP (p &#60;0.05). Also, with motion capture, larger single support time was found WP (p &#60;0.05). With 3-D capture, smaller hip power generation and moments of force were found at heel contact and pre-swing as well as smaller knee power absorption at heel contact, pre-swing, and terminal swing WP compared to NP, when assessed over one cycle (p &#60;0.05). Also, WP yielded smaller moments of force at heel contact and terminal swing along with larger moments at mid-stance of a gait cycle (p &#60;0.05). No changes were found for posture.
NW seems appropriate for promoting a normal gait pattern in older adults. Three-dimensional motion capture should primarily be used during short duration gait analysis (i.e. single gait cycle), while accelerometry systems should be primarily employed in instances requiring longer duration analysis such as during the 6MWT.

The aim was to substantiate optimal use of data collection techniques for Nordic walking gait and posture analysis. Three-dimensional motion capture should be used during short duration analysis (i.e. single gait cycle), while accelerometry should be employed for longer duration analysis (i.e. repeated cycles) like a 6 Minute Walk Test.

Nordic walking (NW) has become a safe and simple form of exercise in recent years, and in studying this gait pattern, various data collection techniques ...

Visualizing Visual Adaptation

Many techniques have been developed to visualize how an image would appear to an individual with a different visual sensitivity: e.g., because of optical or age differences, or a color deficiency or disease. This protocol describes a technique for incorporating sensory adaptation into the simulations. The protocol is illustrated with the example of color vision, but is generally applicable to any form of visual adaptation. The protocol uses a simple model of human color vision based on standard and plausible assumptions about the retinal and cortical mechanisms encoding color and how these adjust their sensitivity to both the average color and range of color in the prevailing stimulus. The gains of the mechanisms are adapted so that their mean response under one context is equated for a different context. The simulations help reveal the theoretical limits of adaptation and generate &#34;adapted images&#34; that are optimally matched to a specific environment or observer. They also provide a common metric for exploring the effects of adaptation within different observers or different environments. Characterizing visual perception and performance with these images provides a novel tool for studying the functions and consequences of long-term adaptation in vision or other sensory systems.

This article describes a novel method for simulating and studying adaptation in the visual system.

Many techniques have been developed to visualize how an image would appear to an individual with a different visual sensitivity: e.g., because of optical ...

Manipulation of Epileptiform Electrocorticograms (ECoGs) and Sleep in Rats and Mice by Acupuncture

Ancient Chinese literature has documented that acupuncture possesses efficient therapeutic effects on epilepsy and insomnia. There is, however, little research to reveal the possible mechanisms behind these effects. To investigate the effect of acupuncture on epilepsy and sleep, several issues need to be addressed. The first is to identify the acupoints, which correspond between humans, rats, and mice. Furthermore, the depth of insertion of the acupuncture needle, the degree of needle twist in manual needle acupuncture, and the stimulation parameters for electroacupuncture (EA) need to be determined. To evaluate the effects of acupuncture on epilepsy and sleep, a feasible model of epilepsy in rodents is required. We administer pilocarpine into the left central nucleus of the amygdala (CeA) to simulate focal temporal lobe epilepsy (TLE) in rats. Intraperitoneal (IP) injection of pilocarpine induces generalized epilepsy and status epilepticus (SE) in rats. Five IP injections of pentylenetetrazol (PTZ) with a one-day interval between each injection successfully induces spontaneous generalized epilepsy in mice. Recordings of electrocorticograms (ECoGs), electromyograms (EMGs), brain temperature, and locomotor activity are used for sleep analysis in rats, while ECoGs, EMGs, and locomotor activity are employed for sleep analysis in mice. ECoG electrodes are implanted into the frontal, parietal, and contralateral occipital cortices, and a thermistor is implanted above the cerebral cortex by stereotactic surgery. EMG electrodes are implanted into the neck muscles, and an infrared detector determines locomotor activity. The criteria for categorizing vigilance stages, including wakefulness, rapid eye movement (REM) sleep, and non-REM (NREM) sleep are based on information from ECoGs, EMGs, brain temperature, and locomotor activity. Detailed classification criteria are stated in the text.

Manipulation of Epileptiform Electrocorticograms ECoGs and Sleep in Rats and Mice by Acupuncture

This paper demonstrates the performance of acupuncture, epilepsy models, and the analysis of sleep in rodents. The acupuncture procedure and the identification of acupoints are described. Pilocarpine or pentylenetetrazol (PTZ) is used to induce epilepsy. Electrocorticogram (ECoG), electromyogram (EMG), brain temperature, and locomotor activity recordings are employed for sleep analysis.

Ancient Chinese literature has documented that acupuncture possesses efficient therapeutic effects on epilepsy and insomnia. There is, however, little ...

Measuring the Kinematics of Daily Living Movements with Motion Capture Systems in Virtual Reality

The inability to complete instrumental activities of daily living (IADL) is a precursor to various neuropsychological diseases. Questionnaire-based assessments of IADL are easy to use but prone to subjective bias. Here, we describe a novel virtual reality (VR) test to assess two complex IADL tasks: handling financial transactions and using public transportation. While a participant performs the tasks in a VR setting, a motion capture system traces the position and orientation of the dominant hand and head in a three-dimensional Cartesian coordinate system. Kinematic raw data are collected and converted into &#39;kinematic performance measures,&#39; i.e., motion trajectory, moving distance, and time to completion. Motion trajectory is the path of a particular body part (e.g., dominant hand or head) in space. Moving distance refers to the total distance of the trajectory, and time to completion is how long it took to complete an IADL task. These kinematic measures could discriminate patients with cognitive impairment from healthy controls. The development of this kinematic measuring protocol allows detection of early IADL-related cognitive impairments.

We designed a virtual reality test to assess instrumental activities of daily living (IADL) with a motion capture system. We propose a detailed kinematic analysis to interpret the participant&#39;s various movements, including trajectory, moving distance, and time to completion to evaluate IADL capabilities.

The inability to complete instrumental activities of daily living (IADL) is a precursor to various neuropsychological diseases. Questionnaire-based ...

Assessing the Autonomic and Behavioral Effects of Passive Motion in Rats using Elevator Vertical Motion and Ferris-Wheel Rotation

The overall goal of this study is to assess the autonomic and behavioral effects of passive motion in rodents using the elevator vertical motion and Ferris-wheel rotation devices. These assays can help confirm the integrity and normal functioning of the autonomic nervous system. They are coupled to quantitative measures based on defecation counting, open-field examination, and balance beam crossing. The advantages of these assays are their simplicity, reproducibility, and quantitative behavioral measures. The limitations of these assays are that the autonomic reactions could be epiphenomena of non-vestibular disorders and that a functioning vestibular system is required. Examination of disorders such as motion sickness will be greatly aided by the detailed procedures of these assays.

Protocols are presented to assess the autonomic and behavioral effects of passive motion in rodents using elevator vertical motion and Ferris-wheel rotation.

The overall goal of this study is to assess the autonomic and behavioral effects of passive motion in rodents using the elevator vertical motion and ...

Analysis of Learning and Memory Ability in an Alzheimer's Disease Mouse Model using the Morris Water Maze

A Morris water maze (MWM) experiment forces experimental animals to swim and learn to find a platform hidden in the water. It is widely used in scientific research to assess the learning and memory of animals. Due to the extensive use of the MWM test, visual experimental protocols are essential for researchers. This manuscript uses the latest studies to introduce the protocol of the MWM test. Alzheimer&#8217; Disease (AD) is characterized by a progressive loss of memory and cognitive function. An alternative and complementary treatment used for AD is Manual Acupuncture (MA). To assess the learning and memory ability of AD model mice, the MWM test was conducted. The visible platform trial, hidden platform trial, probe trial, and reversal trial of MWM were used to evaluate spatial learning and memory ability. In the visible platform trial, the swimming speed and escape latency of mice in different groups was not significantly different. In the hidden platform and reversal trials, the AD group showed a long escape latency. The escape latency decreased significantly after the MA treatment. Low platform crossover number and the proportion of time in the SW quadrant in the probe trial increased after the MA treatment (p &#60; 0.05 or p &#60; 0.01). The results of the MWM tests suggest that MA can effectively improve the spatial learning and memory abilities of AD model mice. Rigorous experimental operations provided assurance of the reliability of the results.

Herein, a protocol to conduct the Morris water maze tests to evaluate the ability of learning and memory of Alzheimer&#8217;s Disease model mice and to assess the effect of manual acupuncture for treating them is described.

A Morris water maze (MWM) experiment forces experimental animals to swim and learn to find a platform hidden in the water. It is widely used in scientific ...

Investigation into Deep Breathing through Measurement of Ventilatory Parameters and Observation of Breathing Patterns

In this protocol, two deep breathing patterns were shown to 15 participants to determine an easy yet effective method of breathing exercise for future application in a clinical setting. The women in their twenties were seated comfortably in a chair with back support. They were fitted with an airtight mask connected to a&#160;gas analyzer. Three electrodes were placed on the chest connected to a wireless transmitter for relaying to the electrocardiograph. They executed a 5 min rest phase, followed by 5 min of deep breathing with a natural breathing pattern, terminating with a 5 min rest phase. This was followed by a 10 min intermission before commencing the second instruction phase of substituting the natural breathing pattern with the diaphragmatic breathing pattern. Simultaneously, the following took place: a) continuous collection, measurement and analysis of the expired gas to assess the ventilatory parameters on a breath-by-breath basis; b) measurement of the heart rate by an electrocardiograph; and c) videotaping of the participant&#8217;s thoracoabdominal movement from a lateral aspect. From the video capture, the investigators carried out visual observation of the fast-forward motion-images followed by classification of the breathing patterns, confirming that the participants had carried out the method of deep breathing as instructed. The amount of oxygen uptake revealed that, during deep breathing, the work of breathing decreased. The results from the expired minute ventilation, respiration rate and tidal volume confirmed increased ventilatory efficiency for deep breathing with the natural breathing pattern compared to that with the diaphragmatic breathing pattern. This protocol suggests a suitable method of instruction for assessing deep breathing exercises on the basis of oxygen consumption, ventilatory parameters, and chest wall excursion.

Here, we present a protocol to assess two deep breathing patterns of natural and diaphragmatic breathing for their effectiveness and ease of execution. Fifteen participants were selected, utilizing an electrocardiograph and expired gas analyzer for measurement of the ventilatory parameters, together with visual assessment by video capture of thoracoabdominal movement.

In this protocol, two deep breathing patterns were shown to 15 participants to determine an easy yet effective method of breathing exercise for future ...