Extending Ultrasound Elastography to Manual Treatment Methods

描述（由申请人提供）：推进手工医学科学的最大障碍是无法测量体内肌肉和软组织;其影响是模糊了对治疗实际效果的直接理解。当手动治疗，甚至一般的生物力学操纵，施加负载到身体，软组织变形，传递力的骨骼和关节结构。产生的应变是由与通常的非线性组织特性一致的内力产生的。变形和应变携带关于身体如何对治疗作出反应的重要信息。这些量可以通过超声弹性成像技术（USN）的适当询问来披露，因此，它们是本次调查的重点。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，探索人工治疗的理论效果的知识体系已经开始出现。每种临床手动治疗方法都假设特定的一组组织是治疗有益效果的接受者。然而，没有现有的方法直接监测哪些组织变形以及所产生的应变的相对强度，以证明临床假设或优先考虑未来的研究。具体而言，可以基于哪些组织最有可能受到影响的证据来研究在不同组织层中如何将治疗机械转换为生物学益处。在静态条件下，将扩展当前软组织USN弹性成像技术，以量化在连续被动运动（CPM）临床手术期间和负重姿势中由小幅度运动引起的组织层（例如皮下、筋膜、最长肌、肌间腱膜和多裂肌）深度上的相对位移和应变（主动和被动）。由于治疗和任务产生的扰动，背部分层的相对运动将使组织的弹性成像询问成为可能。这项研究的结果适用于一些手动治疗，特别是了解生物力学的应变效应的负载分布通过软组织的躯干。这些证据将授权基于对治疗的相对反应的证据对组织生物标志物进行优先化和定量测试。以位移和应变为代表的组织反应路径的信息对于从三个角度促进对手动治疗的理解非常重要：1）告知可能产生临床受益的作用机制; 2）检测安全应用的边界和优化; 3）开发关于如何通过重新定向治疗以实现特定效果来改善临床结果的见解。项目叙述：手动治疗为一些患有背痛的患者提供了益处，但对许多组织层中的哪一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，成为治疗临床效果的来源，并优先考虑未来的工作，以了解背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.