scholarly journals Volume and intramuscular fat content of upper extremity muscles in individuals with chronic hemiparetic stroke

2019 ◽  
Author(s):  
Lindsay R. P. Garmirian ◽  
Ana Maria Acosta ◽  
Ryan Schmid ◽  
Jules P. A. Dewald
Keyword(s):  
Upper Extremity ◽  
Muscle Atrophy ◽  
Upper Limb ◽  
Intramuscular Fat ◽  
Muscle Volume ◽  
Contractile Element ◽  
Paretic Limb ◽  
Hemiparetic Stroke ◽  
Chronic Hemiparetic Stroke ◽  
Wrist Flexors

AbstractStroke survivors often experience upper extremity deficits that make activities of daily living (ADLs) like dressing, cooking and bathing difficult or impossible. Survivors experience paresis, the inability to efficiently and fully activate muscles, which combined with decreased use of the upper extremity, will lead to muscle atrophy and potentially an increase in intramuscular fat. Muscle atrophy has been linked to weakness post stroke and is an important contributor to upper extremity deficits. However, the extent of upper extremity atrophy post hemiparetic stroke is unknown and a better understanding of these changes is needed to inform the direction of intervention-based research. In this study, the volume of contractile tissue and intramuscular fat in the elbow and wrist flexors and extensors were quantified in the paretic and non-paretic upper limb using MRI and the Dixon technique for the first time. Total muscle volume (p≤0.0005) and contractile element volume (p≤0.0005) were significantly smaller in the paretic upper extremity, for all muscle groups studied. The average percent difference between limbs and across participants was 21.3% for muscle volume and 22.9% for contractile element volume. We also found that while the percent intramuscular fat was greater in the paretic limb compared to the non-paretic (p≤0.0005), however, the volume of intramuscular fat was not significantly different between upper limbs (p=0.231). The average volumes of intramuscular fat for the elbow flexors/extensors and wrist flexors/extensors were 28.1, 28.8 and 19.9, 8.8 cm3 in the paretic limb and 29.6, 27.7 and 19.7, 8.8 cm3 in the non-paretic limb. In short, these findings indicate a decrease in muscle volume and not an increase in intramuscular fat, which will contribute to the reduction in strength in the paretic upper limb.

scholarly journals Reduction in voluntary activation of elbow and wrist muscles in individuals with chronic hemiparetic stroke

2019 ◽  
Author(s):  
Lindsay R. P. Garmirian ◽  
Julius P. A. Dewald ◽  
Ana Maria Acosta
Keyword(s):  
Upper Extremity ◽  
Voluntary Activation ◽  
Force Output ◽  
Twitch Interpolation ◽  
Paretic Limb ◽  
Full Capacity ◽  
Muscle Groups ◽  
Hemiparetic Stroke ◽  
Chronic Hemiparetic Stroke ◽  
Wrist Flexors

AbstractAfter a stroke, descending drive is impaired due to the loss of corticospinal and corticobulbar projections which causes a reduction in voluntary activation or an inability of the nervous system to activate muscles to their full capacity, which in turn contributes to weakness of the upper extremity. Voluntary activation has not been quantified at specific joints in the upper extremity, in part because directly assessing changes descending drive is difficult. In this study, voluntary activation of elbow and wrist flexors and extensors was assessed in participants with chronic hemiparetic stroke using twitch interpolation. Twitch interpolation uses electrical stimulation to estimate voluntary activation and relies on the principle that there is an inverse relationship between the amplitude of a twitch evoked by a stimulus and the voluntary force output during stimulation (Taylor, 2009). We measured voluntary activation using twitch interpolation as well as maximum voluntary torque (MVT) of the elbow and wrist flexors and extensors in the paretic and non-paretic limb of ten participants post stroke and the dominant and non-dominant limb of 2 control participants. Results show, MVT interlimb differences were significantly greater for stroke participants compared to control, across muscle groups (p≤0.005). For stroke participants, MVT interlimb differences were significantly greater at the wrist compared to the elbow (P=0.003). Voluntary activation was significantly less in the paretic limb compared to the non-paretic, dominant and non-dominant limbs, across participants and muscle groups (p<0.005 for all four muscle groups). For the stroke participants, the voluntary activation interlimb difference was significantly greater for the wrist muscles compared to the elbow muscles (p<0.005). There was a significant positive correlation (r = 0.39, P = .022) between each participant’s impairment level, as measured by a hand specific subscore of the Fugl-Meyer Assessment, and the wrist extensor voluntary activation in the paretic limb but the relationship was not significant for the other muscle groups.

Virtual Rehabilitation Use for Paretic Upper Limb for Individuals with Chronic Hemiparetic Stroke

2016 ◽  
pp. 101-111
Author(s):  
Renata Cristina Magalhães Lima ◽  
Ana Paula Dias de Menezes ◽  
Maria Carolina Gomes Inácio ◽  
Silvia Moreira Amaral ◽  
Regiane Relva Romano
Keyword(s):  
Upper Limb ◽  
Virtual Rehabilitation ◽  
Hemiparetic Stroke ◽  
Chronic Hemiparetic Stroke

Investigation of the effects of mirror therapy on the spasticity, motor function and functionality of impaired upper limbs in chronic stroke patients

2019 ◽  
Vol 26 (7) ◽  
pp. 1-9
Author(s):  
Luciana Protásio de Melo ◽  
Valton da Silva Costa ◽  
Júlio César Cunha da Silveira ◽  
Tatiana Catarina Albuquerque Clementino
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Functional Independence ◽  
Mirror Therapy ◽  
Stroke Patients ◽  
Number Of Patients ◽  
Limb Spasticity ◽  
Hemiparetic Stroke ◽  
Chronic Hemiparetic Stroke ◽  
The Impact

Background/Aims Strokes lead to different levels of disability. During the chronic stage, hemiparesis, spasticity and motor deficits may cause loss of functional independence. Mirror therapy aims to reduce deficits and increase functional recovery of the impaired upper limb. This study aimed to evaluate the effects of mirror therapy on upper limb spasticity and motor function, as well as its impact on functional independence in chronic hemiparetic patients. Methods In this quasi-experimental study, eight chronic hemiparetic patients (age 55.5 ± 10.8 years) were assessed to determine their degree of spasticity (Modified Ashworth Scale), level of upper limb motor function (Fugl-Meyer Assessment) and functionality (Functional Independence Measure). All participants received 12 sessions of mirror therapy delivered three times per week, over a period of 4 weeks. Participants were re-evaluated post-intervention and these results were compared to their pre-intervention scores to determine the impact of mirror therapy. Results A decrease in spasticity was observed, with significant improvements in shoulder extensors (P=0.033) and a significant increase in motor function (P=0.002). The therapeutic protocol adopted did not have a significant effect on functional independence (P=0.105). Conclusions Mirror therapy led to improvements in upper limb spasticity and motor function in chronic hemiparetic stroke patients. No effects on functional independence were observed. Further research with a larger number of patients is needed to provide more robust evidence of the benefits of mirror therapy in chronic hemiparetic stroke patients.

Hemiparetic Gait Parameters in Overground Versus Treadmill Walking

2001 ◽  
Vol 15 (2) ◽  
pp. 105-112 ◽  
Author(s):  
Michelle L. Harris-Love ◽  
Larry W. Forrester ◽  
Richard F. Macko ◽  
Kenneth H. C. Silver ◽  
Gerald V. Smith
Keyword(s):  
Gait Pattern ◽  
Supporting Evidence ◽  
Gait Symmetry ◽  
Paretic Limb ◽  
Hemiparetic Gait ◽  
Gait Parameters ◽  
Stance Time ◽  
Hemiparetic Stroke ◽  
Chronic Hemiparetic Stroke ◽  
Sparse Methods

Objective: Hemiparetic gait is characterized by high stride-cycle variability, di minished stance time, single-limb stance time, and stance/swing ratio in the paretic limb. Recent studies suggest treadmill (TM) training may improve the motor control underlying these variables, but supporting evidence is sparse. Methods: This study compared gait patterns of untrained chronic hemiparetic stroke patients (n = 18; mean, 39.5 months poststroke) during overground (OG) and TM walking at matched velocities. Variables included relative stance time, relative single-limb stance time, stance/swing ratio, peak force, and impulse. Within-subject variability of these meas ures (CV) was used to assess gait pattern stability. Results: OG and TM cycle dura tions were similar, but CVs differed (TM < OG, p < 0.05). In the paretic limb, dif ferences were seen in relative stance time, relative single-limb stance time, and stance/swing ratio, respectively (TM > OG, p < 0.05). These variables decreased in the nonparetic limb during TM walking (p < 0.05 for all). Improved interlimb sym metry and coordination were evidenced by decreased between-limb differences and improved relative temporal phasing, respectively, in the TM condition (p < 0.05). Conclusions: Collectively, these results demonstrate that the TM induces an imme diate alteration toward a more consistent and symmetric gait pattern. Further inves tigation is needed to determine whether TM training leads to motor relearning and neuroplasticity in chronic hemiparetic subjects. Key Words: Stroke—Rehabilitation— Hemiparetic gait-Treadmill-Gait symmetry.

scholarly journals Muscle Atrophy and Functional Deficits of Knee Extensors and Flexors in People With Chronic Stroke

2012 ◽  
Vol 92 (3) ◽  
pp. 429-439 ◽  
Author(s):  
Christiane L. Prado-Medeiros ◽  
Milla P. Silva ◽  
Giovanna C. Lessi ◽  
Marcela Z. Alves ◽  
Alberto Tannus ◽  
...  
Keyword(s):  
Motor Function ◽  
Muscle Atrophy ◽  
Peak Torque ◽  
Quadriceps Muscle ◽  
Chronic Stroke ◽  
Muscle Volume ◽  
Knee Extensors ◽  
Control Group ◽  
Hamstring Muscle ◽  
Paretic Limb

BackgroundFurther clarification is needed with regard to the degree of atrophy in individual muscle groups and its possible relationship to joint torque deficit poststroke.ObjectiveThe purpose of this study was to investigate quadriceps and hamstring muscle volume and strength deficits of the knee extensors and flexors in people with chronic hemiparesis compared with a control group.DesignThis was a cross-sectional study.MethodsThirteen individuals with hemiparesis due to chronic stroke (hemiparetic group) and 13 individuals who were healthy (control group) participated in this study. Motor function, quadriceps and hamstring muscle volume, and maximal concentric and eccentric contractions of the knee extensors and flexors were assessed.ResultsOnly the quadriceps muscle of the paretic limb showed reduced muscle volume (24%) compared with the contralateral (nonparetic) limb. There were no differences in muscle volume between the hemiparetic and control groups. The peak torque of the paretic-limb knee extensors and flexors was reduced in both contraction modes and velocities compared with the nonparetic limb (36%–67%) and with the control group (49%–75%). The nonparetic limb also showed decreased extensor and flexor peak torque compared with the control group (17%–23%). Power showed similar deficits in strength (12%–78%). There were significant correlations between motor function and strength deficits (.54–.67).LimitationsMagnetic resonance imaging coil length did not allow measurement of the proximal region of the thigh.ConclusionsThere were different responses between quadriceps and hamstring muscle volumes in the paretic limb that had quadriceps muscle atrophy only. However, both paretic and nonparetic limbs showed knee extensor and flexor torque and power reduction.

scholarly journals Correlations between motor and sensory functions in upper limb chronic hemiparetics after stroke

2011 ◽  
Vol 69 (4) ◽  
pp. 624-629 ◽  
Author(s):  
Thais Botossi Scalha ◽  
Erica Miyasaki ◽  
Núbia Maria Freire Vieira Lima ◽  
Guilherme Borges
Keyword(s):  
Upper Limb ◽  
Visual Information ◽  
Stroke Patients ◽  
Weight Discrimination ◽  
Test Items ◽  
Hemiparetic Stroke ◽  
And Performance ◽  
Chronic Hemiparetic Stroke ◽  
Sensory Functions ◽  
Somatosensory Function

OBJECTIVE: Describe the somatosensory function of the affected upper limb of hemiparetic stroke patients and investigate the correlations between measurements of motor and sensory functions in tasks with and without visual deprivation. METHOD: We applied the Fugl-Meyer Assessment (FMA), Nottingham Sensory Assessment (NSA), and several motor and sensory tests: Paper manipulation (PM), Motor Sequences (MS), Reaching and grasping (RG) Tests Functional (TF), Tactile Discrimination (TD), Weight Discrimination (WD) and Tactile Recognition of Objects (RO). RESULTS: We found moderate correlations between the FMA motor subscale and the tactile sensation score of the NSA. Additionally, the FMA sensitivity was correlated with the NSA total; and performance on the WD test items correlated with the NSA. CONCLUSION: There was a correlation between the sensory and motor functions of the upper limb in chronic hemiparetic stroke patients. Additionally, there was a greater reliance on visual information to compensate for lost sensory-motor skills.

scholarly journals Motor Impairment–Related Alterations in Biceps and Triceps Brachii Fascicle Lengths in Chronic Hemiparetic Stroke

2018 ◽  
Vol 32 (9) ◽  
pp. 799-809 ◽  
Author(s):  
Christa M. Nelson ◽  
Wendy M. Murray ◽  
Julius P. A. Dewald
Keyword(s):  
Motor Impairment ◽  
Distal Portion ◽  
Functional Mobility ◽  
Triceps Brachii ◽  
Motor Impairments ◽  
Fascicle Length ◽  
Paretic Limb ◽  
Hemiparetic Stroke ◽  
Long Head ◽  
Chronic Hemiparetic Stroke

Poststroke deficits in upper extremity function occur during activities of daily living due to motor impairments of the paretic arm, including weakness and abnormal synergies, both of which result in altered use of the paretic arm. Over time, chronic disuse and a resultant flexed elbow posture may result in secondary changes in the musculoskeletal system that may limit use of the arm and impact functional mobility. This study utilized extended field-of-view ultrasound to measure fascicle lengths of the biceps (long head) and triceps (distal portion of the lateral head) brachii in order to investigate secondary alterations in muscles of the paretic elbow. Data were collected from both arms in 11 individuals with chronic hemiparetic stroke, with moderate to severe impairment as classified by the Fugl-Meyer assessment score. Across all participants, significantly shorter fascicles were observed in both biceps and triceps brachii ( P < .0005) in the paretic limb under passive conditions. The shortening in paretic fascicle length relative to the nonparetic arm measured under passive conditions remained observable during active muscle contraction for the biceps but not for the triceps brachii. Finally, average fascicle length differences between arms were significantly correlated to impairment level, with more severely impaired participants showing greater shortening of paretic biceps fascicle length relative to changes seen in the triceps across all elbow positions ( r = −0.82, P = .002). Characterization of this secondary adaptation is necessary to facilitate development of interventions designed to reduce or prevent the shortening from occurring in the acute stages of recovery poststroke.

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