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Article

Learning Transversus Abdominis Activation in Older Adults with Chronic Low Back Pain Using an Ultrasound-Based Wearable: A Randomized Controlled Pilot Study

by
Luis Perotti
1,*,†,
Oskar Stamm
1,†,
Hannah Strohm
2,
Jürgen Jenne
2,
Marc Fournelle
3,
Nils Lahmann
1 and
Ursula Müller-Werdan
1,*
1
Department of Geriatrics and Medical Gerontology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13347 Berlin, Germany
2
Fraunhofer Institute for Digital Medicine MEVIS, 28359 Bremen, Germany
3
Department of Ultrasound, Fraunhofer Institute for Biomedical Engineering, 66280 Sulzbach, Germany
*
Authors to whom correspondence should be addressed.
†
These authors contributed equally to this work.
J. Funct. Morphol. Kinesiol. 2025, 10(1), 14; https://doi.org/10.3390/jfmk10010014
Submission received: 27 November 2024 / Revised: 23 December 2024 / Accepted: 30 December 2024 / Published: 1 January 2025
(This article belongs to the Special Issue Innovations in Physical Medicine and Rehabilitation for the Treatment of Musculoskeletal Disorders)
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Abstract

Background/Objectives: Chronic low back pain (CLBP) is prevalent among older adults and leads to significant functional limitations and reduced quality of life. Segmental stabilization exercises (SSEs) are commonly used to treat CLBP, but the selective activation of deep abdominal muscles during these exercises can be challenging for patients. To support muscle activation, physiotherapists use biofeedback methods such as palpation and ultrasound imaging. This randomized controlled pilot study aimed to compare the effectiveness of these two biofeedback techniques in older adults with CLBP. Methods: A total of 24 participants aged 65 years or older with CLBP were randomly assigned to one of two groups: one group performed self-palpation biofeedback, while the other group used real-time ultrasound imaging to visualize abdominal muscle activation. Muscle activation and thickness were continuously tracked using a semi-automated algorithm. The preferential activation ratio (PAR) was calculated to measure muscle activation, and statistical comparisons between groups were made using ANOVA. Results: Both groups achieved positive PAR values during all repetitions of the abdominal-draw-in maneuver (ADIM) and abdominal bracing (AB). Statistical analysis revealed no significant differences between the groups in terms of PAR during ADIM (F(2, 42) = 0.548, p = 0.58, partial η2 = 0.025) or AB (F(2, 36) = 0.812, p = 0.45, partial η2 = 0.043). Both groups reported high levels of exercise enjoyment and low task load. Conclusions: In conclusion, both palpation and ultrasound biofeedback appear to be effective for guiding older adults with CLBP during SSE. Larger studies are needed to confirm these results and examine the long-term effectiveness of these biofeedback methods.
Keywords: chronic low back pain; biofeedback; segmental stabilization; ultrasound imaging; preferential activation ratio; real-time; deep learning chronic low back pain; biofeedback; segmental stabilization; ultrasound imaging; preferential activation ratio; real-time; deep learning

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MDPI and ACS Style

Perotti, L.; Stamm, O.; Strohm, H.; Jenne, J.; Fournelle, M.; Lahmann, N.; Müller-Werdan, U. Learning Transversus Abdominis Activation in Older Adults with Chronic Low Back Pain Using an Ultrasound-Based Wearable: A Randomized Controlled Pilot Study. J. Funct. Morphol. Kinesiol. 2025, 10, 14. https://doi.org/10.3390/jfmk10010014

AMA Style

Perotti L, Stamm O, Strohm H, Jenne J, Fournelle M, Lahmann N, Müller-Werdan U. Learning Transversus Abdominis Activation in Older Adults with Chronic Low Back Pain Using an Ultrasound-Based Wearable: A Randomized Controlled Pilot Study. Journal of Functional Morphology and Kinesiology. 2025; 10(1):14. https://doi.org/10.3390/jfmk10010014

Chicago/Turabian Style

Perotti, Luis, Oskar Stamm, Hannah Strohm, Jürgen Jenne, Marc Fournelle, Nils Lahmann, and Ursula Müller-Werdan. 2025. "Learning Transversus Abdominis Activation in Older Adults with Chronic Low Back Pain Using an Ultrasound-Based Wearable: A Randomized Controlled Pilot Study" Journal of Functional Morphology and Kinesiology 10, no. 1: 14. https://doi.org/10.3390/jfmk10010014

APA Style

Perotti, L., Stamm, O., Strohm, H., Jenne, J., Fournelle, M., Lahmann, N., & Müller-Werdan, U. (2025). Learning Transversus Abdominis Activation in Older Adults with Chronic Low Back Pain Using an Ultrasound-Based Wearable: A Randomized Controlled Pilot Study. Journal of Functional Morphology and Kinesiology, 10(1), 14. https://doi.org/10.3390/jfmk10010014

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