This study is part of the project NODES which has received funding from the MUR - M4C2 1.5 of PNRR with grant agreement no. ECS00000036.

Before data collection, all patients included were provided with an informed consent form to review and sign, ensuring their understanding and agreement to participate in the study. Researchers granted the patient&#39;s privacy throughout all the study procedures, and they maintained compliance with ethical principles outlined in the Declaration of Helsinki32.
1. Organization of CameraLab setting
<ol>
	<li>Turn on the touch screen of the interactive monitor, the central control hub of the video analysis system (see Figure 1 for further details), and push the power button.</li>
	<li>Position of the four high-velocity cameras according to the distances indicated in Figure 2.</li>
	<li>Connect the four cameras to the interactive monitor: insert the network cables into their corresponding doors.</li>
	<li>Start the camera interface for viewing images in real-time. Click on the icon Video Analysis System to open the software.</li>
</ol>
2. Initial patient interview
<ol>
	<li>Provide the informed consent form for review and signature.</li>
	<li>Collect and note down agraphic and anthropometric data.</li>
	<li>Position the patient in the center of the video analysis system with four high-velocity cameras at 3 m each from the patient according to the distances indicated in Figure 2.</li>
</ol>
3. Assessment with functional movement screen (FMS) in accordance with current guidelines33,34
<ol>
	<li>Ask the patient to perform a warm-up.
	<ol>
		<li>Low-intensity cycling: Ask the patient to pedal while maintaining the seat height to allow for easy achievement of 0&#176; knee extension. Adjust the resistance to prevent fatigue throughout the 12 min duration.</li>
		<li>Lower limb stretching exercise: Ask the patient to lie in a supine position. Ask the patient to hug one thigh at a time to his chest with his hands clasped behind it. Then, perform 3 sets of 10 repetitions of knee extension on each leg.</li>
		<li>Core activation: Instruct the patient to start from a supine position with hips flexed and feet flat on the ground. Ask the patient to perform 15 hip extensions, reaching the bridge position for 3 sets, with a 15-s rest between sets.</li>
	</ol>
	</li>
	<li>Administer to the patient the FMS Test (cameras off), including deep squats, Hurdle steps, Inline lunges, shoulder mobility, active straight leg raises, trunk stability push-ups, and rotatory stability, in accordance with the FMS guidelines33,34.</li>
</ol>
4. System acquisition
<ol>
	<li>Ask the patient to perform two different repetitions of the movements to gain confidence with the motor pattern of the test. Subsequently, ask the patient to perform 2 trials recorded with the innovative assessment tool. Include the movements mentioned below.
	<ol>
		<li>Front squat, no hand: Ask the patient to assume the starting position by positioning the feet approximately shoulder width apart and aligned on the sagittal plane. Have the patient position arms extended forward with a bar resting on the arms. Then, ask the patient to descend as far as possible into a squat position while keeping the torso upright, keeping the heels and bar in place. Hold the downward position for a count of one, then return to the starting position.</li>
		<li>Lower Body Motor Control Screen (LB-MCS) (for each side): Ask the patient to assume the position, arms stretched forward and standing only on the foot of the side being evaluated, the contralateral lower limb is kept with the knee extended and with the foot not resting on the ground. Then, ask the patient to descend as far as possible into a squat position while keeping the torso upright and the foot resting in position. Hold the position down for a count of one, then return to the starting position.</li>
	</ol>
	</li>
	<li>Press the Start button to start recording. The system starts data acquisition until the end of the exercise.</li>
	<li>Press Stop to stop the data acquisition. The system provided a video file stored in a specific folder.</li>
</ol>
5. Data analysis on interactive monitor
<ol>
	<li>Create the patient&#39;s folder on the interactive monitor with the recorded videos: right-click on the desktop to open the Desktop menu, choose New Folder, type the name of the new folder, and press Return.</li>
	<li>Open the video selected (Front squat no hand and LB-MCS for right side and LB-MCS for left side).
	<ol>
		<li>For front squat, no hand trial, follow steps 5.2.1.1-5.2.1.8.
		<ol>
			<li>Select the frame from the video generated in lateral views at the point of maximum descent.</li>
			<li>Start video annotation tool for image analysis by double clicking on the Own icon.</li>
			<li>Insert the frame into the report.</li>
			<li>Select the joints in the lateral frame (shoulder, hip, knee, and ankle) by touching the interactive monitor and drawing the skeleton of the limb and trunk axis (see Figure 4). The video annotation tool automatically gives target angles (hip and knee).</li>
			<li>Give scores based on the cut-off (see Table 1) in steps 5.2.1.6-5.2.1.7.</li>
			<li>Lower limb control score: Give a score of 0 if the hip-foot axis does not match the patella with the knee residing medial to the hip-foot axis, give a score of 1 if the hip-foot axis does match the patella laterally, and give a score of 2 if the hip-foot axis does match the patella medially.</li>
			<li>Motor strategy score. Give a score of 0 if active knee flexion &#62; 110&#176; and hip flexion &#62; 100&#176;, give a score of 1 if active knee flexion &#62; 110&#176; or hip flexion &#62; 100&#176;, and give a score of 2 is given if active knee flexion &#8804; 110&#176; and hip flexion &#8804; 100&#176;.</li>
			<li>Add the lower limb control score and the motor strategy score to calculate the total row score.</li>
		</ol>
		</li>
		<li>For LB-MCS for right side and left side, follow steps 5.2.2.1-5.2.2.11.
		<ol>
			<li>Select the frame from the video generated in both lateral and frontal views at the point of maximum descent.</li>
			<li>Start video annotation tool for image analysis by double clicking on the Own icon.</li>
			<li>Insert the frame into the report.</li>
			<li>Select the joint in the frontal frame (trunk axis, hips, and ankle of the side on the floor) by touching the interactive monitor and drawing the skeleton of the limb and trunk axis (see Figure 5).</li>
			<li>Select the joint in the lateral frame (shoulder, hip, knee, and ankle) by touching the interactive monitor and drawing the skeleton of the limb and trunk axis (see Figure 5). The video annotation tool automatically gives target angles (hip and knee).</li>
			<li>Give scores based on the cut-off (see Table 1) in steps 5.2.2.8-5.2.2.10.</li>
			<li>Lower limb control score: Give a score of 0 if the hip-foot axis does not match the patella with the knee residing medial to the hip-foot axis, give a score of 1 if the hip-foot axis does match the patella laterally, and give a score of 2 if the hip-foot axis does match the patella medially.</li>
			<li>Pelvic tilt score: Give a score of 0 if the pelvic angle does tilt &#8805; 15&#176; compared to the horizontal plane, give a score of 1 if the pelvic angle does tilt between 10&#176;-15&#176; compared to the horizontal plane, and give a score of 2 if the pelvic angle does tilt &#8804; 10&#176; compared to the horizontal plane.</li>
			<li>Trunk control score: Give a score of 0 if the deviation of the column segment from the perpendicular plane &#8805; 15&#176;, give a score of 1 if the deviation of the column segment from the perpendicular plane is between 10&#176;-15&#176;, and give a score of 2 if the deviation of the column segment from the perpendicular plane &#8804; 10&#176;.</li>
			<li>Motor strategy score. Give a score of 0 if active knee flexion &#62; 110&#176; and hip flexion &#62; 100&#176;, give a score of 1 if active knee flexion &#62; 110&#176; or hip flexion &#62; 100&#176;, and give a score of 2 if active knee flexion &#8804; 110&#176; and hip flexion &#8804; 100&#176;.</li>
			<li>Calculate the total row score, which is the sum of the lower limb control score, pelvic tilt score, trunk control score, and motor strategy Score.</li>
		</ol>
		</li>
	</ol>
	</li>
	<li>Process indications and return the test results to the patient.</li>
</ol>
Figure 1 shows the schematic representation of the protocol.
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/67006/67006fig01.jpg" /> 
Figure 1: Schematic representation of the protocol. This figure illustrates the step-by-step process of the study protocol. <a href="https://www.jove.com/files/ftp_upload/67006/67006fig01large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>

Innovative Video-Based Tool for Precision Assessment and Rehabilitation of LBP

The authors declare no conflicts of interest.

In this study, we investigated the integration of the CameraLab system into the rehabilitation management of patients with LBP. The findings of this study suggested that this innovative digital solution provides valuable objective data on movement pattern analysis, enhancing the precision and effectiveness of clinical rehabilitation practice in musculoskeletal pain. LBP is a common and complex condition characterized by a multidimensional disability, including biomechanical, psychological, and social determinants 2,8,9,10,11,12. The approach reported in this case series allowed to target several factors characterizing LBP and addressing different domains as reported by the positive results in pain intensity, physical functioning, HR-QoL, and kinesiophobia.
More in detail, the findings of the case reports presented showed a consistent reduction in pain intensity by targeting specific movement patterns and biomechanical dysfunctions identified through the assessment tool. Interestingly, similar results were shown by Marich et al.45 in their study on musculoskeletal pain using a comparable assessment method. In their research, Marich et al.45 reported a potential link between movement patterns and functional limitations in individuals with chronic LBP. These findings highlighted the need for targeted interventions aimed at optimizing movement dysfunctions to reduce pain and improve functional outcomes in individuals with chronic LBP. Improvements in physical functioning and HR-QoL were shown in the three cases, as evidenced by increases in SF-12 PCS and MCS scores. Similarly, the study by Letafatkar et al.46 highlighted the effects of sensorimotor training protocols in improving proprioceptive system function, lumbar movement control, and HR-QoL for patients with chronic nonspecific LBP. The study underlined that a sensorimotor training program with innovative solutions led to consistent improvements in proprioception, lumbar movement control, and Hr-QoL46.
Kinesiophobia, is a common psychological barrier in individuals with LBP, often leading to avoidance behaviors and functional impairment47. The rehabilitation intervention with CameraLab successfully improved the fear of movement by providing objective feedback on movement patterns and biomechanics. By improving confidence in patients&#39; ability to move safely and efficiently, the assessment tool might reduce kinesiophobia and promote active participation in rehabilitation activities. In this context, there has been a growing interest and investment in digital innovation and technological solutions within the field of rehabilitation25,26,48,49,50,51,52. This trend is driven by several factors, including advancements in sensor technology49,50, the increasing availability of portable devices25, and the growing recognition of the potential benefits of integrating digital tools into healthcare practices52. Digital solutions offer the promise of enhancing the delivery of rehabilitation services by providing objective data, improving patient engagement, and facilitating personalized treatment approaches53.
Several conditions might worsen LBP symptoms. In this context, Zaina et al.54 provided a comprehensive overview of the complexity of LBP in patients with and without scoliosis, highlighting that this condition significantly influences both physical and psychological aspects of health. This study highlights how advanced video-based motion analysis technology can accurately capture movement patterns and postural imbalances that contribute to LBP in a patient with scoliosis. This technology offers detailed insights into the biomechanical factors underlying pain that traditional assessment methods may underestimate. By enabling precise and objective assessment of motion, the approach described here provides a valuable tool for clinicians to develop more effective and personalized treatment plans, thereby improving patient outcomes.
Traditional methods of movement assessment, such as observational techniques or subjective clinical evaluations, are related to biases and difficulties in standardization20,27,28. In contrast, digital technologies, such as motion capture systems, inertial sensors, and computer vision algorithms, enable clinicians to capture and analyze movement data with a high degree of accuracy and reliability20. By quantifying movement parameters objectively, the assessment tool has shown the potential to identify biomechanical abnormalities, track progress over time, and tailor interventions to individual patient needs. Moreover, LBP can negatively impact disorders of kinesiological chains during movements, such as squats, through altered movement patterns. One study found that individuals with chronic LBP exhibit greater hip and knee range of motion relative to ankle ROM than those without LBP. These findings suggest that people with LBP overload their hip and knee joints more during squats, which may contribute to their condition55.
Moreover, Frontera et al.56 highlighted the importance of health policy and health services research in improving rehabilitation practices in real-life settings. The ability to accurately analyze and document movement patterns offers a significant advancement in rehabilitation. In support of this, our findings demonstrate that video analysis technology not only provides detailed biomechanical insights but also supports the development of more personalized and effective treatment strategies. This is in line with the study by Frontera et al.56, which aims to integrate research findings into clinical practice to bridge the gap between research and rehabilitation, ultimately strengthening the quality and accessibility of care for patients with LBP. By targeting specific movement patterns, CameraLab-guided interventions might enhance functional outcomes but might also have positive implications in the long-term, reducing recurrence rates of LBP and improving overall HR-QoL.
Besides these positive considerations, this study is not free from limitations. While CameraLab offers significant advantages in movement assessment, a specific initial setup and calibration of the system is necessary before rehabilitation starts. Moreover, the findings of the present manuscript are based on a small sample size, which aligns with the methodological framework of the case series. Although this approach allows for an in-depth analysis of each case, caution should be posed on the generalizability of the study results. Moreover, different cases with heterogeneous causes of LBP were assessed in this case series. However, this study might offer preliminary insights about an innovative technology that might be further studied in larger cohort studies with homogeneous samples. Lastly, the cost and availability of the technology may limit its widespread adoption in clinical settings. On the other hand, it should be noted that this technology might be one of the most inexpensive and cost-effective in rehabilitation settings compared to similar movement pattern analysis systems. In accordance with other similar movement pattern analysis systems, there might be a risk of bias in inter-operator repeatability, landmark identification, or selection of the maximum descent point57. To address these limitations, we ensure that all personnel involved in the technique are adequately trained and experienced. Future research should aim to validate the effectiveness of this assessment tool further in larger patient populations and compare its outcomes with traditional rehabilitation approaches.
In conclusion, our study suggests that the CameraLab system could have a role in the rehabilitation management of patients with LBP. By providing objective data on movement patterns and facilitating targeted interventions, the assessment tool has the potential to improve outcomes and implement clinical practice. Further research is needed to fully understand its implications and optimize its integration into routine care.

Low back pain (LBP) is a complex and prevalent musculoskeletal condition severely affecting physical functioning and Health-related Quality of Life (HR-QoL)1,2. LBP is a growing global public health problem, consistently ranking as a major cause of disability and limitations in function in daily life. According to the Global Burden of Disease (GBD) 2021 study, the prevalence of LBP is increasing, estimating nearly 619 million people worldwide in 2020. The study highlights that LBP represents a substantial portion of years lived with disability, with prevalence observed primarily in individuals aged 45 to 64 years3. Due to the aging of the population, its prevalence is expected to rise in the future decades while growing research is currently focusing on innovative approaches to improve the management of this condition4,5,6. The 2019 GBD analysis further confirms these findings, indicating that LBP remains a prevalent condition in several regions of the world, with a strong impact on HR-QoL7. Projections suggest that without effective intervention, the prevalence and burden of LBP will continue to grow, necessitating comprehensive global approach for prevention and management3,7.
While the optimal therapeutic strategy is typically based on the precise pathophysiology of LBP, different therapeutic approaches have been suggested to address the multifaceted management of this disabling condition8,9,10,11,12. The WHO Rehabilitation Guide provides a comprehensive framework for global rehabilitation practices, emphasizing their critical role in managing chronic LBP13. These guidelines underline the need for an integrated and personalized approach to the patient, addressing the biopsychosocial aspects of chronic pain management. This involves a coordinated effort among multidisciplinary healthcare professionals to provide non-surgical interventions based on scientific evidence and tailored to the individual needs of each patient. A comprehensive approach is essential to reduce variability in care, improve quality of life, and improve overall outcomes for those with LBP. The guidance also highlights the importance of accessibility and equity in rehabilitation services, ensuring that interventions are feasible and acceptable in different contexts, thus supporting universal health coverage and improving global public health13.
In this context, it is interesting to notice that patients with LBP are frequently characterized by crucial biomechanical changes that should be precisely addressed for an effective rehabilitation approach14,15,16. These alterations might include deviations in spinal alignment17, muscle imbalances18, joint stiffness or hypermobility19, aberrant movement patterns20, asymmetries in muscle activation12, and compromised neuromuscular control21,22. As a result, identifying and addressing these specific biomechanical changes are crucial for tailoring rehabilitation programs to target the underlying mechanisms contributing to LBP and facilitating optimal recovery outcomes23,24.
In this context, assessment methods for movement patterns might include motion inertial sensors, force plates, standardized observational tests, and qualitative observation criteria25,26,27,28,29,30. Motion inertial sensors, while offering portability and ease of use, have limitations primarily related to data accuracy and reliability. Their measurements can be affected by sensor drift, orientation errors, and signal noise, leading to inaccuracies in movement analysis29. Additionally, motion inertial sensors may have limited capacity to assess complex movement patterns accurately, especially in dynamic activities, including rapid movements or changes in direction20. Force plates, although valuable for quantifying ground reaction forces and kinetics during movement, have limitations regarding their spatial and temporal resolution30. They may not provide detailed information on movement quality or kinematic patterns and are primarily focused on assessing forces exerted on the ground rather than the movement patterns30. On the other hand, qualitative observation criteria, while useful for capturing qualitative aspects of movement, lack standardization and may vary between observers lacking in standardization and reliably27,28. Interestingly, the recent review by van Dijk et al.20 underlined that only specific domains of movement quality (such as range of motion (ROM) and gate analysis) were effectively assessed by objective methods in patients with LBP and significantly differed by the general population.
As a result, objective and quantifiable methods for movement assessment are lacking, and several challenges still affect both the intervention and monitoring processes for patients with LBP20. Moreover, the barriers to the effective integration of these tools into routine clinical practice further improve the challenges associated with effectively addressing LBP conditions.
Taken together, this evidence suggests that there remains a substantial gap in knowledge regarding digital instruments designed for evaluating movement quality during functional exercises. Furthermore, the implications of integrating precise movement assessment analysis into the rehabilitation process have yet to be fully characterized.
Therefore, here we present a case series introducing CameraLab system, an innovative digital solution that provides objective data about movement pattern analysis in patients with LBP. In some cases, instrumental examinations with X-Rays have little indication regarding rehabilitation implications in patients with LBP. In this case, the functional assessment with motion capture could fill this gap and provide answers to rehabilitation needs31. In this case series, we showed the effective integration of the innovative assessment tool into the comprehensive rehabilitation management of patients with LBP, underlining the functional and objective data achieved with this technological solution in order to enhance the precision and effectiveness of clinical rehabilitation practice in people with LBP.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>ApowerREC</td>
			<td>Apowersoft</td>
			<td>https://www.apowersoft.com/record-all-screen</td>
			<td>This screen recorder serves to capture and annotate screen activity during analysis sessions</td>
		</tr>
		<tr>
			<td>Functional Movement Screen kit</td>
			<td>Functional Movement Systems Inc., Chatham, VA</td>
			<td>N/A</td>
			<td>Funtional Movement Screen kit consisting of a two-inch by six-inch board, one four-foot-long dowel, two short dowels, and an elastic cord, is used to administer the FMS test.</td>
		</tr>
		<tr>
			<td>Hikvision Cameras IP POE DOME</td>
			<td>Hikvision</td>
			<td>DS-2CD1623G0-IZ</td>
			<td>The cameras are equipped to record precise motion sequences and to capture dynamic movements with exceptional speed and detail.</td>
		</tr>
		<tr>
			<td>Kinovea</td>
			<td>Kinovea</td>
			<td>Version 0.9.5</td>
			<td>Kinovea is a video annotation tool designed for sport analysis. It features utilities to capture, slow down, compare, annotate and measure motion in videos.</td>
		</tr>
		<tr>
			<td>Sharp Big Pad (PN-85 TH1)</td>
			<td>Sharp Corporation</td>
			<td>PN-85 TH1</td>
			<td>The PN-85TH1 interactive BIG PAD monitor combines &#34;4K reading&#34; and the &#34;Pen-on-Paper&#34; user experience with the high precision of InGlass touch technology. Includes whiteboard and wireless capabilities to further enhance the customer experience</td>
		</tr>
		<tr>
			<td>Synology Surveillance Station&#160;</td>
			<td>Synology</td>
			<td>N/A</td>
			<td>Robust and versatile Video Management System (VMS) designed to turn Synology Network Attached Storage (NAS) devices into centralized surveillance solutions</td>
		</tr>
	</tbody>
</table>

biomechanical changes related to low back pain: an innovative tool for movement pattern assessment and treatment evaluation in rehabilitation

Low back pain (LBP) is a highly prevalent disorder frequently related to biomechanical alterations. Movement pattern assessments have a role in the rehabilitation management of patients with LBP; however, a precise assessment is challenging in routine clinical settings. Thus, this study aims to assess the biomechanical alterations related to LBP through the development and application of an innovative assessment tool named CameraLab. Patients with LBP were assessed through a video analysis system. The movement pattern assessment tool includes a touchscreen interface and four high-velocity cameras, enabling real-time data acquisition during movement assessments. The cameras capture dynamic movements, facilitating a thorough examination of motor function. A video analysis software application is employed for precise angle assessments and joint tracking. Three patients with LBP were assessed, demonstrating positive results in pain intensity, functional independence, and overall well-being. The integration of advanced technology highlighted the movement pattern alterations and contributed to tailored rehabilitation strategies. The study offers a paradigm shift toward precision rehabilitation. This innovative approach provides valuable insights into the biomechanical changes related to LBP, fostering a deeper understanding for clinicians and paving the way for effective personalized interventions in the management of LBP.

Biomechanical Changes Related to Low Back Pain: An Innovative Tool for Movement Pattern Assessment and Treatment Evaluation in Rehabilitation

This study shows the role of an innovative tool for assessing and treating biomechanical alterations in low back pain (LBP) patients. Three LBP patients demonstrated improved pain intensity and functional independence post-assessment. The technology aids in tailored rehabilitation strategies, offering insights into LBP biomechanics for personalized interventions.

Low back pain (LBP) is a highly prevalent disorder frequently related to biomechanical alterations. Movement pattern assessments have a role in the ...

biomechanical-changes-related-to-low-back-pain-an-innovative-tool-for

Research

JoVE Journal

Medicine

327 Views.  the University of Eastern Piedmont "A. Avogadro". This study shows the role of an innovative tool for assessing and treating biomechanical alterations in low back pain (LBP) patients. Three LBP patients demonstrated improved pain intensity and functional independence post-assessment. The technology aids in tailored rehabilitation strategies, offering insights into LBP biomechanics for personalized interventions.

Video: Biomechanical Changes Related to Low Back Pain: An Innovative Tool for Movement Pattern Assessment and Treatment Evaluation in Rehabilitation

The Measurement and Treatment of Suppression in Amblyopia

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current estimates put the prevalence of amblyopia at approximately 1-3%1-3, the majority of cases being monocular2. Amblyopia is most frequently caused by ocular misalignment (strabismus), blur induced by unequal refractive error (anisometropia), and in some cases by form deprivation.
Although amblyopia is initially caused by abnormal visual input in infancy, once established, the visual deficit often remains when normal visual input has been restored using surgery and/or refractive correction. This is because amblyopia is the result of abnormal visual cortex development rather than a problem with the amblyopic eye itself4,5 . Amblyopia is characterized by both monocular and binocular deficits6,7 which include impaired visual acuity and poor or absent stereopsis respectively. The visual dysfunction in amblyopia is often associated with a strong suppression of the inputs from the amblyopic eye under binocular viewing conditions8. Recent work has indicated that suppression may play a central role in both the monocular and binocular deficits associated with amblyopia9,10 .
Current clinical tests for suppression tend to verify the presence or absence of suppression rather than giving a quantitative measurement of the degree of suppression. Here we describe a technique for measuring amblyopic suppression with a compact, portable device11,12 . The device consists of a laptop computer connected to a pair of virtual reality goggles. The novelty of the technique lies in the way we present visual stimuli to measure suppression. Stimuli are shown to the amblyopic eye at high contrast while the contrast of the stimuli shown to the non-amblyopic eye are varied. Patients perform a simple signal/noise task that allows for a precise measurement of the strength of excitatory binocular interactions. The contrast offset at which neither eye has a performance advantage is a measure of the "balance point" and is a direct measure of suppression. This technique has been validated psychophysically both in control13,14 and patient6,9,11 populations.
In addition to measuring suppression this technique also forms the basis of a novel form of treatment to decrease suppression over time and improve binocular and often monocular function in adult patients with amblyopia12,15,16 . This new treatment approach can be deployed either on the goggle system described above or on a specially modified iPod touch device15.

Amblyopia is a developmental disorder of the visual cortex that is often accompanied by strong suppression of one eye. We present a new technique for measuring and treating interocular suppression in patients with amblyopia that can be deployed using virtual reality goggles or a portable iPod Touch device.

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current ...

The Multiple Sclerosis Performance Test (MSPT): An iPad-Based Disability Assessment Tool

Precise measurement of neurological and neuropsychological impairment and disability in multiple sclerosis is challenging. We report a new test, the Multiple Sclerosis Performance Test (MSPT), which represents a new approach to quantifying MS related disability. The MSPT takes advantage of advances in computer technology, information technology, biomechanics, and clinical measurement science. The resulting MSPT represents a computer-based platform for precise, valid measurement of MS severity. Based on, but extending the Multiple Sclerosis Functional Composite (MSFC), the MSPT provides precise, quantitative data on walking speed, balance, manual dexterity, visual function, and cognitive processing speed. The MSPT was tested by 51 MS patients and 49 healthy controls (HC). MSPT scores were highly reproducible, correlated strongly with technician-administered test scores, discriminated MS from HC and severe from mild MS, and correlated with patient reported outcomes. Measures of reliability, sensitivity, and clinical meaning for MSPT scores were favorable compared with technician-based testing. The MSPT is a potentially transformative approach for collecting MS disability outcome data for patient care and research. Because the testing is computer-based, test performance can be analyzed in traditional or novel ways and data can be directly entered into research or clinical databases. The MSPT could be widely disseminated to clinicians in practice settings who are not connected to clinical trial performance sites or who are practicing in rural settings, drastically improving access to clinical trials for clinicians and patients. The MSPT could be adapted to out of clinic settings, like the patient&#8217;s home, thereby providing more meaningful real world data. The MSPT represents a new paradigm for neuroperformance testing. This method could have the same transformative effect on clinical care and research in MS as standardized computer-adapted testing has had in the education field, with clear potential to accelerate progress in clinical care and research.

The Multiple Sclerosis Performance Test MSPT: An iPad-Based Disability Assessment Tool

Precise measurement of neurological and neuropsychological impairment and disability in multiple sclerosis is challenging. We report methodologic details on a new test, the Multiple Sclerosis Performance Test (MSPT). This new approach to the objective of quantification of MS related disability provides a computer-based platform for precise, valid measurement of MS severity.

Precise measurement of neurological and neuropsychological impairment and disability in multiple sclerosis is challenging. We report a new test, the ...

The Monoiodoacetate Model of Osteoarthritis Pain in the Mouse

A major symptom of patients with osteoarthritis (OA) is pain that&#160;is triggered by peripheral as well as central changes within the pain pathways. The current treatments for OA pain such as NSAIDS or opiates are neither sufficiently effective nor devoid of detrimental side effects. Animal models of OA are being developed to improve our understanding of OA-related pain mechanisms and define novel pharmacological targets for therapy. Currently available models of OA in rodents include surgical and chemical interventions into one knee joint. The monoiodoacetate (MIA) model has become a standard for modelling joint disruption in OA in both rats and mice. The model, which is easier to perform in the rat, involves injection of MIA into a knee joint that induces rapid pain-like responses in the ipsilateral limb, the level of which can be controlled by injection of different doses. Intra-articular injection of MIA disrupts chondrocyte glycolysis by inhibiting glyceraldehyde-3-phosphatase dehydrogenase and results in chondrocyte death, neovascularization, subchondral bone necrosis and collapse, as well as inflammation. The morphological changes of the articular cartilage and bone disruption are reflective of some aspects of patient pathology. Along with joint damage, MIA injection induces referred mechanical sensitivity in the ipsilateral hind paw and weight bearing deficits that are measurable and quantifiable. These behavioral changes resemble some of the symptoms reported by the patient population, thereby validating the MIA injection in the knee as a useful and relevant pre-clinical model of OA pain.
The aim of this article is to describe the methodology of intra-articular injections of MIA and the behavioral recordings of the associated development of hypersensitivity with a mind to highlight the necessary steps to give consistent and reliable recordings.

Osteoarthritis (OA), or degenerative joint disease, is a debilitating condition associated with pain that remains only partially controlled by available analgesics. Animal models are being developed to improve our understanding of OA-related pain mechanisms. Here we describe the methodology for the monoiodoacetate model of OA pain in the mouse.

A major symptom of patients with osteoarthritis (OA) is pain that&#160;is triggered by peripheral as well as central changes within the pain pathways. The ...

3D Ultrasound Imaging: Fast and Cost-effective Morphometry of Musculoskeletal Tissue

The developmental goal of 3D ultrasound imaging (3DUS) is to engineer a modality to perform 3D morphological ultrasound analysis of human muscles. 3DUS images are constructed from calibrated freehand 2D B-mode ultrasound images, which are positioned into a voxel array. Ultrasound (US) imaging allows quantification of muscle size, fascicle length, and angle of pennation. These morphological variables are important determinants of muscle force and length range of force exertion. The presented protocol describes an approach to determine volume and fascicle length of m.&#160;vastus lateralis and m.&#160;gastrocnemius medialis. 3DUS facilitates standardization using 3D anatomical references. This approach provides a fast and cost-effective approach for quantifying 3D morphology in skeletal muscles. In healthcare and sports, information on the morphometry of muscles is very valuable in diagnostics and/or follow-up evaluations after treatment or training.

3D ultrasound imaging (3DUS) allows fast and cost-effective morphometry of musculoskeletal tissues. We present a protocol to measure muscle volume and fascicle length using 3DUS.

The developmental goal of 3D ultrasound imaging (3DUS) is to engineer a modality to perform 3D morphological ultrasound analysis of human muscles. 3DUS ...

Regenerative Therapy by Suprachoroidal Cell Autograft in Dry Age-related Macular Degeneration: Preliminary In Vivo Report

This study is aimed at examining whether a suprachoroidal graft of autologous cells can improve best corrected visual acuity (BCVA) and responses to microperimetry (MY) in eyes affected by dry Age-related Macular Degeneration (AMD) over time through the production and secretion of growth factors (GFs) on surrounding tissue. Patients were randomly assigned to each study group. All patients were diagnosed with dry AMD and with BCVA equal to or greater than 1 logarithm of the minimum angle of resolution (logMAR). A suprachoroidal autologous graft by Limoli Retinal Restoration Technique (LRRT) was carried out on group A, which included 11 eyes from 11 patients. The technique was performed by implanting adipocytes, adipose-derived stem cells obtained from the stromal vascular fraction, and platelets from platelet-rich plasma in the suprachoroidal space. Conversely, group B, including 14 eyes of 14 patients, was used as a control group. For each patient, diagnosis was verified by confocal scanning laser ophthalmoscope and spectral domain-optical coherence tomography (SD-OCT). In group A, BCVA improved by 0.581 to 0.504 at 90 days and to 0.376 logMAR at 180 days (+32.20%) postoperatively. Furthermore, MY test increased by 11.44 dB to 12.59 dB at 180 days. The different cell types grafted behind the choroid were able to ensure constant GF secretion in the choroidal flow. Consequently, the results indicate that visual acuity (VA) in the grafted group can increase more than in the control group after six months.

Regenerative Therapy by Suprachoroidal Cell Autograft in Dry Age-related Macular Degeneration: Preliminary In Vivo Report

The goal of this study is to assess whether the suprachoroidal graft of adipose-derived stem cells included in the stromal vascular fraction and platelets derived from platelet-rich plasma by the Limoli Retinal Restoration Technique can improve visual acuity and retinal sensitivity responses in eyes affected by dry age-related macular degeneration.

This study is aimed at examining whether a suprachoroidal graft of autologous cells can improve best corrected visual acuity (BCVA) and responses to ...

Quantitative [18F]-Naf-PET-MRI Analysis for the Evaluation of Dynamic Bone Turnover in a Patient with Facetogenic Low Back Pain

Imaging techniques that reflect dynamic bone turnover may aid in characterizing a wide range of bone pathologies. Bone is a dynamic tissue undergoing continuous remodeling with the competing activity of osteoblasts, which produce the new bone matrix, and osteoclasts, whose function is to eliminate mineralized bone. [18F]-NaF is a positron emission tomography (PET) radiotracer that enables visualization of bone metabolism. [18F]-NaF is chemically absorbed into hydroxyapatite in the bone matrix by osteoblasts and can thus noninvasively detect osteoblastic activity, which is occult to conventional imaging techniques. Kinetic modeling of dynamic [18F]-NaF-PET data provides detailed quantitative measures of bone metabolism. Conventional semi-quantitative PET data, which utilizes standardized uptake values (SUVs) as a measure of radiotracer activity, is referred to as a static technique due to its snapshot of tracer uptake in time.&#160; Kinetic modeling, however, utilizes dynamic image data where tracer levels are continuously acquired providing tracer uptake temporal resolution. From the kinetic modeling of dynamic data, quantitative values like blood flow and metabolic rate (i.e., potentially informative metrics of tracer dynamics) can be extracted, all with respect to the measured activity in the image data. When combined with dual modality PET-MRI, region-specific kinetic data can be correlated with anatomically registered high-resolution structural and pathologic information afforded by MRI. The goal of this methodological manuscript is to outline detailed techniques for performing and analyzing dynamic [18F]-NaF-PET-MRI data. The lumbar facet joint is a common site of degenerative arthritis disease and a common cause for axial low back pain.&#160; Recent studies suggest [18F]-NaF-PET may serve as a useful biomarker of painful facetogenic disease.&#160; The human lumbar facet joint will, therefore, be used as a prototypical region of interest for dynamic [18F]-NaF-PET-MRI analysis in this manuscript.

Quantitative [18F]-Naf-PET-MRI Analysis for the Evaluation of Dynamic Bone Turnover in a Patient with Facetogenic Low Back Pain

Imaging techniques that reflect dynamic bone turnover may aid in characterizing a wide range of bone pathologies. We present detailed methodologies for performing and analyzing dynamic [18F]-NaF-PET-MRI data in a patient with facetogenic low back pain using the lumbar facet joints as a prototypical region of interest.

Imaging techniques that reflect dynamic bone turnover may aid in characterizing a wide range of bone pathologies. Bone is a dynamic tissue undergoing ...

Assessment of the Efficacy of An Osteopathic Treatment in Infants with Biomechanical Impairments to Suckling

Breastfeeding can be challenging for mother-infant dyads experiencing biomechanical suckling difficulties. Although lactation consultants (LCs) all over the world have increased their skills in this field and can provide support to help position the infant at the breast, the impact of their intervention might be limited in the presence of stiff structures in the infants. Here we present a protocol for a randomized controlled trial to assess the efficacy of osteopathic treatment, coupled with lactation consultation, for infants&#39; biomechanical suckling difficulties. It proposes a set-up and a sequence of actions to ensure an optimal context for treatment, as well as a blinding of parents and LCs to the intervention. Data such as the infant&#39;s latch ability measured with the LATCH Assessment Tool, the mother&#39;s nipple pain with a visual analog scale (VAS), and the mother&#39;s perceptions are collected by LCs four times over a 10-day period. Osteopathic lesions are documented by the osteopath, using a standardized assessment grid. Structures of interest are coherent with the anatomical zones involved in latching onto the breast. This protocol also proposes a strategy to document systematically an osteopathic profile of infants with biomechanical suckling difficulties in their first weeks of life. The implementation of this protocol confirms its feasibility for osteopathic assessment and treatment and paves the way for future trials to further explore the efficacy of osteopathic techniques for infants with biomechanical suckling difficulties.

Osteopathy is an emerging field of clinical research. Here we present a protocol to assess the efficacy of an osteopathic intervention coupled with lactation consultation, in infants with biomechanical issues impeding breastfeeding.

Breastfeeding can be challenging for mother-infant dyads experiencing biomechanical suckling difficulties. Although lactation consultants (LCs) all over ...

Standardized Rat Coronary Ring Preparation and Real-Time Recording of Dynamic Tension Changes Along Vessel Diameter

As a key event of cardiovascular system diseases, coronary artery disease (CAD) has been widely regarded as the main culprit of atherosclerosis, myocardial infarction, and angina pectoris, which seriously threaten the life and health of people all over the world. However, how to record the dynamic biomechanical characteristics of isolated blood vessels has long puzzled people. Meanwhile, precise positioning and isolation of coronary arteries to measure in vitro dynamic vascular tension changes have become a trend in CAD drug development. The present protocol describes the macroscopic identification and microscopic separation of rat coronary arteries. The contraction and dilation function of the coronary artery ring along the vessel diameter was monitored using the established multi myograph system. The standardized and programmed protocols of coronary ring tension measurement, from sampling to data acquisition, tremendously improve the repeatability of the experimental data, which ensures the authenticity of vascular tension records after physiological, pathological, and drug intervention.

The present protocol describes the wire myograph technique for measuring vascular reactivity of the rat coronary artery.

As a key event of cardiovascular system diseases, coronary artery disease (CAD) has been widely regarded as the main culprit of atherosclerosis, ...

Muscle Function Obtained with Motion Mode Ultrasound and Surface Electromyography during Core Endurance Exercise

Motion mode (M-mode) ultrasound allows researchers and clinicians to measure the change of muscle thickness across time. Muscle thickness can be measured between fascial borders at a given time point during an exercise. This selected time point produces a one-dimensional image resulting in real-time, live observation of anatomy. Ultrasound used during functional movement can be referred to as dynamic ultrasound; this is feasible and reliable with the use of a linear transducer, elastic belt, and foam block to secure consistent transducer placement. The lateral abdominal wall is commonly investigated using ultrasound due to the overlapping nature of the muscles. Surface electromyography (sEMG) can complement M-mode ultrasound imaging because it measures the electrical representation of muscle activation. There is minimal evidence using M-mode ultrasound and sEMG simultaneously during core exercise. Exercises that challenge the core musculature involve both isometric holds (e.g., side plank), as well as oscillatory extremity movements (e.g., dead bug). In this study, both instruments will be used simultaneously to measure core muscle function during exercise. Ultrasound measurements will be obtained using a linear transducer and ultrasound unit, and sEMG measurements will be acquired from a wireless sEMG system. To make comparisons between participants and exercises, normalization methods using static, exercise starting positions for both instruments will be used. An activation ratio will be used for ultrasound and calculated by dividing the contracted thickness (thickness during a time point of exercise) by the rested (starting position) thickness. Muscle thickness will be measured in centimeters from the superior inferior fascial border to inferior superior fascial border. These methods aim to offer an innovative and practical measurement of muscle function with M-mode ultrasound and sEMG during core endurance exercises.

This protocol uses motion mode ultrasound and surface electromyography simultaneously to measure muscle function of the core. Muscle thickness and activation of the local stabilizers (e.g., transverse abdominis, internal oblique) and global movers (e.g., external oblique) is achievable during specific time points of the side plank and dead bug exercises.

Motion mode (M-mode) ultrasound allows researchers and clinicians to measure the change of muscle thickness across time. Muscle thickness can be measured ...

Improving FSN Therapy in the Rat Model&#58; Minimizing Discomfort and Maximizing Efficiency

Efficacy of Fu's Subcutaneous Needling on Sciatic Nerve Pain: Behavioral and Electrophysiological Changes in a Chronic Constriction Injury Rat Model

Fu&#39;s subcutaneous needling (FSN), an invented acupuncture technique from traditional Chinese medicine, is used worldwide for pain relief. However, the mechanisms of action are still not fully understood. During FSN treatment, the FSN needle is inserted and retained in the subcutaneous tissues for a long duration with a swaying movement. However, challenges arise from maintaining a posture while manipulating FSN in animal models (e.g., rats) for researchers. Uncomfortable treatment can lead to fear and resistance to FSN needles, increasing the risk of injury and may even affect research data. Anesthesia may also affect the study results too. Hence, there is a need for strategies in FSN therapy on animals that minimize injury during the intervention. This study employs a chronic constriction injury model in Sprague-Dawley rats to induce neuropathic pain. This model replicates the pain induced by nerve injury observed in humans through surgical constriction of a peripheral nerve, mimicking the compression or entrapment seen in conditions such as nerve compression syndromes and peripheral neuropathies. We introduce an appropriate manipulation for easily inserting an FSN needle into the subcutaneous layer of the animal&#39;s body, including needle insertion and direction, needle retention, and swaying movement. Minimizing the rat&#39;s discomfort prevents the rat from being tense, which causes the muscle to contract and hinder the entry of the needle and improves the study efficiency.

Author Spotlight: Unveiling the Therapeutic Effects of FSN Treatment &#8211; Bridging Research and Clinical Applications in Neuropathic Pain

We present a protocol for using Fu's subcutaneous needling in a chronic constriction injury model to induce sciatic nerve pain in rats.

Fu&#39;s subcutaneous needling (FSN), an invented acupuncture technique from traditional Chinese medicine, is used worldwide for pain relief. However, the ...