Applications for Sonography in Hand Therapy
Sonographic imaging has numerous potential applications for enhancing rehabilitative care as part of an occupation-centered intervention plan within hand therapy. Our work resulted in multiple findings supporting the use of sonography within hand therapy.
- Evidence places point-of-care sonographic imaging of musculoskeletal structures at the intersection of subjective reports, objective findings, and functional performance. This convergence has important implications for improving intervention efficacy through enhanced clinical reasoning and for advancing evidence that substantiates clinical interventions.
- Sonography has exceptional potential to augment the biopsychosocial principles central to occupational therapy interventions. A growing body of evidence supports the use of integrative, mind–body interventions to reduce clients’ length of stay in a clinical setting and speed recovery. Hand therapy practitioners can use sonographic imaging for patient education and dynamic visual biofeedback during functional activity performance to actively engage patients and establish a mind-body connection.
Further examination of implementation strategies and development of occupation-centered imaging interventions, training models, and definitions of clinical competency is necessary to ensure that hand therapy practitioners are adequately informed and prepared to use this technology to ensure therapists continue to provide efficient, effective care required by the medical system. The MSOP research lab is actively engaged in examining new techniques and protocols for the use of musculoskeletal songoraphy within upper extremity rehabilitation including applications such as:
- Biofeedback and patient education to support productive movement post-injury
- Examination of healing in post-surgical flexor tendon repair patients
- Evaluation of treatment effects in patients with systemic sclerosis (i.e., scleroderma)
- Exploration of the cause of non-specific pain
Novel precision medicine approach to advance rehabilitation of surgically reparied tendons of the hand
National Institute of Arthritis and Musculoskeletal and Skin Diseases / National Institutes of Health
F31-AR074894 (PI: Takata; Sponsor: Roll)
Total Funding: $90,032
Funding Period: 8/1/19 – 7/31/21
Informing a precision medicine approach to post-surgical flexor tendon rehabilitation using sonography
American Hand Therapy Foundation
(PI: Takata; Co-I: Roll)
Total Funding: $5,000
Funding Period: 4/1/19 – 12/31/20
Development of a songorahpic image acquisition ana analysis protocol for surgically repaired flexor tendons of the hand
Soceity for Diagnostic Medical Sonography Foundation
(PI: Takata; Co-I: Roll)
Total Funding: $6,350
Funding Period: 7/1/19 – 6/30/21
Quantifying songoraphic changes in upper extremity tissue integrity following application of negative pressure in patients with systemtic sclerosis
(PI: Murphy; Consultant: Roll)
Total Funding: $9,000
Funding Period: 3/1/19 – 2/28/20
Rehabilitation Research Career Development Program
K12-HD055929 (PI: Ottenbacher, Scholar: Roll)
Funding Period: 9/1/11 – 8/31/16
Gray, J. M., Frank, G., & Roll, S. C. (2017). Integrating musculoskeletal sonography into rehabilitation: Therapists' experiences with training and implementation. OTJR: Occupation, Participation and Health, 37(1), 40-49. https://doi.org/10.1177/1539449216681275 Show abstract
Musculoskeletal sonography is rapidly extending beyond radiology; however, best practices for successful integration into new practice contexts are unknown. This study explored non-physician experiences with the processes of training and integration of musculoskeletal sonography into rehabilitation. Qualitative data were captured through multiple sources, and iterative thematic analysis was used to describe two occupational therapists' experiences. The dominant emerging theme was competency, in three domains: technical, procedural, and analytical. In addition, three practice considerations were illuminated: (a) understanding imaging within the dynamics of rehabilitation, (b) navigating nuances of interprofessional care, and (c) implications for post-professional training. Findings indicate that sonography training for rehabilitation providers requires multi-level competency development and consideration of practice complexities. These data lay a foundation on which to explore and develop best practices for incorporating sonographic imaging into the clinic as a means for engaging clients as active participants in the rehabilitation process to improve health and rehabilitation outcomes.
Roll, S. C., Asai, C., & Tsai, J. (2016). Clinical utilization of musculoskeletal sonography involving non-physician rehabilitation providers: A scoping review. European Journal of Physical and Rehabilitation Medicine, 52(2), 253-262. Full text Show abstract
Background. Musculoskeletal sonography use in point-of-care physical medicine and rehabilitation is rapidly expanding, not only by physiatrists, but also by non-physician rehabilitation providers.
Aim. To evaluate the current range, extent and nature of literature and to identify emerging areas of evidence for the use of musculoskeletal sonography involving non-physician rehabilitation providers to guide research and clinical practice.
Design. Scoping Review
Setting. Inpatient, Outpatient, Other
Population. Musculoskeletal conditions
Methods. Five databases were searched and 578 unique abstracts were identified and screened for eligibility. Three raters independently read 68 full texts and 36 articles that reported on applied uses of sonography by non-physician rehabilitation providers were included.
Results. Eighteen studies described direct clinical use, primarily for outcomes measurement (n=12) or as a biofeedback intervention (n=10). Twelve laboratory studies were included that related morphology to patient reports or validated clinical interventions. Six additional studies, although not involving non-physician providers, were included as they presented potential valuable uses that were not noted in the other included studies, such as monitoring bone healing, tendon repair, and evaluation of idiopathic symptom reports or non-specific primary diagnoses.
Conclusion. This review indicates that non-physician rehabilitation providers use sonography for outcomes measurement and biofeedback interventions. Research is needed to evaluate effects of these uses on patient outcomes and to explore additional potential uses for clinical reasoning, treatment planning, and monitoring of tissue healing related to intervention.
Clinical Rehabilitation Impact. Implementation of musculoskeletal sonography by non-physician rehabilitation providers has the potential to be a critically advantageous addition to improve care.
Roll, S. C., Gray, J. M., Frank, G., & Wolkoff, M. (2015). Exploring occupational therapists' perceptions of the usefulness of musculoskeletal sonography in upper-extremity rehabilitation [Brief report]. American Journal of Occupational Therapy, 69(4), 6904350020p1-6904350020p6. https://doi.org/10.5014/ajot.2015.016436 Show abstract
Objective. To identify the potential utility of musculoskeletal sonographic imaging in upper-extremity rehabilitation.
Method. Two occupational therapists in an outpatient hand rehabilitation clinic were recruited by convenience, were trained in the use of sonography, and implemented sonographic imaging in their clinical practice. Qualitative data were obtained during and after the implementation period by means of questionnaires and interviews. Data collection, analysis, and interpretation were completed in an iterative process that culminated in a thematic analysis of the therapists' perceptions.
Results. The data indicate four potential areas of utility for musculoskeletal sonography in upper-extremity rehabilitation: (1) mastering anatomy and pathology, (2) augmenting clinical reasoning, (3) supplementing intervention, and (4) building evidence.
Conclusion. Numerous potential uses were identified that would benefit both therapist and client. Further exploration of complexities and efficacy for increasing patient outcomes is recommended to determine best practices for the use of musculoskeletal sonography in upper-extremity rehabilitation.
Roll, S. C. (2015). Role of sonographic imaging in occupational therapy practice [In brief]. American Journal of Occupational Therapy, 69(3), 6903360010p1-6903360010p8. https://doi.org/10.5014/ajot.2015.015941 Show abstract
Occupational therapy practice is grounded in the delivery of occupation-centered, patient-driven treatments that engage clients in the process of doing to improve health. As emerging technologies, such as medical imaging, find their way into rehabilitation practice, it is imperative that occupational therapy practitioners assess whether and how these tools can be incorporated into treatment regimens that are dually responsive to the medical model of health care and to the profession's foundation in occupation. Most medical imaging modalities have a discrete place in occupation-based intervention as outcome measures or for patient education; however, sonographic imaging has the potential to blend multiple occupational therapy practice forms to document treatment outcomes, inform clinical reasoning, and facilitate improved functional performance when used as an accessory tool in direct intervention. Use of medical imaging is discussed as it relates to occupational foundations and the professional role within the context of providing efficient, effective patient-centered rehabilitative care.
Complete Presentation List
Roll, S. C., & Aguillon, A. (2017). Diagnostic ultrasonography: A clinical tool for occupational therapists. Tech Day presentation at 95th Annual Conference of the American Occupational Therapy Association, Philadelphia, PA.
Roll, S. C., McLaughlin-Gray, J., & Frank, G. (2016). Training and competency development for the clinical implementation of musculoskeletal sonography by hand therapists. Paper presentation at 39th Annual Meeting of the American Society of Hand Therapists, Washington, DC.
Roll, S. C., McLaughlin-Gray, J., & Hardison, M. E. (2016). Musculoskeletal sonography of the upper extremity: Training and implementation in the rehabilitation clinic. Poster presentation at 96th Annual Conference of the American Occupational Therapy Association, Chicago, IL.
Roll, S. C., McLaughlin-Gray, J., Frank, G., & Wolkoff, M. (2015). Therapist perceptions of the utility of sonographic imaging in the rehabilitation of musculoskeletal disorders. Paper presentation at 4th Annual Occupational Therapy Summit of Scholars, Los Angeles, CA.
Roll, S. C., McLaughlin-Gray, J., & Frank, G. (2015). Competency development and complexities of clinical integration of musculoskeletal sonography by non-physician rehabilitation providers. Research paper presented at the 15th World Congress of Ultrasound in Medicine and Biology, Orlando, FL.
Roll, S. C., McLaughlin-Gray, J., & Frank, G. (2015). Therapist perceptions of the utility of sonographic imaging in the rehabilitation of musculoskeletal disorders. Poster presentation at 95th Annual Conference of the American Occupational Therapy Association, Nashville, TN.
Roll, S. C. (2014). Introducing musculoskeletal sonography, part I: Structures and pathologies of the hand. Instructional course presented at American Society of Hand Therapists Annual Meeting, Boston, MA.
Roll, S. C. (2014). Introducing musculoskeletal sonography, part II: Clinical applications for hand therapy. Instructional course presented at American Society of Hand Therapists Annual Meeting, Boston, MA.
Roll, S. C., Rocker, J. D., & Aguillon, A. (2014). Enhancing treatment for patients with pain and limitations in functional hand use with sonography. Short course presentation at 94th Annual Conference of of the American Occupational Therapy Association, Baltimore, MD.
Roll, S. C., Rocker, J. D., & Aguillon, A. (2014). Dynamic, real-time visualization of musculoskeletal tissues using sonography. Tech Day presentation at 94th Annual Conference of of the American Occupational Therapy Association, Baltimore, MD.
Roll, S. C., Rocker, J. D., & Aguillon, A. (2013). Hands-on sonographic imaging for hand therapists. Continuing education workshop for Hand Therapy Society of Greater Los Angeles, November 2013.
Wolkoff, M., McLaughlin-Gray, J., Frank, G., & Roll, S. C. (2013). Therapist perceptions of implementation of musculoskeletal sonography in hand therapy. Poster presented at American Society of Hand Therapists Annual Meeting, Chicago, IL.
Tsai, J., & Roll, S. C. (2013). Applications for musculoskeletal sonography in orthopedic rehabilitation: A scoping review. Poster presented at American Society of Hand Therapists Annual Meeting, Chicago, IL.
Roll, S. C., Rocker, J. D., Aguillon, A., & Wolkoff, M. (2013). If only I could see inside! Cutting edge use of sonography to enhance upper extremity orthopedic rehabilitation. Workshop presented at 93rd Annual Conference of the American Occupational Therapy Association, San Diego, CA.
Roll, S. C. (2013). Diagnostic ultrasonography: A clinical tool for occupational therapists. Tech Day presentation at 92nd Annual Conference of the American Occupational Therapy Association, Indianapolis, IN.