Back to the iPad – explaining spinal conditions to your patients using iSpineCare

Regular blog readers will recall previous posts describing a range of different anatomy applications for the iPhone and iPad, useful for both learning anatomy and for patient education. A particular favourite of mine thus far has been the 3D4Medical series of Apps discussed in a previous blog post, describing anatomy and pathology of various joints in the body, but these have not included an app designed specifically to cover just anatomy and pathology of the spine to date.

Anatomate-Apps (anatomical animation applications) is a Australian Company founded in 2009  by Dr John Hart, in order to develop iTunes applications designed by clinicians involved in the assessment and treatment of patients with spinal conditions, for use as patient education tools.

The over-riding idea is that patients who are given visual and spoken information in the form of interactive digital media during the consultation may experience an improved quality of care overall, as they are better informed about their condition(s) in a way that they can easily understand, and can then go on to make better informed decisions about their subsequent care.

Whilst there are some patients and clinicians such as myself who undoubtedly welcome these applications for use during the consultation, there are other patients and clinicians who will prefer a more traditional approach. Nevertheless, it is hard to argue against the view that the use of applications designed for patient education on the new iDevices is likely to significantly increase in the future, and I for one am using these more and more in my patient consultations to good effect.

iSpineCare is the first spinal anatomy and patient education application for iDevices that I have come across with such a comprehensive and accurate description of spinal anatomy and pathology. Constituting a hefty download at around 1.7GB of information on iPhone or iPad, the application consists of a main menu with folders relating to cervical and lumbar spinal anatomy, movements, and pathologies together with a folder of conservative care options and an exercise library folder.

Navigating through the different sections is easy and quick, and takes you to a context-specific menu which contains links to a series of movies which can be paused, rewound, or fast-forwarded to different points of interest, together with an image library of key stills from the movies allowing for prolonged discussion around particular points of interest. In addition, a pdf document linked to each movie is presented giving a more detailed explanation of different topics.

Another bonus is the availability of medical imaging alongside the individual movies. This section contains a series of x-rays, CT scans and MRI scans and has interactive labels  and reports to help to explain the images further to patients. This section may also be useful for junior clinicians to assist with learning about spinal pathology from a visual perspective.

The quality of the images and in particular the movies is outstanding, with crystal-clear animations allowing for easy recognition of the relevant spinal anatomy and pathologies. Some of the movies have voice-overs explaining salient points, whereas others are animation-only allowing for the clinician to talk the patient through the particular points of interest important for that individual patient to be aware of and focus on during the consultation. In addition, there is a section where particular images can be added to a list of the user’s favourite movies allowing for quick access to a particular user’s most often-used animations.

Another section of movies under the folder ‘Conservative Care’ offers a number of movies describing back-safe ways of performing everyday duties such as gardening, shopping and typing. There are also movies offering advice on a variety of lifestyle topics.

Finally, there is an ‘Exercise Library’ folder with several sub-folders offering animations describing a series of exercises for different purposes including cervical flexibility exercises and core stability exercises.

The overall package is very slick, well thought-out, and accurate in the descriptions of spinal pathologies and anatomical features. Stand-out points are the quality of the animations and the wide range of animations available. An internet connection is not necessary for the app to run, as all of the animations are downloaded embedded within the main app.

Anatomate-Apps also offers other similar applications describing spinal surgery (iSpineOperations) and pain management (iSpinePainManagement), and there are some smaller-sized applications offering information focussed on some particular aspects of spinal pathologies and operations for those who don’t need the larger apps.

As a Sport and Exercise Medicine Physician, I would have liked a little more emphasis on some of the conditions more commonly seen in my patient population including symptomatic spondylolysis, and cervical ‘stingers’ and ‘burners.’  However, most common pathologies are well represented and I can see iSpineCare and iSpinePainManagement becoming an important part of my clinical practice in the future.

Anatomate-Apps are available on the iTunes Apps store, and a video review of iSpineCare highlighting some of its features is available from the App show iPad edition on the link below.

Next generation of anatomy apps for learning and patient education here NOW!!

Regular readers of the blog may remember the previous post on anatomy applications (apps) back in June last year, when I presented my top 5 anatomy apps on the Apple apps store for both learning anatomy and educating patients.

For those of you who need a quick reminder, apps from the Apple store are computer programs that work on several Apple-platform mobile devices including iPads, iPhones and the iPod touch, with certain apps and features within apps being available only on certain devices, limited only by hardware and next generation development issues. For example, the iPad 2 has an integrated camera whereas the first generation device had none. The value of anatomy apps lies both within clinician and patient education.

The next generation of anatomy apps are now available from 3D4Medical, running on both first and second generation iPads. There are updates for both of the Skeletal System and Muscle System Pro Nova apps (now in their 3rd editions), and new dedicated apps for the hip joint, knee joint and shoulder joint which include the complete anatomy of these regions including musculoskeletal anatomy, nervous system and vascular anatomy.

I am pleased to say that there has been a significant improvement to the existing apps which were already excellent in quality. Now, they are simply outstanding in many ways. The quality of the visuals has not gone unnoticed by Apple themselves who have showcased some of the apps on their latest TV adverts. The images really are stunning when seen on the iPad.

Both Skeletal and Muscle System Pro Nova III apps come with a new interface which allows for simpler navigation. Images can be more easily manipulated than before for different viewing angles allowing for simpler rotation, single finger-swipe cuts for coronal, saggital and transverse views, and a double-tap zoom feature. This allows you to get to the images you really want to see much quicker than before. There is a hint feature to help you to get to grips with the new graphical interface features which can be turned off once you get used to these. Pin Media labels are more extensive, and these are now spoken to allow users to hear the correct pronunciation of each anatomical feature.

The pin labels themselves now come with additional media, such as animations of anatomical movements or further images. There are also linked public notes which allows for users to read notes made by other users of the apps in the public domain. The images can be easily annotated, and shared with patients or other people who may wish to view them by email and social media via twitter and Facebook.

The new dedicated apps are perhaps the ones of most interest to clinicians, for the first time including all of the relevant anatomy of the regions to give a clear picture of the entire anatomy from surface to bone. The clarity of images within these apps is outstanding, and the animations are especially helpful for explaining how certain muscles produce certain movements to patients. Structures such as the subacromial bursa in the shoulder can easily be visualised, and when combined with the animations showing movement at the shoulder joint, it is much easier than before to explain to patients how impingement of this structure can occur under the subacromial arch.

You can check out the new features in the Knee Pro Nova video below (will only show on standard site).

Having used the earlier apps during my patient consultations as an educational tool, I have now started to use these new apps and have found them easier to use both in the consulting room and at the training ground than the previous incarnations. Patients seem to gain a better understanding of the anatomy relevant to their injuries or conditions when seeing the visuals, and the multimedia content really helps to bring functional anatomy to life.

Perhaps future additions to the series might include videos specifically related to pathologies. Examples might be video image of an inflamed bursa impinging under the subacromial arch, a ruptured anterior cruciate ligament in real time, or the dynamic anatomy of a snapping hip. For now, however, these apps give clinicians an extremely powerful set of tools for patient education, and for learning anatomy.

For further information on 3D4Medical’s new apps, see the 3D4Medical website, or check out videos of the other apps on youtube via these links :

Shoulder Pro

Hip Pro

Skeletal System Pro III (Nova Series)

Muscle System Pro III (Nova Series)

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Groin problems keep two prominent 100 meter sprinters out of the World Championships

The Jamaican 100 meter sprinter and former twice world record holder at that distance, Asafa Powell, is the latest big name to pull out of a forthcoming event with a groin problem. Powell apparently originally developed symptoms following a race in Budapest in July this year, and later pulled out of the London Grand Prix hoping that things would settle in time for him to be able to compete at the World Championships in Daegu, South Korea later this month. However, he was forced to pull out of the 100 meter heats, although may make himself available for the 4 x 100m relay on the 4th of September.

Powell is the second high profile athlete who is unable to compete at the World Championships at the 100m distance, with Tyson Gay having previously undergone arthroscopic surgery on his hip earlier this year. Gay was reported to have been suffering from hip impingement, according to his surgeon Dr Marc Phillipon.

Groin pain is surely one of the most frustrating conditions suffered by those who participate in sport, and presents one of the trickiest diagnostic challenges for Sports Physicians, especially in its chronic presentation. Acute hip and groin pain often occurs in those sports that require quick changes in direction and kicking such as soccer, and chronic groin pain similarly tends to occur in those who participate in sports in which explosive sprints are combined with twisting and kicking. The diagnostic challenge of chronic groin pain presents due to a combination of factors, including complex regional anatomy, the heterogeneity of sites where pain occurs and tenderness can be elicited, and often the co-existence of a number of different pathologies including some of the more obscure, less well-recognised conditions such as obturator nerve entrapment, described here in CJSM by Bradshaw and McCrory.

In a paper published in BJSM in 2007, Per Hölmich identified 3 primary patterns of longstanding groin pain amongst 207 consecutive athletes involved in a number of different sports using a standardised clinical examination programme, categorising patterns related to adductor-related dysfunction, iliopsoas-related dysfunction, and rectus abdominis-related dysfunction together with combinations of these patterns. This concept of clinical entities was later extended in the 3rd Edition of Clinical Sports Medicine by Brukner and Khan to include pubic bone stress-related dysfunction, but how useful this concept is in Clinical Practice continues to be a subject for debate.

Falvey and colleagues, in a paper in the British Journal of Sports Medicine, more recently attempted to make sense of the so-called ‘groin triangle,’ suggesting a ‘novel educational model based on patho-anatomical concepts’ in order to assist in the diagnosis of chronic groin pain in athletes.

Even more recently, Bizzini described the groin area as the ‘Bermuda triangle’ of sports medicine, and I think that it is fair to say that most clinicans will continue to find themselves lost from time-to-time when assessing their patients with groin pain.

Any tips from our blog readers on the assessment of chronic groin pain? CJSM would love to hear your practice pearls.

(picture by Chell Hill, 2010)

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