Ultrasound Imaging as a Visual Biofeedback Tool in Rehabilitation: An Updated Systematic Review

Abstract

Rehabilitative ultrasound imaging (RUSI) is used by physical therapists as a feedback tool for measuring changes in muscle morphology during therapeutic interventions such as motor control exercises (MCE). However, a structured overview of its efficacy is lacking. We aimed to systematically review the efficacy of RUSI for improving MCE programs compared with no feedback and other feedback methods. MEDLINE, PubMed, SCOPUS and Web of Science databases were searched for studies evaluating efficacy data of RUSI to improve muscular morphology, quality, and/or function of skeletal muscles and MCE success. Eleven studies analyzing RUSI feedback during MCE were included. Most studies showed acceptable methodological quality. Seven studies assessed abdominal wall muscles, one assessed pelvic floor muscles, one serratus anterior muscle, and two lumbar multifidi. Eight studies involved healthy subjects and three studies clinical populations. Eight studies assessed muscle thickness and pressure differences during MCE, two assessed the number of trials needed to successfully perform MCE, three assessed the retain success, seven assessed the muscle activity with electromyography and one assessed clinical severity outcomes. Visual RUSI feedback seems to be more effective than tactile and/or verbal biofeedback for improving MCE performance and retention success, but no differences with pressure unit biofeedback were found.

Identifying Demographic, Clinical, Muscular and Histological Factors Associated with Ultrasound Cervical Multifidus Measurement Errors in a Chronic Neck Pain Population

“…The use of ultrasound imaging (US) is currently increasing among physiotherapists as is a portable, safe, accessible and low-cost (in comparison with other imaging methods) tool for a wide variety of purposes [ 1 ]. Currently, physiotherapists access US equipment for guiding invasive procedures in order to ensure the patients’ safety [ 2 ], as a visual feedback tool for guiding motor control exercises [ 3 ] and as an instrument for evaluating and monitoring musculoskeletal structures [ 4 ].…”

Efficacy of Electromyographic Biofeedback in Muscle Recovery after Meniscectomy in Soccer Players

“…Furthermore, it would be relevant in future studies to analyze possible differences between biofeedback modalities such as ultrasound imaging, pressure biofeedback units, and electromyography. In previous research, it has been observed that different types of feedback can generate different effects depending on the protocol applied and the type of injury [57], which could enrich the knowledge developed around the recovery processes and the use of biofeedback applied in the type of injury considered in this article.…”

Inter-Examiner Disagreement for Assessing Cervical Multifidus Ultrasound Metrics Is Associated with Body Composition Features

“…In addition to these advantages, clinicians currently demand biosensors with acceptable utility (i.e., reliability, specificity, sensitivity, and validity) as a complement or alternative to manual explorations [ 31 , 32 ]. Since recent developments in US technology allow the measurement of multiple objective metrics by using Doppler (for detecting and analyzing flows) [ 33 ], M-mode (for real-time feedback during muscle contractions or for measuring thickness changes) [ 34 ], or elastography (for measuring stiffness metrics) [ 35 ], along with the assessment of large structures that previously could not be entirely visualized in a single image (i.e., panoramic US) [ 36 ], this tool is one of the most attractive alternatives to these imaging methods to meet these demands.…”