The effects of two different visual feedback exercise tools based on rehabilitative ultrasound imaging in the elderly

Objective: This study aimed to investigate the effects of an ultrasound-based bar graph proportional to the quadriceps muscle thickness as a real-time visual feedback training tool in the elderly. Design: Cross-sectional study. Methods: Twenty-four elderly persons participated in this study and were randomly divided into three groups: oral training group (n=8, group 1), ultrasound imaging group (n=8, group 2), and graph group (n=8, group 3). In the pre condition, all participants performed maximal voluntary isometric contraction (MVIC) of the quadriceps with knee extension three times with oral training. In the post condition, group 1 performed MVIC of the quadriceps with oral training, group 2 performed MVIC of the quadriceps with real-time visual feedback using ultrasound imaging, and group 3 performed MVIC of the quadriceps with real-time visual feedback using a bar graph proportional to the quadriceps muscle thickness, three times for all groups. Muscle thickness, activity (mean, peak), tone, stiffness, logarithmic decrement, relaxation, and creep were measured in both conditions in all participants. Results: Visual feedback with a bar graph showed significant effects on muscle thickness, mean muscle activity, and peak muscle activity compared with oral training and visual feedback with ultrasound imaging (p<0.05). Conclusions: Isometric training of the quadriceps with real-time visual feedback using a bar graph proportional to the quadriceps muscle thickness may be more effective than other methods in improving muscle thickness and muscle activity. This study presented a tool that can help increase muscle thickness in the elderly.