Multifidus Thickness Research Articles

Changes in Muscle Thickness Across Positions on Ultrasound Imaging in Participants With or Without a History of Low Back Pain.

Injury-prediction models have identified trunk muscle function as an identifiable factor for future injury. A history of low back pain (HxLBP) may also place athletes at increased risk for future low back pain. Reduced muscle thickness of the lumbar multifidus (LM) and transversus abdominis (TrA) has been reported among populations with clinical low back pain via ultrasound imaging in multiple positions. However, the roles of the LM and TrA in a more functional cohort and for injury prediction are still unknown. To (1) assess the reliability of LM and TrA ultrasound measures, (2) compare changes in muscle thickness across positions between persons reporting or not reporting HxLBP, and (3) determine the ability to distinguish between groups. Cross-sectional study. Research laboratory. Participants were 34 people who did not report HxLBP (age = 22 ± 7 years, body mass index = 23.7 ± 2.7) and 25 people who reported HxLBP (age = 25 ± 10 years, body mass index = 24.0 ± 3.2). Muscle thickness and changes in muscle thickness of the LM and TrA as shown on ultrasound imaging. Intraclass correlation coefficients ranged from 0.641 to 0.943 for all thickness measures and from 0 to 0.693 for all averaged thickness modulations bilaterally. Participants who reported HxLBP had voluntarily reduced TrA thickness modulations compared with those not reporting HxLBP ( P = .03), and the testing position influenced TrA thickness modulations ( P < .01). No differences were observed for LM thickness modulations between groups or positions ( P > .05). A tabletop cutoff value of 1.32 had a sensitivity of 0.640 and a specificity of 0.706, whereas a seated cutoff value of 1.18 had a sensitivity of 0.600 and a specificity of 0.647. In participants reporting HxLBP, TrA thickness modulations were lower and both tabletop and seated thickness modulations were able to distinguish reported HxLBP status. These findings suggest that TrA muscle function may be altered by HxLBP.

Exercise intervention for unilateral amputees with low back pain: study protocol for a randomised, controlled trial

BackgroundAtraumatic lower limb amputation is a life-changing event for approximately 185,000 persons in the United States each year. A unilateral amputation is associated with rapid changes to the musculoskeletal system including leg and back muscle atrophy, strength loss, gait asymmetries, differential mechanical joint loading and leg length discrepancies. Even with high-quality medical care and prostheses, amputees still develop secondary musculoskeletal conditions such as chronic low back pain (LBP). Resistance training interventions that focus on core stabilization, lumbar strength and dynamic stability during loading have strong potential to reduce LBP and address amputation-related changes to the musculoskeletal system. Home-based resistance exercise programs may be attractive to patients to minimize travel and financial burdens.Methods/designThis study will be a single-assessor-blinded, pre-post-test randomised controlled trial involving 40 men and women aged 18–60 years with traumatic, unilateral transtibial amputation. Participants will be randomised to a home-based, resistance exercise group (HBRX) or a wait-list control group (CON). The HBRX will consist of 12 weeks of elastic resistance band and bodyweight training to improve core and lumbopelvic strength. Participants will be monitored via Skype or Facetime on a weekly basis. The primary outcome will be pain severity (11-point Numerical Pain Rating Scale; NRSpain). Secondary outcomes will include pain impact on quality of life (Medical Outcomes Short Form 36, Oswestry Disability Index and Roland Morris Disability Questionnaire), kinematics and kinetics of walking gait on an instrumented treadmill, muscle morphology (muscle thickness of multifidus, transversus abdominis, internal oblique), maximal muscle strength of key lumbar and core muscles, and daily step count.DiscussionThe study findings will determine whether a HBRX program can decrease pain severity and positively impact several physiological and mechanical factors that contribute to back pain in unilateral transtibial amputees with chronic LBP. We will determine the relative contribution of the exercise-induced changes in these factors on pain responsiveness in this population.Trial registrationClinicalTrials.gov, ID: NCT03300375. Registered on 2 October 2017.

Ultrasonic analysis on the effect of strengthening exercise with strong tendon on lumbosacral multifidus muscles

To study effects of strengthening exercise with strong tendon on the lumbosacral multifidus muscle. Among 30 healthy volunteers, there were 21 males and 9 females, with an average age of(31.30±6.48) years old(ranged, 25 to 55 years old). The mean BMI was (21.70±1.95) kg/m²(ranged, 18.1 to 24.9 kg/m²). The ultrasonic image was used to analyze the thickness of lumbosacral multifidus(LM) under the follow conditions: supine position, and supine position with leg lifting 30°, 60°, 90°; seat and hip flexion, flexion to limit position, front to limit position with both hands climbing and strengthening the kidneys and the waist. The average lumbosacral multifidus thickness was (16.867±2.460) mm, (19.010±2.510) mm, (22.477±2.220) mm, and(27.593±2.370) mm respectively in supine position with leg lifting 0°, 30°, 60°, 90°. There were statistical differences(F=423.619, P<0.05). The average lumbosacral multifidus thickness was (25.810±2.440) mm, (15.677±2.130) mm, and (15.533±2.110) mm respectively in seat and hip flexion, flexion to limit, front to limit positions with both hands climbing and strengthening the kidneys and the waist. There were statistical differences(F=597.789, P<0.05). When healthy volunteers in Shi's Orthopedics strengthen muscle exercises training, multifidus thickness is increased with the increasing of leg degree, reduced with the increasing of the flexion degree. It can change the stretching state of multifidus muscle by a specific training, so as to achieve the purpose of training the multifidus muscle.

Movement amplitude on the Functional Re-adaptive Exercise Device: deep spinal muscle activity and movement control

PurposeLumbar multifidus (LM) and transversus abdominis (TrA) show altered motor control, and LM is atrophied, in people with low-back pain (LBP). The Functional Re-adaptive Exercise Device (FRED) involves cyclical lower-limb movement against minimal resistance in an upright posture. It has been shown to recruit LM and TrA automatically, and may have potential as an intervention for non-specific LBP. However, no studies have yet investigated the effects of changes in FRED movement amplitude on the activity of these muscles. This study aimed to assess the effects of different FRED movement amplitudes on LM and TrA muscle thickness and movement variability, to inform an evidence-based exercise prescription.MethodsLumbar multifidus and TrA thickness of eight healthy male volunteers were examined using ultrasound imaging during FRED exercise, normalised to rest at four different movement amplitudes. Movement variability was also measured. Magnitude-based inferences were used to compare each amplitude.ResultsExercise at all amplitudes recruited LM and TrA more than rest, with thickness increases of approximately 5 and 1 mm, respectively. Larger amplitudes also caused increased TrA thickness, LM and TrA muscle thickness variability and movement variability. The data suggests that all amplitudes are useful for recruiting LM and TrA.ConclusionsA progressive training protocol should start in the smallest amplitude, increasing the setting once participants can maintain a consistent movement speed, to continue to challenge the motor control system.

Reliability and Precision of Sonography of the Lumbar Multifidus and Transversus Abdominis During Dynamic Activities.

To determine the intrarater reliability and precision of lumbar multifidus and transversus abdominis thickness measurements using freehand sonography in a range of static and dynamic conditions. Fifteen asymptomatic participants performed a range of exercises while sonography was used to measure absolute muscle thickness and changes in muscle thickness from rest. Exercise conditions included the abdominal drawing-in maneuver, active straight leg raise, contralateral arm lift, both unloaded and loaded, treadmill walking, and using the Functional Readaptive Exercise Device. Intraday and interday reliability was assessed by intraclass correlation coefficients, and the standard error of measurement was used to assess measurement precision. Good to excellent reliability was achieved for absolute transversus abdominis and lumbar multifidus thickness in all conditions. Measurement precision for absolute lumbar multifidus thickness was ≤2.8 mm for the unloaded contralateral arm lift, ≤1.8 mm for the loaded contralateral arm lift, ≤3.1 mm for treadmill walking, and ≤3.8 mm for the Functional Readaptive Exercise Device; for absolute transversus abdominis thickness, precision was ≤0.6 mm for the abdominal drawing-in maneuver, ≤0.5 mm for the active straight leg raise, ≤0.7 mm for treadmill walking, and ≤0.5 mm for the Functional Readaptive Exercise Device. Good to excellent reliability was achieved for relative transversus abdominis and lumbar multifidus thickness in all conditions. Measurement precision for relative lumbar multifidus thickness was ≤3.7% for the unloaded contralateral arm lift, ≤3.8% for the loaded contralateral arm lift, ≤6.3% for treadmill walking, and ≤7.6% for the Functional Readaptive Exercise Device; for relative transversus abdominis thickness, precision was ≤13.6% for the abdominal drawing-in maneuver, ≤6.9% for the active straight leg raise, ≤11.1% for treadmill walking, and ≤7.2% for the Functional Readaptive Exercise Device. Acceptable reliability and precision of measurement is achieved for absolute and relative measures of deep spinal muscle thickness using freehand sonography in relatively static and dynamic exercises.

CSM 2017 Orthopaedic Section Platform Presentations (Abstracts OPL1–OPL64)

CSM 2017 Orthopaedic Section Platform Presentations (Abstracts OPL1–OPL64)

Test-retest reliability of measurements of abdominal and multifidus muscles using ultrasound imaging in adults aged 50–79 years

Test-retest reliability of the combined process of ultrasound imaging (USI) and image measurement of thickness of abdominal and upper lumbar multifidus (MF) muscles and MF cross sectional area (CSA) of older adults has not been established. Imaging muscles of older adults can be challenging due to age-related changes in the spine and skeletal muscle so establishing test-retest reliability in this population is important. This study aimed to evaluate test-retest reliability of USI of abdominal and MF muscle thickness and MF CSA for adults aged 50–79 years. One operator took single sets of ultrasound images of abdominal and MF muscles of 23 adults aged 50–79 years participating in a clinical trial of vitamin D supplementation for knee osteoarthritis, on two occasions, one week apart. Images were subsequently measured by a single examiner. Test-retest reliability for abdominal muscle thickness and MF CSA was substantial (intraclass correlation coefficients (ICC) > 0.81) and for MF thickness ranged from fair to substantial (ICC 0.55–0.86). The standard error of measurement (SEM) was low (0.02–0.21) in every case. ICCs were low and SEM values were high for percentage thickness change. The substantial test-retest reliability of abdominal and MF (L4-L5) muscle thickness and of MF CSA supports the use of USI as a clinical and research tool to assess abdominal and MF muscle thickness and MF CSA of older adults.

Differential Activation of the Dorsal Neck Muscles During a Light Arm-Elevation Task in Patients With Chronic Nonspecific Neck Pain and Asymptomatic Controls: An Ultrasonographic Study

BackgroundDisturbance in neck muscle function is a well-known complication of chronic nonspecific neck pain (CNNP). It is, however, unclear which muscles are more susceptible to functional impairment in patients with CNNP during upper limb tasks. ObjectivesTo compare ultrasonographic changes in dorsal neck muscles thickness in patients with CNNP and asymptomatic controls while they performed a light load upper-limb movement. DesignCase control. SettingUniversity research laboratory. ParticipantsTwenty individuals with CNNP with a mean age of 23.35 ± 2.94 and 20 asymptomatic controls with a mean age of 22.30 ± 2.86, without any history of cervical diskopathy, fracture, trauma, inflammation, and spinal deformity were recruited for this study. MethodsUltrasonographic measurement of dorsal neck muscles thickness was performed during a light load 3-second arm-elevation task (shoulder scaption to 120°) in the 2 groups. Associations between pain intensity and patients’ perceived disability and between pain intensity and muscle thickness also were evaluated at the state of rest. Main Outcome MeasurementsThe thickness changes of the dorsal neck muscles throughout the arm elevation were calculated. The pain intensity and the patient’s perceived disability also were measured. ResultsA significant main effect of muscle activity status was revealed for the multifidus and semispinalis cervicis and the splenius capitis, indicating an increase in their thickness throughout the arm elevation (P < .001). The only muscle that showed a difference between groups was the multifidus (P = .007). Direct associations between pain and disability (r = .48, P = .03) and between pain and multifidus thickness (r = −.49, P = .03) also were observed. ConclusionThe deteriorating effect of CNNP on the neck muscles targets the deep layer of the dorsal neck muscles (ie, the multifidus) more than the superficial muscles during light upper-limb tasks. Level of EvidenceIII

골반압박벨트가 뭇갈래근과 척추세움근의 근두께에 융합적으로 미치는 영향

본 연구는 초음파 영상(ultrasound imaging)을 이용하여 네발기기 자세(quadruped position)에서 골반압박벨트(pelvic compression belt)가 뭇갈래근과 척추세움근의 근두께에 융합적으로 미치는 영향을 알아보기 위해 실시되었다. 대상자는 30명의 남자대학생으로 실험에 자발적으로 참여한 자로 선정하였다. 골반압박벨트를 위앞엉덩뼈가시아래(anterior superior iliac spines)에 착용한 상태와 착용하지 않은 상태에서 네발기기 자세를 실시하였고, 초음파영상 진단장치를 이용하여 근 두께를 측정하였다. 자료분석은 반복측정분산분석을 이용하였다. 연구결과, 뭇갈래근의 경우 골반압박벨트를 착용하였을 때가 착용하지 않았을 때보다 근두께가 유의하게 증가하였고(p<.05), 척추세움근의 경우도 골반압박벨트를 착용하였을 때가 착용하지 않았을 때보다 근두께가 유의하게 증가하였다(p<.05). 따라서 본 연구결과를 통해 골반압박벨트의 착용이 요통환자에게 효과적이며, 임상에서 다양한 네발기기 자세운동의 처방과 적용 시에 유용한 자료로 활용하고자 한다. The purpose of this study was to determine the effectiveness of the pelvic compression belt on the thickness of the erector spinae and multifidus during hip extension on quadruped position. Thirty male university students volunteered to participate in this study. The pelvic compression belt was positioned below the anterior superior iliac spines with the stabilizing pressure using elastic compression bands. Subjects were instructed to perform hip extension in quadruped position with and without applying the pelvic compression belt. The thickness of the erector spinae and multifidus was measured ultrasound during prone position, quadruped position without applying pelvic compression belt and quadruped position applying pelvic compression belt. Data were analyzed using repeated ANOVA. Muscle thickness of multifidus was significantly higher applying the pelvic compression belt than without applying the pelvic compression belt (p<.05). Muscle thickness of elector spinae was significantly higher applying the pelvic compression belt than without applying the pelvic compression belt (p<.05). Therefore, the research can contribute to the prescription and application of quadruped position exercises in clinical practices.

Comparison of Lateral Abdominal Muscle Thickness and Cross Sectional Area of Multifidus in Adolescent Soccer Players with and without Low Back Pain: A Case Control Study.

BackgroundLow back pain (LBP) is a common complaint amongst adolescent athletes. While different studies have shown association between LBP and trunk muscle thickness in the general population, few articles have studied it in adolescent athletes.ObjectivesThe aim of this study is to compare lateral abdominal muscle thickness and function, and cross sectional area (CSA) of lumbar multifidus (LM) in adolescent soccer players with and without LBP.MethodsIn total, 28 adolescent soccer players with and without LBP, from the premier league participated in this study. The thickness of external oblique, internal oblique and transversus abdominis and the CSA of the LM muscles at L4 level on both sides were measured at rest and contraction via ultrasound imaging (USI). In addition, leg length discrepancy, hamstring flexibility, active lumbar forward flexion, and isometric muscle endurance of trunk extensors were measured in both groups. (study design/setting: case control study).ResultsThe mean (SD) age in LBP group and non-LBP group were 14.0 (1.1) and 14.1 (0.9) years, respectively. There was no significant difference in baseline characteristics of participants between groups. Findings showed no significant difference between LBP and non-LBP groups comparing all measured variables.ConclusionsThe data obtained support that there is not a correlation between abdominal muscle thickness and CSA of the lumbar multifidi and LBP in adolescent soccer players. These findings suggest that other factors rather than the thickness of deep trunk muscles may play a more significant role in the etiology of LBP in adolescent soccer players.

The Comparison of Various Positions on Lumbar Multifidus Activation

Background/Objectives: Core stability means muscular control on the back regions. Lumbar multifidus is important for stabilization in back region. To demonstrate how multifidus activation would be changed in the various positions. Methods/Statistical Analysis: Thirty healthy males were recruited for the study. The researchers educated the participants how to make the right positions, which consists of the prone, the side lying, and the sitting position. The researchers measured the subjects' lumbar multifidus two times randomly using the ultrasonography. The transducer that is rectangular and has flat surface used 7-10MHz with a 50mm penetration depth. The raw data was analyzed using one-way repeated measures ANOVA to compare the positions. Findings: In the prone position, the lumbar multifidus' thickness was 22.7cm, whereas in the sidelying and sitting position, the lumbar multifidus thickness was 19.4cm and 20.0cm. It means that the Lumbar multifidus more activated in the prone position than other positions. Among those positions, if lumbar multifidus exercise is needed for patients who do not have any kind of lumbar pain, the prone position would be the best position for lumbar multifidus exercise to the patients. There were only few studies about comparing multifidus activation in various positions, but even in previous studies, no studies examined that how the lumbar multifidus worked in those three positions. Thus, the study proved that in which positions the lumbar multifidus activates more. Application/Improvements: Many patients need to core muscles exercise for their low back pain. In that case, doing lumbar multifidus exercise in the prone position would be the best position.

음파진동기와 스위스볼을 이용한 허리안정화운동이 근육두께와 수축시간에 미치는 영향

Purpose : The purpose of this study was to investigate the effects on the muscle thickness and contraction time using sound wave vibrator and swiss ball. Methods : This study was performed on 20 subjects. 20 subjects were divided into two groups; Lumbar stability exercise using sound wave vibrator exercise(n=10)(Group1), Lumbar stability exercise using Swiss ball exercise(n=10)(Group2). Both of the group performed the exercise 3 times a week for 5 weeks. The data was analyzed by the paired t-test to compare before and after difference of factors on each group and the Independent t-test to compare the between groups. Results : Both group were increased muscle contracture time on Straight Leg Rise(SLR) test (p<0.05). It means both group were increased lumbar stability. However, by comparing the between groups, there were no statistically significant difference about muscle thickness of multifidus and transverse abdominal.(p>0.05). Conclusion : As a result of this study, we suggest that the sound wave vibrator may be effective exercise tool for lumbar stability exercise like a swiss ball.

Effects of Low-Load Motor Control Exercises and a High-Load Lifting Exercise on Lumbar Multifidus Thickness: A Randomized Controlled Trial.

Randomized controlled trial. The aim of this study was to compare the effects of low-load motor control (LMC) exercises and a high-load lifting (HLL) exercise, on lumbar multifidus (LM) thickness on either side of the spine and whether the effects were affected by pain intensity or change in pain intensity. There is evidence that patients with low back pain (LBP) may have a decreased size of the LM muscles with an asymmetry between sides in the lower back. It has also been shown that LMC training can affect this asymmetry. It is, however, not known whether a high-load exercise has the same effect. Sixty-five participants diagnosed with nociceptive mechanical LBP were included and randomized into LMC exercises or a HLL exercise, the deadlift. The LM thickness was measured using rehabilitative ultrasound imaging (RUSI), at baseline and after a 2-month training period. There were no differences between interventions regarding effect on LM muscle thickness. However, the analysis showed a significant effect for asymmetry. The thickness of the LM muscle on the small side increased significantly compared with the large side in both intervention groups, without influence of pain at baseline, or change in pain intensity. At baseline, there was a difference in thickness of the LM muscles between sides. It seems that exercises focusing on spinal alignment may increase the thickness of the LM muscles on the small side, irrespective of exercise load. The increase in LM thickness does not appear to be mediated by either current pain intensity or the magnitude of change in pain intensity. 2.

Trunk Stabilization Exercise Using a Both Sides Utilized Ball in Children With Spastic Diplegia: Case Study

This study examined the effects of trunk stabilization exercise on balance and trunk control in children with spastic diplegia. Four children with ambulatory spastic diplegia participated in the trunk stabilization exercise program using a Both Sides Utilized (BOSU) ball, 30 minutes a day, two times a week for eight weeks. Outcome variables included the pediatric balance scale, trunk control movement scale and multifidus thickness using ultrasound image. After trunk stabilization exercise, there was statistically no significant improvement in pediatric balance scale, trunk control movement scale and multifidus thickness. However, individual outcomes were observed with some positive changes. Balance, trunk control movement, and thickness of multifidus were found to be improved. Trunk stabilization exercise using a BOSU ball could improve trunk control and increase the thickness of multifidus in children with spastic diplegia. Further investigation is needed to evaluate subjects according to type of cerebral palsy and to understand the relationship between postural control and gait.

Do participants with low back pain who respond to spinal manipulative therapy differ biomechanically from nonresponders, untreated controls or asymptomatic controls?

Nonrandomized controlled study. To determine whether patients with low back pain (LBP) who respond to spinal manipulative therapy (SMT) differ biomechanically from nonresponders, untreated controls or asymptomatic controls. Some but not all patients with LBP report improvement in function after SMT. When compared with nonresponders, studies suggest that SMT responders demonstrate significant changes in spinal stiffness, muscle contraction, and disc diffusion. Unfortunately, the significance of these observations remains uncertain given methodological differences between studies including a lack of controls. Participants with LBP and asymptomatic controls attended 3 sessions for 7 days. On sessions 1 and 2, participants with LBP received SMT (+LBP/+SMT, n = 32) whereas asymptomatic controls did not (-LBP/-SMT, n = 57). In these sessions, spinal stiffness and multifidus thickness ratios were obtained before and after SMT and on day 7. Apparent diffusion coefficients from lumbar discs were obtained from +LBP/+SMT participants before and after SMT on session 1 and from an LBP control group that did not receive SMT (+LBP/-SMT, n = 16). +LBP/+SMT participants were dichotomized as responders/nonresponders on the basis of self-reported disability on day 7. A repeated measures analysis of covariance was used to compare apparent diffusion coefficients among responders, nonresponders, and +LBP/-SMT subjects, as well as spinal stiffness or multifidus thickness ratio among responders, nonresponders, and -LBP/-SMT subjects. After the first SMT, SMT responders displayed statistically significant decreases in spinal stiffness and increases in multifidus thickness ratio sustained for more than 7 days; these findings were not observed in other groups. Similarly, only SMT responders displayed significant post-SMT improvement in apparent diffusion coefficients. Those reporting post-SMT improvement in disability demonstrated simultaneous changes between self-reported and objective measures of spinal function. This coherence did not exist for asymptomatic controls or no-treatment controls. These data imply that SMT impacts biomechanical characteristics within SMT responders not present in all patients with LBP. This work provides a foundation to investigate the heterogeneous nature of LBP, mechanisms underlying differential therapeutic response, and the biomechanical and imaging characteristics defining responders at baseline. 3.

Interday Reliability and Precision of Lumbar Multifidus and Transversus Abdominis Thickness Change During Dynamic Activities

Interday Reliability and Precision of Lumbar Multifidus and Transversus Abdominis Thickness Change During Dynamic Activities

Whole-body Vibration Training For Knee Osteoarthritis

Results: The non-exercise group demonstrated significantly different trend of changes in left multifidus compared to the exercise group (p= 0.03). The left multifidus of the exercise group demonstrated increases of thickness at rest, while the non-exercise group demonstrated decreases of resting thickness. However, both group demonstrated significant increase in NDI at 6th month (p= 0.03). Other measurements in patients, including VAS, axial symptom, TUG and muscle strength, have no significant difference. Conclusion(s): Patients underwent single level ACDF demonstrate different patterns of change of thickness of multifidus at 6th month. Motor control training targeting the activation of the deep neck muscles could prevent the decrease of thickness of multifidus in patient with ACDF. Implications: The preliminary findings of this study will have important implications for physiotherapist in the management of post-operative spinal patients of ACDF. The recommendation about exercise for patients to reduce pain and improve function need further investigation.

Whole-body vibration training for knee osteoarthritis: a systematic review and meta-analysis

Results: The non-exercise group demonstrated significantly different trend of changes in left multifidus compared to the exercise group (p= 0.03). The left multifidus of the exercise group demonstrated increases of thickness at rest, while the non-exercise group demonstrated decreases of resting thickness. However, both group demonstrated significant increase in NDI at 6th month (p= 0.03). Other measurements in patients, including VAS, axial symptom, TUG and muscle strength, have no significant difference. Conclusion(s): Patients underwent single level ACDF demonstrate different patterns of change of thickness of multifidus at 6th month. Motor control training targeting the activation of the deep neck muscles could prevent the decrease of thickness of multifidus in patient with ACDF. Implications: The preliminary findings of this study will have important implications for physiotherapist in the management of post-operative spinal patients of ACDF. The recommendation about exercise for patients to reduce pain and improve function need further investigation.

Motor control exercise prevent decrease of multifidus thickness in patients with cervical spondylotic myelopathy undergone anterior cervical discectomy and fusion

Chi-square test was used for comparison non-parametric data and rate. SPSS18.0 softwarewas employed for statistical analyses. Results: 1. There was significant main effect of the time in the two groups (P 0.05). Every variable trend diagram in both groups showed consistent increase trend. 2. All scores were increased significantly right after training in both groups (P 0.05). Conclusion(s): 1. The effect of training program performed by patients’ carers was approach to that of therapists and it can be improve or maintain for a short term. 2. The sensorimotor training was an effective way of rehabilitation for stroke patients with wild or moderate motor function handicap. Implications: We wish this appropriate training program will be popularized from rehabilitation institutions to patients’ home. The severe shortage of therapist in the rehabilitation institutions will be relieved in China.

Reliability of ultrasound imaging for the assessment of lumbar multifidi thickness in older adults with chronic low back pain.

Ultrasound imaging (USI) has been shown to be a reliable measure for direct assessment of the lumbar multifidi among younger adults. However, given age- and chronic low back pain (CLBP)-related spinal changes, similar studies are needed before clinical use of USI among older adults with CLBP. The goals of this study were to evaluate intra- and interexaminer reliability for USI assessment of multifidi thickness at rest and during a contraction and to determine standard error of measurement values (SEMs) and minimal detectable change values (MDCs) among older adults with CLBP. Thirty-one adults, aged 60 to 85 years, with CLBP were recruited. Two examiners performed USI assessments of multifidus thickness at rest and during a contralateral lower extremity lift. Intraclass correlation coefficients (ICCs) were used to estimate inter- and intraexaminer reliability. Additionally, SEMs and MDCs were calculated. All USI measurement techniques demonstrated excellent within-day, interexaminer procedural reliability (ICCs: 0.82-0.85) and good-to-excellent between-day, interexaminer procedural reliability (ICCs: 0.72-0.79). The SEMs ranged from 0.36 to 0.46 cm; MDCs ranged from 1.01 to 1.26 cm. Regardless of the measurement technique, examiner 1, the more experienced examiner, demonstrated lower SEMs and MDCs than examiner 2. Lower ICCs, greater SEMs, and greater MDCs for USI multifidus thickness assessment in older adults with CLBP, when compared with previously published, procedural reliability results for younger adults with and without low back pain, may indicate that imaging is more challenging in this patient population. Factors, such as examiner training and participant anthropometrics, may impact reliability. Good-to-excellent intra- and interexaminer USI procedural reliability may provide clinicians a direct assessment technique for clinical evaluation of the lumbar multifidi in older adults with CLBP. SEMs and MDCs may allow for accurate interpretation of USI assessments in this population.