Extending Ultrasound Elastography to Manual Treatment Methods

描述（由申请人提供）：推进手工医学科学的唯一最大障碍是无法测量体内肌肉和软组织；其结果是模糊了对治疗实际作用的直接理解。当手工治疗，甚至一般的生物力学操作，对身体施加负荷时，软组织变形，将力传递给骨骼和关节结构。产生的应变是由内力产生的，与通常的非线性组织特性一致。变形和拉伤携带着身体对治疗反应的重要信息。这些数量可以通过超声（USN）弹性成像技术的适当询问来披露，因此，它们是本研究的重点。该项目将扩展一项有前途的技术的最新进展，以评估简单和临床相关治疗条件下的软组织力学。在过去的三十年里，一个探索手工治疗理论效应的知识体系已经开始出现。每种临床手工治疗方法都假设一组特定的组织是治疗有益效果的接受者。然而，目前还没有一种方法可以直接监测哪些组织变形和应变的相对强度，从而证明临床假设的合理性或优先考虑未来的研究。具体来说，可以根据哪些组织最有可能受到影响的证据，研究治疗如何在不同组织层中机械转导为生物效益。目前的软组织USN弹性成像技术，在静态条件下，将被扩展到量化在连续被动运动（CPM）临床过程和负重姿势中由小幅度运动引起的组织层深度（如皮下、筋膜、最长肌、肌间腱膜和多裂肌）的相对位移和应变（主动和被动）。背部分层层的相对运动，从治疗和任务产生的扰动，将使组织的弹性成像审讯。本研究的结果适用于一些具体的手工处理，并用于理解通过躯干软组织的负载分布的应变效应的生物力学。这些证据将使组织生物标志物的优先级和定量测试基于对治疗的相对反应的证据。以位移和应变为代表的组织反应路径的信息对于从三个方面推进对手工疗法的理解是重要的：1)告知可能产生临床益处的作用机制；2)安全应用边界检测与优化；3)对如何通过重定向治疗以达到特定效果来改善临床结果产生见解。项目简介：手工治疗对一些患有背痛的患者有益，但对哪些组织层受到影响知之甚少。这项研究将有助于确定哪些组织可能被充分刺激，作为治疗临床效果的来源，并优先考虑未来的工作，以了解背部疼痛的机制和改善护理。

DESCRIPTION (provided by applicant): The single greatest obstacle to advancing the science of manual medicine is the inability to measure muscle and soft tissue in vivo; the effect is to obscure direct understanding of what treatments actually do. When manual treatments, and even general biomechanical manoeuvres, apply loads to the body, the soft tissues deform, transmitting force to the bone and joint structures. The strains that arise are generated by internal forces consistent with the often non-linear tissue properties. The deformations and strains carry important information on how the body is responding to treatment. These quantities can be disclosed through an appropriate interrogation by ultrasound (USN) elastography techniques and therefore, they are the focus of this investigation. This project will extend recent advances in a promising technology to evaluate soft tissue mechanics under simple and clinically relevant treatment conditions. A body of knowledge probing theoretical effects of manual treatments has begun to arise over the past three decades. Each clinical manual therapy approach assumes that a specific set of tissues is the recipient of the beneficial effects of treatment. Yet, no prior method directly monitors which tissues deform and the relative intensity of the strain that is developed in order to justify clinical assumptions or to prioritize future research. Specifically, research on how mechanical transduction of treatment into biological benefit occurs in the different tissue strata can be engaged based on evidence of which tissues are most likely being affected. Current soft-tissue USN elastography techniques, under static conditions, will be extended to quantify relative displacement and strains (active and passive) across the depth of tissue strata (e.g. subcutaneous, fascia, longissimus, intermuscular aponeuroses, and multifidus) that arise from small amplitude motions during continuous passive motion (CPM) clinical procedures and in weight bearing postures. Relative movement of the stratified layers of the back, from treatment and task-generated perturbations, will enable the elastography interrogation of the tissues. Results from this study are applicable to a number of manual treatments specifically, and to understanding the biomechanics of strain effects from the load distribution through the soft-tissues of the torso. Such evidence will empower prioritization and quantitative testing of tissue biomarkers based on evidence of relative response to treatment. Information on tissue response path as represented by displacement and strain is important to advancing the understanding of manual therapies from three perspectives: 1) informing on the mechanisms of action that may yield clinical benefit; 2) detecting boundaries for and optimization of safe application; and 3) developing insights on how to improve clinical results by redirecting treatment to achieve specific effects. Project Narrative: Manual treatment offers benefit to some patients suffering from back pain but little is known about which of the many tissue layers are affected. This study will help identify which tissues may be stimulated sufficiently to be a source for the clinical effects of treatment and to prioritize future work to understand mechanisms of back pain and to improve care.