Training intensity of robot-assisted gait training in children with cerebral palsy.

AIM: We compared three different intensities of robot-assisted gait training (RAGT) for achieving favourable outcomes in children with cerebral palsy (CP). METHOD: This study was conducted using a randomized controlled, single-blind design. Thirty children (19 males and 11 females; mean age 6 years 1 month, SD 2 years) with CP classified in Gross Motor Function Classification System levels II and III were assigned to three different RAGT intensity groups: high-intensity (fastest walking speed and lowest body weight support [BWS]), low-intensity (slowest speed and highest BWS), and comfortable intensity (intermediate speed and intermediate BWS). The RAGT intervention was performed three times a week for 6 weeks. Outcome measures included the 88-item Gross Motor Function Measure, stability index, spatiotemporal parameters of gait analysis, paediatric functional independence measure, and the Canadian Occupational Performance Measure. RESULTS: The 88-item Gross Motor Function Measure was significantly improved after training in the high-intensity (D Δ8.3 ± 15.6; E Δ3.8 ± 4.1) and comfortable intensity (D Δ2.9 ± 3.1; E Δ1.2 ± 2.0) groups, whereas gait speed was improved in the comfortable intensity group, without statistically significant group differences. Only the low-intensity group showed improvement on the stability index (Δ -0.6 ± 0.9, p = 0.05). Everyday functional performance significantly improved in all three groups, with the comfortable intensity group showing the greatest improvement. INTERPRETATION: Different training intensities produced improvement in different areas; individualized RAGT intensity adjustment is therefore needed based on the rehabilitation goal.

Medical service utilization by children with physical or brain disabilities in South Korea.

BACKGROUND: Children with physical or brain disabilities experience several functional impairments and declining health complications that must be considered for adequate medical support. This study investigated the current medical service utilization of children expressing physical or brain disabilities in South Korea by analyzing medical visits, expenses, and comorbidities. METHODS: We used a database linked to the National Rehabilitation Center of South Korea to extract information on medical services utilized by children with physical or brain disabilities, the number of children with a disability, medical visits for each child, medical expenses per visit, total medical treatment cost, copayments by age group, condition severity, and disability type. RESULTS: Brain disorder comorbidities significantly differed between those with mild and severe disabilities. Visits per child, total medical treatment cost, and copayments were higher in children with severe physical disabilities; however, medical expenses per visit were lower than those with mild disabilities. These parameters were higher in children with severe brain disabilities than in mild cases. Total medical expenses incurred by newborns to three-year-old children with physical disorders were highest due to increased visits per child. However, medical expenses per visit were highest for children aged 13-18. CONCLUSION: Medical service utilization varied by age, condition severity, and disability type. Severe cases and older children with potentially fatal comorbidities required additional economic support. Therefore, a healthcare delivery system for children with disabilities should be established to set affordable medical costs and provide comprehensive medical services based on disability type and severity.

Fat quantification of the rotator cuff muscles using CT histogram analysis in comparison with Dixon MRI sequence.

OBJECTIVES: To quantify the proportion of fat within the rotator cuff muscles using CT histogram analysis (HA) and to compare fat fraction (FF) values obtained from CT and T2*-corrected 6-echo three-dimensional gradient-echo Dixon sequences. METHODS: Twenty-six patients who underwent both shoulder CT and MRI were enrolled. The FF of rotator cuff muscles was measured on FF maps of the Dixon technique. Using CT, the FF values were obtained in two ways: 1) CT mean Hounsfield Unit (HU) measurement-based fat quantification using subcutaneous fat and the teres major muscle as internal standards; and 2) CT HA-based fat quantification in which pixels from -190 to -30 HU were arbitrarily classified as fat, and those from -30 to 150 HU as muscle. Afterward, the relationship between FF values from MRI (FF-MR), CT mean HU-based analysis (FF-HU), and CT HA (FF-HA) was assessed. RESULTS: There were strong positive correlations (p < 0.001) between FF-MR and FF-HA, which were higher when compared with FF-HU (r = 0.90 vs. 0.77 for total). For a total of 104 rotator cuff muscles, the intraclass correlation between FF-MR and FF-HA was excellent (ICC, 0.90), which was higher than that between FF-MR and FF-HU (ICC, 0.76). The ICCs showed excellent interobserver agreement between FF-MR, FF-HU, and FF-HA (ICCs, 0.93-0.96). CONCLUSIONS: Fat quantification within the rotator cuff muscles using CT HA is both feasible and reliable. ADVANCES IN KNOWLEDGE: CT HA provides reliable quantification of intramuscular fat and has strengths regarding its retrospective applicability to conventional CT studies without additional radiation dose to subjecting patients.

Association between Low Blood Pressure and Subsequent Risk of Parkinson's Disease in Older Adults Aged ≥75 Years.

INTRODUCTION: The association between blood pressure (BP) and incidence of Parkinson's disease (PD) in older adults remains uncertain. Therefore, this study aimed to investigate the association between BP (high or low) and PD incidence in adults aged ≥75 years. METHODS: In this nationwide population-based cohort study, we enrolled participants aged ≥75 years without a prior PD diagnosis who had undergone health examination provided by the Korean National Health Insurance Service at least once from January 1, 2009, to December 31, 2012. The participants were followed up until December 31, 2019, or the date of their death. The Cox proportional hazards model was used to assess the risk of PD depending on systolic BP (SBP), diastolic BP (DBP), and pulse pressure. RESULTS: Overall, 963,525 participants were enrolled in the analysis and followed up until December 31, 2019, or the date of death (40.7% male, mean age 78.5 ± 3.6 years). The mean SBP and DBP were 131.4 ± 16.7 and 77.9 ± 10.3 mm Hg, respectively. During the 10-year follow-up period, 16,414 (1.7%) newly diagnosed cases of PD were reported. A significant inverse dose-response association was found between SBP and PD incidence. In the subgroup analysis, this association was maintained for most variables, including sex, use of antihypertensive medication, comorbidities, alcohol consumption, physical activity, and body mass index, except for smoking status. CONCLUSION: Lower SBP and DBP were associated with a higher PD incidence in older adults. These results may have substantial implications for determining the optimal BP control target in adults aged ≥75 years.

Early Neurodevelopmental Assessments of Neonates Discharged From the Neonatal Intensive Care Unit: A Physiatrist's Perspective.

The survival rate of children admitted in the neonatal intensive care unit (NICU) after birth is on the increase; hence, proper evaluation and care of their neurodevelopment has become an important issue. Neurodevelopmental assessments of individual domains regarding motor, language, cognition, and sensory perception are crucial in planning prompt interventions for neonates requiring immediate support and rehabilitation treatment. These assessments are essential for identifying areas of weakness and designing targeted interventions to improve future functional outcomes and the quality of lives for both the infants and their families. However, initial stratification of risk to select those who are in danger of neurodevelopmental disorders is also important in terms of cost-effectiveness. Efficient and robust functional evaluations to recognize early signs of developmental disorders will help NICU graduates receive interventions and enhance functional capabilities if needed. Several age-dependent, domain-specific neurodevelopmental assessment tools are available; therefore, this review summarizes the characteristics of these tools and aims to develop multidimensional, standardized, and regular follow-up plans for NICU graduates in Korea.

Home-based virtual reality-enhanced upper limb training system in children with brain injury: a randomized controlled trial.

Background: Rehabilitation of upper limb function can be challenging in children with brain lesion. Recent virtual reality (VR) rehabilitation may be an additional treatment option in pediatric rehabilitation. Objectives: To assess the feasibility and effectiveness of a home-based VR-enhanced rehabilitation program with wearable multi-inertial measurement unit (IMU) sensors on upper limb functions in children with brain injury. Methods: This multicenter single blind randomized controlled trial included 40 children with cerebral palsy (CP) or static brain injury. Subjects were randomized 1:1 to experimental and control group. Both the groups maintained the same therapeutic content and dose of occupational therapy during the intervention period. The experimental group performed additional training at home using the VR-enhanced program for at least 30 min/day, 5 days/week, for 6 weeks. VR training consisted of daily activities or games promoting wrist and forearm articular movements using wearable IMU sensors. The Melbourne Assessment of Unilateral Upper Limb Function-version 2 (MA2), Upper Limb Physician's Rating Scale (ULPRS), Pediatric Evaluation of Disability Inventory-computer adaptive test (PEDI-CAT), computerized 3D motion analysis, and user satisfaction survey were performed. Mann-Whitney U test was used to compare treatment effects between groups, and Friedman and Wilcoxon signed-rank tests were used to compare pre and post intervention. Results: Overall 35 children (15 in VR group and 20 in control group) completed the protocol. In the experimental group, an average VR training time was 855 min. The accuracy of motion measured by MA2, segmental movements by ULPRS, daily living capability and social cognitive function by PEDI-CAT, movement time and shoulder movement pattern by motion analysis showed significant improvements. However, there were no significant differences in any of the functional outcome measures compared to the control group. All the children and parents reported positive experiences. Conclusions: Home-based VR training though it had limited impact on improving upper limb function, it could help improve social cognitive function, movement pattern, and efficiency in children with brain injury and could be an effective means of extending clinical therapy to the home. Clinical Trial Registration: CRIS.nih.go.kr: identifier KCT0003172.

Feasibility and clinical usefulness of deep learning-accelerated MRI for acute painful fracture patients wearing a splint: A prospective comparative study.

OBJECTIVE: To evaluate the feasibility and clinical usefulness of deep learning (DL)-accelerated turbo spin echo (TSEDL) sequences relative to standard TSE sequences (TSES) for acute radius fracture patients wearing a splint. METHODS: This prospective consecutive study investigated 50 patients' preoperative wrist MRI scans acquired between July 2021 and January 2022. Examinations were performed at 3 Tesla MRI with body array coils due to the wrist splint. Besides TSES obtained according to the routine protocol, TSEDL sequences for axial T2-, coronal T1-, and coronal PD-weighted TSE sequences were scanned for comparison. For quantitative assessment, the relative signal-to-noise ratio (rSNR), the relative contrast-to-noise ratio (rCNR), and the relative contrast ratio (rCR) were measured. For qualitative assessment, all images were assessed by two independent musculoskeletal radiologists in terms of perceived SNR, image contrast, image sharpness, artifacts disturbing evaluation, overall image quality and diagnostic confidence for injuries using a four- or five-point Likert scale. RESULTS: The scan time was shortened approximately by a factor of two for TSEDL compared to TSES. TSEDL images showed significantly better rSNR, rCNR, and rCR values for all sequences, and scored significantly better in terms of both image quality and diagnostic confidence for both readers than TSES images (all p < .05). Interrater reliabilities were in almost perfect agreement. CONCLUSION: The DL-accelerated technique proved to be very helpful not only to reduce scan time but also to improve image quality for acute painful fracture patients wearing a splint despite using body array coils instead of a wrist-specific coil. Based on our study, the DL-accelerated technique can be very useful for MRI of any part of the extremities in trauma settings just with body array coils.

Comparison of Metal Artifact Reduction Algorithms in Patients with Hip Prostheses: Virtual Monoenergetic Images vs. Orthopedic Metal Artifact Reduction.

Purpose: To assess the usefulness of various metal artifact reduction (MAR) methods in patients with hip prostheses. Materials and Methods: This retrospective study included 47 consecutive patients who underwent hip arthroplasty and dual-energy CT. Conventional polyenergetic image (CI), orthopedic-MAR (O-MAR), and virtual monoenergetic image (VMI, 50-200 keV) were tested for MAR. Quantitative analysis was performed in seven regions around the prostheses. Qualitative assessments included evaluation of the degree of artifacts and the presence of secondary artifacts. Results: The lowest amount of image noise was observed in the O-MAR, followed by the VMI. O-MAR also showed the lowest artifact index, followed by high-keV VMI in the range of 120-200 keV (soft tissue) or 200 keV (bone). O-MAR had the highest contrast-to-noise ratio (CNR) in regions with severe hypodense artifacts, while VMI had the highest CNR in other regions, including the periprosthetic bone. On assessment of the CI of pelvic soft tissues, VMI showed a higher structural similarity than O-MAR. Upon qualitative analysis, metal artifacts were significantly reduced in O-MAR, followed by that in VMI, while secondary artifacts were the most frequently found in the O-MAR (p < 0.001). Conclusion: O-MAR is the best technique for severe MAR, but it can generate secondary artifacts. VMI at high keV can be advantageous for evaluating periprosthetic bone.

Deep Radiomics-based Approach to the Diagnosis of Osteoporosis Using Hip Radiographs.

Purpose: To develop and validate deep radiomics models for the diagnosis of osteoporosis using hip radiographs. Materials and Methods: A deep radiomics model was developed using 4924 hip radiographs from 4308 patients (3632 women; mean age, 62 years ± 13 [SD]) obtained between September 2009 and April 2020. Ten deep features, 16 texture features, and three clinical features were used to train the model. T score measured with dual-energy x-ray absorptiometry was used as a reference standard for osteoporosis. Seven deep radiomics models that combined different types of features were developed: clinical (model C); texture (model T); deep (model D); texture and clinical (model TC); deep and clinical (model DC); deep and texture (model DT); and deep, texture, and clinical features (model DTC). A total of 444 hip radiographs obtained between January 2019 and April 2020 from another institution were used for the external test. Six radiologists performed an observer performance test. The area under the receiver operating characteristic curve (AUC) was used to evaluate diagnostic performance. Results: For the external test set, model D (AUC, 0.92; 95% CI: 0.89, 0.95) demonstrated higher diagnostic performance than model T (AUC, 0.77; 95% CI: 0.70, 0.83; adjusted P < .001). Model DC (AUC, 0.95; 95% CI: 0.92, 0.97; adjusted P = .03) and model DTC (AUC, 0.95; 95% CI: 0.92, 0.97; adjusted P = .048) showed improved diagnostic performance compared with model D. When observer performance without and with the assistance of the model DTC prediction was compared, performance improved from a mean AUC of 0.77 to 0.87 (P = .002). Conclusion: Deep radiomics models using hip radiographs could be used to diagnose osteoporosis with high performance.Keywords: Skeletal-Appendicular, Hip, Absorptiometry/Bone Densitometry© RSNA, 2022.

Detection of Soft Tissue Sarcoma Recurrence: Feasibility of Ultrafast 3D Gradient-Echo Sequence in Addition to Conventional Contrast-Enhanced MRI to Provide Early-Phase Postcontrast Information.

Objectives: Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has been investigated to better detect recurrent tumors of malignant soft tissue sarcoma (STS), however, DCE-MRI is time-consuming and not available at all medical centers. This study aims to evaluate the feasibility of dual-phase postcontrast MRI sequences (early 3D spoiled gradient-echo [GRE] and delayed fast spin-echo [FSE] T1WI) for the differentiation of recurrent tumor from nonneoplastic lesions. Materials and methods: A total of 297 patients under postoperative surveillance for malignant STS were included in this retrospective study and divided into three subgroups, as follows: group A, recurrent tumors (n = 82); group B, pseudomasses (n = 55); and group C, postoperative inflammation (n = 160). All MRI examinations included dual-phase post-contrast sequences. The contrast-to-noise ratio (CNR) and the signal-intensity ratio (SIR) were used to evaluate the degree of contrast enhancement in target lesions. ROC curve analysis was performed to assess the diagnostic performance for recurrent tumor. Results: In the early phase, all mean CNR and SIR values were significantly higher in group A (all, p < 0.05). However, the difference of the CNR between early and delayed post-contrast MRI showed a significantly lesser increase in group A than in the other groups when muscle was used as the reference tissue (p = 0.026). A comparison of ROC curves showed that dual-phase MRI had significantly better diagnostic performance than conventional postcontrast MRI. Conclusion: The addition of an early postcontrast 3D GRE to conventional FSE-T1WI is useful to detect recurrent tumors by providing additional information on early enhancement.

Deep learning-based fully automated body composition analysis of thigh CT: comparison with DXA measurement.

OBJECTIVES: To compare volumetric CT with DL-based fully automated segmentation and dual-energy X-ray absorptiometry (DXA) in the measurement of thigh tissue composition. METHODS: This prospective study was performed from January 2019 to December 2020. The participants underwent DXA to determine the body composition of the whole body and thigh. CT was performed in the thigh region; the images were automatically segmented into three muscle groups and adipose tissue by custom-developed DL-based automated segmentation software. Subsequently, the program reported the tissue composition of the thigh. The correlation and agreement between variables measured by DXA and CT were assessed. Then, CT thigh tissue volume prediction equations based on DXA-derived thigh tissue mass were developed using a general linear model. RESULTS: In total, 100 patients (mean age, 44.9 years; 60 women) were evaluated. There was a strong correlation between the CT and DXA measurements (R = 0.813~0.98, p < 0.001). There was no significant difference in total soft tissue mass between DXA and CT measurement (p = 0.183). However, DXA overestimated thigh lean (muscle) mass and underestimated thigh total fat mass (p < 0.001). The DXA-derived lean mass was an average of 10% higher than the CT-derived lean mass and 47% higher than the CT-derived lean muscle mass. The DXA-derived total fat mass was approximately 20% lower than the CT-derived total fat mass. The predicted CT tissue volume using DXA-derived data was highly correlated with actual CT-measured tissue volume in the validation group (R2 = 0.96~0.97, p < 0.001). CONCLUSIONS: Volumetric CT measurements with DL-based fully automated segmentation are a rapid and more accurate method for measuring thigh tissue composition. KEY POINTS: • There was a positive correlation between CT and DXA measurements in both the whole body and thigh. • DXA overestimated thigh lean mass by 10%, lean muscle mass by 47%, but underestimated total fat mass by 20% compared to the CT method. • The equations for predicting CT volume (cm3) were developed using DXA data (g), age, height (cm), and body weight (kg) and good model performance was proven in the validation study.

Improved diagnostic performance of plain radiography for cervical ossification of the posterior longitudinal ligament using deep learning.

BACKGROUND: A high false-negative rate has been reported for the diagnosis of ossification of the posterior longitudinal ligament (OPLL) using plain radiography. We investigated whether deep learning (DL) can improve the diagnostic performance of radiologists for cervical OPLL using plain radiographs. MATERIALS AND METHODS: The training set consisted of 915 radiographs from 207 patients diagnosed with OPLL. For the test set, we used 200 lateral cervical radiographs from 100 patients with cervical OPLL and 100 patients without OPLL. An observer performance study was conducted over two reading sessions. In the first session, we compared the diagnostic performance of the DL-model and the six observers. The diagnostic performance was evaluated using the area under the receiver operating characteristic curve (AUC) at the vertebra and patient level. The sensitivity and specificity of the DL model and average observers were calculated in per-patient analysis. Subgroup analysis was performed according to the morphologic classification of OPLL. In the second session, observers evaluated the radiographs by referring to the results of the DL-model. RESULTS: In the vertebra-level analysis, the DL-model showed an AUC of 0.854, which was higher than the average AUC of observers (0.826), but the difference was not significant (p = 0.292). In the patient-level analysis, the performance of the DL-model had an AUC of 0.851, and the average AUC of observers was 0.841 (p = 0.739). The patient-level sensitivity and specificity were 91% and 69% in the DL model, and 83% and 68% for the average observers, respectively. Both the DL-model and observers showed decreases in overall performance in the segmental and circumscribed types. With knowledge of the results of the DL-model, the average AUC of observers increased to 0.893 (p = 0.001) at the vertebra level and 0.911 (p < 0.001) at the patient level. In the subgroup analysis, the improvement was largest in segmental-type (AUC difference 0.087; p = 0.002). CONCLUSIONS: The DL-based OPLL detection model can significantly improve the diagnostic performance of radiologists on cervical radiographs.

Spatiotemporal parameters from instrumented motion analysis represent clinical measurement of upper limb function in children with cerebral palsy.

BACKGROUND: There are various tools that measure upper limb function in children with cerebral palsy(CP) clinically, but these measurement methods are examiner-dependent and scale values are not proportional to the upper limb function which makes it difficult to quantify the function. RESEARCH QUESTION: The purpose of this study was to investigate whether the new parameters derived from 3D motion analysis reflect the upper limb function which measured by Melbourne Assessment 2 (MA2) in children with cerebral palsy (CP) compared to the clinical measurements. METHODS: Forty children with CP (24 boys, 16 girls; mean [SD] age, 6 years 11 months [3 years 5 months]) were recruited. Motion capture was conducted during phases T1-T4 of Reach and Grasp Cycles. New parameters (movement time, number of movement units, index of curvature) were derived from wrist marker data. Range of motion (ROM), accuracy, dexterity, and fluency of unilateral upper limb function were assessed using MA2. Spearman rank coefficients were determined to evaluate correlations between MA2 and the new parameters. RESULTS AND SIGNIFICANCE: Index of curvature correlated negatively with MA2 accuracy scores during T1 (rs -0.347, p < 0.05), T2 (rs -0.471, p < 0.01), and T3 (rs -0.660, p < 0.01). Number of movement units correlated negatively with MA2 ROM, accuracy, and fluency scores during T1 (ROM rs -0.334; accuracy rs -0.331; fluency rs -0.375; p < 0.05) and T3 (ROM rs -0.499; accuracy rs -0.531; fluency rs -0.515; p < 0.01). Index of curvature and number of movement units are objective, simple parameters showing fair to good correlation with MA2 accuracy and fluency of upper limb function.

Distinct mechanisms for talker adaptation operate in parallel on different timescales.

The mapping between speech acoustics and phonemic representations is highly variable across talkers, and listeners are slower to recognize words when listening to multiple talkers compared with a single talker. Listeners' speech processing efficiency in mixed-talker settings improves when given time to reorient their attention to each new talker. However, it remains unknown how much time is needed to fully reorient attention to a new talker in mixed-talker settings so that speech processing becomes as efficient as when listening to a single talker. In this study, we examined how speech processing efficiency improves in mixed-talker settings as a function of the duration of continuous speech from a talker. In single-talker and mixed-talker conditions, listeners identified target words either in isolation or preceded by a carrier vowel of parametrically varying durations from 300 to 1,500 ms. Listeners' word identification was significantly slower in every mixed-talker condition compared with the corresponding single-talker condition. The costs associated with processing mixed-talker speech declined significantly as the duration of the speech carrier increased from 0 to 600 ms. However, increasing the carrier duration beyond 600 ms did not achieve further reduction in talker variability-related processing costs. These results suggest that two parallel mechanisms support processing talker variability: A stimulus-driven mechanism that operates on short timescales to reorient attention to new auditory sources, and a top-down mechanism that operates over longer timescales to allocate the cognitive resources needed to accommodate uncertainty in acoustic-phonemic correspondences during contexts where speech may come from multiple talkers.

Relation of Flatfoot Severity with Flexibility and Isometric Strength of the Foot and Trunk Extensors in Children.

BACKGROUND: Flatfoot is a deformity in which the foot is flattened due to a decrease in or loss of the medial longitudinal arch. STATEMENT OF THE PROBLEM: Few studies have investigated the relationship between the severity of flat feet, trunk strength, and joint flexibility. PURPOSE: The aim of this study is to investigate the relationship between the severity of flatfoot and joint flexibility and foot and trunk strength in children with flexible flatfoot. METHODS: This study included 16 children (boys, 12; girls, 4; age, 4~8 years) with flexible flatfeet. We examined the resting calcaneal stance position angle (RCSPA) and foot posture index (FPI) scores for clinical severity and radiographic parameters, such as calcaneal pitch angle, talometatarsal angle (TMA), and talocalcaneal angle (TCA). Muscle thicknesses of the tibialis posterior (TP), peroneus longus (PL), and L1 multifidus were measured by sonography. Isometric contraction of ankle inversion, eversion in a seating position, and lumbar extension at a prone position were induced using a handheld dynamometer to measure the maximum muscle strength for each muscle. Beighton's scoring system was used to assess joint flexibility by evaluating the hyperextension of the joint for each category when performing stretching motion. Spearman's rank correlation coefficient for nonparametric data was used. RESULTS: The FPI showed a moderately negative correlation with the muscle thickness of TP (r = -0.558, p = 0.009) and L1 multifidus (r = -0.527, p = 0.012), and the strength of the ankle inverter (r = -0.580 p = 0.005) and lumbar extensor (r = -0.436 p = 0.043). RCSPA showed a moderately positive correlation with TCA (r = 0.510, p = 0.006). Beighton's score showed no significant correlation with all parameters. CONCLUSION: In children with flatfoot, FPI reflected the clinical severity; thus, the more severe the symptoms, the weaker the ankle inverter and lumbar extensor.

Relationship between the more-affected upper limb function and daily activity performance in children with cerebral palsy: a cross-sectional study.

BACKGROUND: There are differences in roles between the more-affected and less-affected upper limb of children with cerebral palsy (CP). However, there is a lack of studies of the relationship between the more-affected limb function and activities of daily living (ADL) in children with CP. Thus, the aim of this prospective cross-sectional study was to investigate the relationship between more-affected upper limb function and ADL in children with CP. METHODS: Children with spastic CP (unilateral CP n = 28, bilateral CP n = 31; 34 males, 25 females; mean age ± SD, 6.8 ± 3.1y [range, 3-14y]) participated in this study. Function of the more-affected upper limb was measured using the Melbourne Assessment of Unilateral Upper limb Function, version 2 (MA2) and the Upper Limb Physician's Rating Scale (ULPRS). Performance of daily living activities was measured using the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT). RESULTS: The range, accuracy and fluency dimension of MA2 and ULPRS total scores were moderately correlated with the daily activity domain (r = 0.47, 0.47, 0.56 for MA2 and r = 0.50 for ULPRS, respectively; P < 0.001) rather than the mobility, social/cognitive, and responsibility domains of the PEDI-CAT. ULPRS scores for elbow extension, supination in extension, supination in flexion, and two-handed function were moderately correlated with the PEDI-CAT daily activity domain (r = 0.44, 0.43, 0.41, and 0.49, respectively; P < 0.01). Finger opening and thumb-in-palm deformity of the ULPRS did not correlate with any PEDI-CAT domain. CONCLUSIONS: The MA2 range, accuracy, and fluency domains (rather than dexterity) had the strongest correlations with the PEDI-CAT daily activity domain. Elbow extension, forearm supination, and two-handed function (rather than wrist and finger movements) of the ULPRS had the strongest correlations with the PEDI-CAT daily activity domain.

CT Hounsfield unit and histogram analysis for differentiation of recent versus remote vertebral compression fractures.

OBJECTIVES: The purpose of this study was to analyze the intraosseous tissue changes in recent vertebral compression fractures (VCFs) and to differentiate recent from remote VCFs using CT Hounsfield unit histogram analysis (HUHA). METHODS: 65 patients with T11 to L3 VCFs were included. HUHA of 2 vertebral bodies (VBs)- a fractured VB and the closest lower-level unaffected VB-was done. The mean Hounsfield unit (HU) value and HU proportions of 5 ranges (HU ≤ 0, 0 < HU ≤ 50, 50 < HU ≤ 100, 100 < HU ≤ 150, and HU > 150) were obtained. Then, ΔHU value and ΔHU proportion were calculated by subtracting the values from the two vertebrae. Finally, the obtained values were compared between the recent and remote VCF groups and subjected to ROC curve analysis. RESULTS: In recent VCF group, the ΔHU proportion (HU ≤ 0) corresponding to normal fatty marrow was lower (-0.17 vs 0.01) and the ΔHU proportion (HU > 150) representing trabecular bone was higher (0.23 vs 0.04) than in remote VCF group (p < 0.001). In the differentiation of recent from remote VCF, the ΔHU value and ΔHU proportion (HU > 150) showed high area under the curve (AUC, 0.939 and 0.912, respectively). CONCLUSION: CT HUHA demonstrated both trabecular bone and bone marrow changes in recent VCFs, and showed high diagnostic performance in differentiating between recent and remote VCFs. ADVANCES IN KNOWLEDGE: With its vendor neutral applicability, CT HUHA can be used for the differentiation of recent and remote VCFs.

Is Longstanding Congenital Muscular Torticollis Provoking Pelvic Malalignment Syndrome?

It has been reported that congenital muscular torticollis (CMT) may result in secondary scoliosis over long-term follow-ups. However, there are few reports on whether CMT causes pelvic malalignment syndrome (PMS). This study aimed to investigate the relationship between CMT and PMS and to determine the factors associated with the development of PMS in children with longstanding CMT. Medical records of 130 children with CMT who had long-term follow-up were reviewed retrospectively. The chi-squared test and logistic regression analysis were used to determine which initial clinical parameters contributed to the development of PMS. Among 130 children with CMT, 51 (39.2%) developed PMS with or without compensatory scoliosis during long-term follow-up, indicating a high prevalence of PMS in children with a CMT history. Initial clinical symptoms such as a limited range of motion of the neck or the presence of a neck mass could not predict the development of PMS. Even if the clinical symptoms are mild, long-term follow-up of children with CMT is essential to screen for PMS.

Using Convolutional Neural Network with Taguchi Parametric Optimization for Knee Segmentation from X-Ray Images.

Loss of knee cartilage can cause intense pain at the knee epiphysis and this is one of the most common diseases worldwide. To diagnose this condition, the distance between the femur and tibia is calculated based on X-ray images. Accurate segmentation of the femur and tibia is required to assist in the calculation process. Several studies have investigated the use of automatic knee segmentation to assist in the calculation process, but the results are of limited value owing to the complexity of the knee. To address this problem, this study exploits deep learning for robust segmentation not affected by the environment. In addition, the Taguchi method is applied to optimize the deep learning results. Deep learning architecture, optimizer, and learning rate are considered for the Taguchi table to check the impact and interaction of the results. When the Dilated-Resnet architecture is used with the Adam optimizer and a learning rate of 0.001, dice coefficients of 0.964 and 0.942 are obtained for the femur and tibia for knee segmentation. The implemented procedure and the results of this investigation may be beneficial to help in determining the correct margins for the femur and tibia and can be the basis for developing an automatic diagnosis algorithm for orthopedic diseases.

Fat-suppressed T2 mapping of human knee femoral articular cartilage: comparison with conventional T2 mapping.

BACKGROUND: There is paucity of studies applying fat suppressed (FS) technique to T2 mapping to overcome chemical shift artifacts. The purpose of the study is to difference between FS T2 and conventional T2 mapping and reproducibility of FS T2 mapping in the femoral articular cartilage. METHODS: Eighteen patients who had normal-looking femoral cartilage and underwent knee MRI with conventional T2 and FS T2 mapping were included. T2 values of each mapping were measured by two readers independently from nine regions in the medial femoral condyle (MFC) and lateral femoral condyle (LFC). Each anatomical region was divided by lines at ± 10°, 30°, 50°, 70°, 90°, and 110°. Comparisons of T2 values between conventional and FS T2 mapping were statistically analyzed. The T2 values between FS and conventional T2 mapping in the anterior, central and posterior femoral condyles were compared. RESULTS: The overall femoral condyle T2 values from the FS T2 map were significantly lower than those from the conventional T2 map (48.5ms vs. 51.0ms, p < 0.001). The differences in the T2 values between the two maps were significantly different among the three divisions of the LFC (p = 0.009) and MFC (p = 0.031). The intra-class correlation coefficients indicated higher agreement in the FS T2 map than in the conventional T2 map (0.943 vs. 0.872). CONCLUSIONS: The T2 values of knee femoral cartilage are significantly lower on FS T2 mapping than on conventional T2 mapping. FS T2 mapping is a more reproducible method for evaluating knee femoral cartilage.