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At the inaugural Rehabilitative Ultrasound Symposium held in San Antonio, TX in 2007, the consensus was reached to adopt the title rehabilitative ultrasound imaging (RUSI) for the utilization of ultrasound imaging by physical therapy professionals. At the symposium, the delegates unanimously agreed to a ‘‘Rehabilitative Ultrasound Imaging International Consensus Statement’’ as follows: RUSI is a procedure used by physical therapists to evaluate muscle and related soft tissue morphology and function during exercise and physical tasks. RUSI is used to assist in the application of therapeutic interventions aimed at improving neuromuscular function. This includes providing feedback to the patient and physical therapist to improve clinical outcomes.

There are no specific PT codes for RUSI, it is a component of a standard timed charge that includes training of movement systems such as therapeutic activities, therapeutic exercise or neuromuscular re-education. The re-evaluation of muscle function in an established patient could be a component of a brief re-evaluation charge. Note, some Medicare intermediaries only accept neuromuscular re-ed when it accompanies a neurologic diagnosis (stroke, head trauma, Parkinson’s etc.)

Patients progress much faster when they can actually see the deep stabilizing muscles you want them to activate. The therapist can quickly observe suboptimal activation strategies and provide instantaneous feedback. The fact that your clinic is using state of the art technology to advance patient outcomes could be a strong marketing tool.

Surface EMG provides a quantitative value of the motor action potential of the pelvic floor muscles, but can not validate PFM lift which is associated with continence. RUSI can provide information on muscle morphology such as size, tissue quality as well as motor activation patterns for the PFM, abdominal wall, and lumbar stabilizers. The ability to evaluate post void residuals and rectal distention is invaluable for urinary frequency and pediatric patients.

Patients with overactive pelvic floor or abdominal muscles can clearly see their muscle activation pattern as well as a voluntary inhibition. This motor pattern is visible from a suprapubic view using the bladder as a window or a transperineal view observing the anterior and posterior compartment.

You should refer to your governing practice act, but currently there are no known requirements for certification for PTs performing RUSI in the US. Some provinces in Canada allow for limited use. Certifications for physical therapists do exist through third-party agencies. These are more for the orthopedic and sports medicine therapists evaluating for muscle conditions, none are recognized by the APTA. At present, RUSI training courses are offered through multiple continuing education companies to include Herman & Wallace Pelvic Rehabilitation Institute.

All purchases of the Pathway® RUSI system include access to online training videos and libraries via the EcoGen portal. Videos will also include clinical applications such as measuring bladder volume, male and female transperineal imaging plus a library of stored images with labels and select patient cases. The EcoGen Portal is designed to augment clinical application, not a substitute for classroom learning.  Hands-on rehabilitative ultrasound imaging courses are available through Herman & Wallace.  For course dates and locations, click here.

Yes, however your computer must have the correct specifications which includes a high optical resolution of at least 1366 x 786. If not, your image will be poor and structures difficult to visualize. You will also need to have at minimum a Core 16 2.3 GHZ processor with 4GB of RAM and a 500 GB hard drive. The tablet that has been chosen for the system is specially selected for its compatibility for RUSI image display.

The current software is only Windows compatible; it will display on a Windows tablet or laptop and has touch-screen capabilities.

When an image is saved, you have the option of sending a copy of that image to a flash drive as a JPG. Most EMR’s have an “import file” function you can use to copy the files into the medical record.