Browsing by Author "Loghmani, M. Terry"
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Item A Handheld Quantifiable Soft Tissue Manipulation Device for Tracking Real-Time Dispersive Force-Motion Patterns to Characterize Manual Therapy Treatment(IEEE, 2023) Bhattacharjee, Abhinaba; Anwar, Sohel; Chien, Stanley; Loghmani, M. Terry; Physical Therapy, School of Health and Human SciencesObjective: Low back pain (LBP) is one of the leading neuromusculoskeletal (NMSK) problems around the globe. Soft Tissue Manipulation (STM) is a force-based, non-invasive intervention used to clinically address NMSK pain conditions. Current STM practice standards are mostly subjective, suggesting an urgent need for quantitative metrics. This research aims at developing a handheld, portable smart medical device for tracking real-time dispersive force-motions to characterize manual therapy treatments as Quantifiable Soft Tissue Manipulation (QSTM). Methods: The device includes two 3D load-cells to quantify compressive and planar-shear forces, coupled with a 6 degrees-of-freedom IMU sensor for acquiring volitionally adapted therapeutic motions while scanning and mobilizing myofascial restrictions over larger areas of the body. These force-motions characterize QSTM with treatment parameters (targeted force, application angle, rate, direction, motion pattern, time) as a part of post-processing on a PC software (Q-Ware©). A human case study was conducted to treat LBP as proof-of-concept for the device's clinical usability. Results: External validation of treatment parameters reported adequate device precision required for clinical use. The case study findings revealed identifiable therapeutic force-motion patterns within treatments indicating subject's elevated force-endurance with self-reported pain reduction. Conclusion: QSTM metrics may enable study of STM dosing for optimized pain reduction and functional outcomes using documentable manual therapy. Clinical trials will further determine its reliability and comparison to conventional STM. Significance: This medical device technology not only advances the state-of-the-art manual therapy with precision rehabilitation but also augments practice with reproducibility to examine neurobiological responses of individualized STM prescriptions for NMSK pathology.Item Acute Effects of Sound Assisted Soft Tissue Mobilization (SASTM) on Lower Extremity Flexibility, Isokinetic and Isometric Strength(2019-07) Beer, Jeffrey Allen; Bahamonde, Rafael E.; Loghmani, M. Terry; Naugle, Keith E.; Streepey, Jefferson W.SASTMTM is a myofascial technique used to mobilize soft tissue and aid in the elongation of soft tissue and create physiological change. The purpose of the study was to determine the acute effects of Sound Assisted Soft Tissue Mobilization (SASTMTM) on lower extremity hamstring strength (isokinetic & isometric) and flexibility. Thirty division III male athletes with limited ROM of ≤ 90o of knee extension with 90o of hip flexion while lying supine consented to volunteer. Each subject was treated and measured through a double-blinded experimental design where the subjects and tester were unaware of the real treatment being administered and measured. The research consisted of 4 visits (familiarization/baseline, and 3 data collection session). Testing sessions were conducted a week after the baseline session, followed by two sessions, 2 days and a week after the 1st session. Three different modalities (SASTMTM, Therapeutic Ultrasound and “The Stick”) were performed on a treatment leg, and the opposite leg served as a control. Data collection consisted of a warm-up on a cycle ergometer followed by one randomly chosen modality on the treatment leg. Data collection was conducted using a Cybex 300-isokinetic device and a digital goniometer. Isokinetic strength testing was performed at 60, 180 and 240o/s. Isometric testing was collected at 45o of knee flexion. Repeated two-way ANOVA’s (3-Treatment x 3-Time) were used for statistical analyses to determine the effects of interventions and the time on strength and flexibility. The statistical analyses resulted in no significant results (p≤.05) for acute effects for either strength or flexibility with respect to time, treatment or treatment and time interactions.Item Communication tools and strategies for interprofessional teamwork in a comprehensive pain assessment clinic in primary care(Elsevier, 2022-12-01) Glassburn, Susan; Delbridge, Emilee; Loghmani, M. Terry; Newton, April D.; Binion, Kelsey; Romito, Laura; Willis , Deanna R.; School of NursingThe Comprehensive Pain Assessment Clinic (CoPAC) is a grant-funded clinic embedded in a family medicine residency center providing care to an under-resourced urban population. This interprofessional clinic brings together 10 professions, including healthcare professionals, university faculty, and learners to assess patients with chronic pain. The focus of the clinic is to develop a functional and dynamic model of teamwork including communication strategies to facilitate assessment. The communication/teamwork tools and strategies include pre-visit preparation sheets, pre-visit team huddles, “teamlet” visits, handoff communication tools, care plan development, patient education, follow-up care coordination, and post-clinic debriefs, which are used for continuous quality improvement. The process model for the clinic, communication tools, and qualitative comments from learners are described. Lessons learned are discussed, including time management, intentional mentoring, interprofessional education and collaborative practice (IPECP) coordination, and implementation of best practices.Item Conference Report: 6th Annual International Symposium on Regenerative Rehabilitation(Future Medicine, 2018-06) Loghmani, M. Terry; Roche, Joseph A.; Physical Therapy, School of Health and Human SciencesThe 6th International Symposium on Regenerative Rehabilitation, hosted by the Alliance for Regenerative Rehabilitation Research and Training (AR3T), included a preconference meeting of institutional representatives of the International Consortium of Regenerative Rehabilitation, keynote talks from distinguished scientists, platform and poster presentations from experts and trainees, panel discussions and postconference workshops. The following priorities were identified: increasing rigor in basic, preclinical and clinical studies, especially the use of better controls; developing better outcome measures for preclinical and clinical trials; focusing on developing more tissue-based interventions versus cell-based interventions; including regenerative rehabilitation in curricula of professional programs like occupational and physical therapy; and developing better instruments to quantify rehabilitative interventions.Item Development of a Force Sensing Instrument Assisted Soft Tissue Mobilization Device(ASME, 2016-11) Alotaibi, Ahmed M.; Anwar, Sohel; Loghmani, M. Terry; Chien, Stanley; Mechanical Engineering, School of Engineering and TechnologyInstrument assisted soft tissue mobilization (IASTM) is a form of massage using rigid manufactured or cast devices. The delivered force, which is a critical parameter in massage during IASTM, has not been measured or standardized for most clinical practices. In addition to the force, the angle of treatment and frequency play an important role during IASTM. As a result, there is a strong need to characterize the delivered force to a patient, angle of treatment, and stroke frequency. This paper proposes a novel mechatronic design for a specific instrument from Graston Technique® (Model GT-3), which is a frequently used tool to clinically deliver localize pressure to the soft tissue. The design uses a 3D load cell, which can measure all three force components force simultaneously. The overall design is implemented with an IMUduino microcontroller chip which can also measure tool orientation angles and provide computed stroke frequency. The prototype of the mechatronic IASTM tool was validated for force measurements using an electronic plate scale that provided the baseline force values to compare with the applied force magnitudes measured by the device. The load cell measurements and the scale readings were found to be in agreement within the expected degree of accuracy. The stroke frequency was computed using the force data and determining the peaks during force application. The orientation angles were obtained from the built-in sensors in the microchip.Item Dysfunctional stem and progenitor cells impair fracture healing with age(Baishideng Publishing Group, 2019-06-26) Wagner, Diane R.; Karnik, Sonali; Gunderson, Zachary J.; Nielsen, Jeffery J.; Fennimore, Alanna; Promer, Hunter J.; Lowery, Jonathan W.; Loghmani, M. Terry; Low, Philip S.; McKinley, Todd O.; Kacena, Melissa A.; Clauss, Matthias; Li, Jiliang; Orthopaedic Surgery, IU School of MedicineSuccessful fracture healing requires the simultaneous regeneration of both the bone and vasculature; mesenchymal stem cells (MSCs) are directed to replace the bone tissue, while endothelial progenitor cells (EPCs) form the new vasculature that supplies blood to the fracture site. In the elderly, the healing process is slowed, partly due to decreased regenerative function of these stem and progenitor cells. MSCs from older individuals are impaired with regard to cell number, proliferative capacity, ability to migrate, and osteochondrogenic differentiation potential. The proliferation, migration and function of EPCs are also compromised with advanced age. Although the reasons for cellular dysfunction with age are complex and multidimensional, reduced expression of growth factors, accumulation of oxidative damage from reactive oxygen species, and altered signaling of the Sirtuin-1 pathway are contributing factors to aging at the cellular level of both MSCs and EPCs. Because of these geriatric-specific issues, effective treatment for fracture repair may require new therapeutic techniques to restore cellular function. Some suggested directions for potential treatments include cellular therapies, pharmacological agents, treatments targeting age-related molecular mechanisms, and physical therapeutics. Advanced age is the primary risk factor for a fracture, due to the low bone mass and inferior bone quality associated with aging; a better understanding of the dysfunctional behavior of the aging cell will provide a foundation for new treatments to decrease healing time and reduce the development of complications during the extended recovery from fracture healing in the elderly.Item Finite Element Simulation and Analysis of Drop Tests to Improve the Mechanical Design of a Handheld QSTM Medical Device(ASME, 2022-10-30) Bhattacharjee, Abhinaba; Loghmani, M. Terry; Anwar, Sohel; Electrical and Computer Engineering, School of Engineering and TechnologyThe structural integrity of an electro-mechanical assembly significantly determines the robustness of the design and durability of a product. Handheld portable medical devices require more attention on their compactness and packaging to ensure design fidelity for manufacturing and avoid permanent damages during inevitable drops or rough handling in a clinical setup. Hence, a finite element analysis is performed for quality conservation, risk assessment, and design failure mode error analysis. This paper investigates the mechanical impacts of drop tests on a handheld portable mechatronic medical device used to quantify real-time dispersive force-motion patterns in the form of Quantifiable Soft Tissue Manipulation (QSTM) for therapeutic massage, clinical manual therapy, and pain level assessments against neuro-musculoskeletal conditions. Structural analysis of the handheld medical device’s mechanical design and assembly has been performed by finite element methods to identify parts of assembly susceptible to maximum stress and deformation during static impact loading and impacts of collisions at drop test simulations. The CAD model of the medical device is illustrated and evaluated with material modeling and structural analysis to distinguish weaker supports and further reinforce them with modified design iterations. This analysis enabled a revised design of the QSTM device which showed significant reduction in stresses and deformations as compared to the baseline design.Item A Force Sensing Instrument Assisted Soft Tissue Mobilization Device(ASME, 2017-10) Alotaibi, Ahmed M.; Anwar, Sohel; Loghmani, M. Terry; Mechanical and Energy Engineering, School of Engineering and TechnologyInstrument assisted soft tissue mobilization (IASTM) is a form of massage using rigid manufactured or cast devices. The delivered force, which is a critical parameter in massage during IASTM, has not been measured or standardized for most clinical practices. There is a strong need to characterize the delivered force to a patient. This paper proposes a novel mechatronic design for a specific instrument to apply localized pressure which is a frequently used tool to clinically deliver localize pressure to treat soft tissue. The design is based on 1-D compression load cells, where 4-load cells are used to measure the force components in three-dimensional space. Here the proposed design of the mechatronic IASTM tool is modeled, analyzed, and simulated as a mechanical structure with simplifying assumptions on the elastic behavior of the skin under a certain amount of force conditions. A finite element model of a human arm is simulated to show the relationship between the applied forces, stress and strain on the skin, and force measurements to improve the design. The relation between device’s tip and the modeled arm was assumed to be frictional contact similar to the real IASTM practice.Item Instrument-assisted cross fiber massage increases tissue perfusion and alters microvascular morphology in the vicinity of healing knee ligaments(Springer Nature, 2013-09-28) Loghmani, M. Terry; Warden, Stuart J.; Physical Therapy, School of Health and Human SciencesBackground: Ligament injuries are common clinical problems for which there are few established interventions. Instrument-assisted cross fiber massage (IACFM) was recently shown to accelerate the restoration of biomechanical properties in injured rodent knee medial collateral ligaments (MCL). The current study aimed to investigate the influence of IACFM on regional perfusion and vascularity in the vicinity of healing rodent knee MCL injuries. Methods: Bilateral knee MCL injuries were induced in female Sprague-Dawley rats. Commencing 1 week post-injury, 1 minute of IACFM was introduced unilaterally 3 times/week for 3 weeks. The contralateral injured MCL served as an internal control. Regional tissue perfusion was assessed in vivo throughout healing using laser Doppler imaging, whereas regional microvascular morphology was assessed ex vivo via micro-computed tomography of vessels filled with contrast. Results: IACFM had no effect on tissue perfusion when assessed immediately, or at 5, 10, 15 or 20 min following intervention (all p > 0.05). However, IACFM-treated hindlimbs had enhanced tissue perfusion when assessed 1 day following the 4th and 9th (last) treatment sessions (all p < 0.05). IACFM-treated hindlimbs also had greater perfusion when assessed 1 wk following the final treatment session (32 days post-injury) (p < 0.05). Subsequent investigation of microvascular morphology found IACFM to increase the proportion of arteriole-sized blood vessels (5.9 to <41.2 μm) in the tibial third of the ligament (p < 0.05). Conclusions: These findings suggest IACFM alters regional perfusion and vascularity in the vicinity of healing rodent knee MCL injuries. This effect may contribute to the beneficial effect of IACFM observed on the recovery of knee ligament biomechanical properties following injury.Item International Expert Consensus on Instrument-Assisted Soft-Tissue Mobilization Precautions and Contraindications: A Modified Delphi Study(MDPI, 2025-03-15) Cheatham, Scott W.; Baker, Russell T.; Loghmani, M. Terry; Schleip, Robert; Physical Therapy, School of Health and Human SciencesBackground: Instrument-assisted soft-tissue mobilization (IASTM) is a popular myofascial intervention used by healthcare professionals. Despite the growing body of research evidence, there is still a gap in understanding what healthcare professionals consider as treatment precautions or contraindications. To date, no consensus on precautions and contraindications has been established among IASTM experts. The purpose of this modified Delphi survey was to determine IASTM precautions and contraindications among international IASTM experts. Methods: A three-round Delphi study of 24 international IASTM experts was conducted. In round 1, experts chose from a list of 81 medical conditions and treatment considerations that could be a concern for IASTM treatment. Consensus was considered if more than 70% of experts agreed on an item. Round 2 included the updated list of 39 items, and the experts decided if each item should be a precaution, contraindication, or both. The strength of agreement grade scale was used to rank the precautions and contraindications, by the level of expert agreement using grades A-D (e.g., A-strong, B-moderate, C-weak, D-both). Grade D conditions could potentially be both a precaution and contraindication. In round 3, the final list of categories and items was presented to the experts for final approval. Results: All recruited experts (n = 24) participated in the three rounds and the final list of items received 100% approval. Contraindications had the highest number of conditions (n = 16) across the strength of agreement grade categories A-C followed by category D (both) (n = 8). Discussion: This Delphi study was the first survey to document expert consensus on precautions and contraindications based upon the strength of agreement. This study offers a beginner's guide for clinicians to safely implement IASTM by establishing required precautions and contraindications through consensus agreement. Conclusions: This survey should be the first step in a series of planned IASTM studies on precautions and contraindications to establish the best-practice recommendations for the application of IASTM in clinical practice.