Quadriceps Thickness and Echo Intensity Predict Gait Independence in Individuals with Severe and Mild Hemiparetic Stroke

2020 ◽  
Vol 83 (2) ◽  
pp. 167-173 ◽  
Author(s):  
Hisashi Maeda ◽  
Ken Imada ◽  
Koji Ishida ◽  
Hiroshi Akima
Keyword(s):  
Functional Independence Measure ◽  
Muscle Thickness ◽  
Intramuscular Fat ◽  
Functional Independence ◽  
Quadriceps Femoris ◽  
Limiting Factors ◽  
Muscle Size ◽  
Echo Intensity ◽  
Paretic Limb ◽  
Hemiparetic Stroke

Introduction: Smaller muscle size and higher adipose tissue ratio of the quadriceps femoris are often observed after stroke. However, it is unclear whether muscle size and the intramuscular fat ratio of the quadriceps measured with ultrasonography (US) reflect gait independence in individuals with mild or severe hemiparetic stroke. Objective: The present study was performed to examine the relationships of gait independence with muscle thickness (MT) and echo intensity (EI) of the quadriceps femoris in individuals with hemiparesis after stroke. Methods: We examined 43 individuals with hemiparetic stroke. We assessed functional independence measure (FIM) gait scores and measured thickness and EI of the quadriceps using US. The relationships of FIM gait scores with MT and EI were examined using Spearman’s correlation coefficients in mild (n = 21) and severe (n = 22) hemiparetic stroke groups. Results: In the mild hemiparetic group, FIM gait scores were correlated with paretic limb MT (rho = 0.60, p < 0.01) and EI (rho = −0.57, p < 0.01). In the severe hemiparetic group, FIM gait scores were correlated with paretic limb MT (rho = 0.67, p < 0.01) and EI (rho = −0.43, p < 0.05), as well as non-paretic limb MT (rho = 0.86, p < 0.01) and EI (rho = −0.56, p < 0.01). Conclusions: Quadriceps thickness and EI were associated with the degree of gait independence. Atrophy and increased intramuscular fat of the quadriceps may be limiting factors for achieving gait independence.

Relationship of Quadriceps Muscle Thickness with Motor Paralysis and Muscle Echo Intensity in Post-Stroke Patients

2019 ◽  
Vol 81 (1-2) ◽  
pp. 56-62 ◽  
Author(s):  
Hisashi Maeda ◽  
Ken Imada ◽  
Koji Ishida ◽  
Hiroshi Akima
Keyword(s):  
Muscle Thickness ◽  
Quadriceps Muscle ◽  
Muscle Quality ◽  
Quality Loss ◽  
Echo Intensity ◽  
Stroke Patients ◽  
Post Stroke ◽  
Paretic Limb ◽  
Motor Paralysis ◽  
Relationship Of

Introduction: Quadriceps muscle atrophy and quality loss, defined as an increased ratio of intramuscular fat and/or connective tissue, are often observed especially in the paretic limb of post-stroke patients. This study was performed to examine the relationship of quadriceps muscle thickness (MT) with muscle echo intensity (EI) and the severity of motor paralysis after stroke. Methods: Thirty-six hemiparetic subacute post-stroke patients were enrolled. We examined the MT (index of muscle quantity) and the EI (index of muscle quality) at the anterior mid-thigh in both limbs. We also assessed the Brunnstrom stage (BR stage), subcutaneous adipose tissue thickness, time since stroke, age, body weight, sex, number of medications, and nutritional and inflammation status. Results: The MT in the paretic limb was explained by the BR stage (β = –0.26, p < 0.01), body weight (β = 0.68, p < 0.01), and serum albumin (β = 0.34, p < 0.01), with an adjusted R2 of 0.81. The MT in the non-paretic limb was explained by the muscle EI (β = –0.55, p < 0.01) and age (β = –0.40, p < 0.01), with an adjusted R2 of 0.69. The muscle EI was explained by the MT in the paretic limb (β = –0.34, p < 0.01) and non-paretic limb (β = –0.69, p < 0.01). Conclusions: Our results suggest that motor paralysis, aging, and malnutrition contribute to quadriceps atrophy in post-stroke patients. Moreover, a potential countermeasure to diminish muscle quality loss is maintenance of muscle quantity.

scholarly journals Association of physical activity with age-related changes in muscle echo intensity in older adults: a 4-year longitudinal study

2018 ◽  
Vol 125 (5) ◽  
pp. 1468-1474 ◽  
Author(s):  
Yoshihiro Fukumoto ◽  
Yosuke Yamada ◽  
Tome Ikezoe ◽  
Yuya Watanabe ◽  
Masashi Taniguchi ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Longitudinal Study ◽  
Muscle Thickness ◽  
Quadriceps Femoris ◽  
Community Dwelling ◽  
Echo Intensity ◽  
Longitudinal Changes ◽  
Age Related ◽  
Age Related Changes

Ultrasonic echo intensity (EI), an easy-to-use measure of intramuscular fat and fibrous tissues, is known to increase with aging. However, age-related changes in EI have not been examined in a longitudinal design. The objective of this study was to investigate 4-yr longitudinal changes in the EI of the quadriceps femoris in older adults, based on difference in physical activity (PA). This study included 131 community-dwelling older adults with a mean age of 72.9 ± 5.2 yr. Subcutaneous fat thickness (FT), muscle thickness (MT), and EI of the quadriceps femoris were measured by ultrasound. Isometric knee extensor strength was also measured. PA was assessed using a questionnaire at baseline, and participants were classified into the high or low PA groups. In 4 yr, a significant decrease in FT, MT, and strength was observed in both groups ( P < 0.05), whereas a significant decrease in EI was observed only in the high PA group ( P < 0.05). Multiple linear regression analyses revealed that the difference in PA was a significant predictor of 4-yr changes in MT (β = 0.189, P = 0.031) and EI (β = −3.145, P = 0.045) but not in the body mass index, FT, or strength adjusted for potential confounders. The present findings suggest that greater PA has a positive effect on longitudinal changes in the MT and EI of the quadriceps femoris in older adults. In addition, greater PA may contribute to a future decrease in EI, and an increase in EI may not occur in 4 yr, even in older adults with lesser PA. NEW & NOTEWORTHY Our results suggest that greater physical activity (PA) may mitigate future changes in muscle thickness and echo intensity (EI). A decrease in EI over 4 yr was observed in older adults with greater PA, and an increase in EI was not observed, even in older adults with smaller PA. Several cross-sectional studies demonstrated an increase in EI with aging. Additionally, the results of our longitudinal study suggest that an age-related increase in EI may be moderated after the old-age period.

Retraining selective trunk muscle activity: A key to more successful rehabilitation outcomes for hemiparetic stroke patients

2021 ◽  
pp. 1-8
Author(s):  
Matteo Bigoni ◽  
Veronica Cimolin ◽  
Luca Vismara ◽  
Andrea G. Tarantino ◽  
Silvia Baudo ◽  
...  
Keyword(s):  
Treatment Cycle ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Berg Balance Scale ◽  
Rehabilitation Program ◽  
Trunk Muscles ◽  
Single Subject ◽  
Rehabilitation Outcomes ◽  
Additional Improvement ◽  
Hemiparetic Stroke

BACKGROUND: Hemiparetic patients lose the ability to move their trunk selectively, abdominals are affected and neither voluntary nor reflex activity is present. OBJECTIVE: To investigate if the inclusion of specific exercises for the trunk muscles in a rehabilitation program for chronic hemiparetic patients could lead to an additional improvement. METHODS: A multiple-participant single-subject design was replicated in patients with hemiplegia. The study was conducted in two cycles: for the first cycle (A), patients received conventional rehabilitation program, then for the second cycle (B), six months later, the same subjects received conventional rehabilitation therapy plus an additional specific selective trunk muscles training. Trunk Impairment Scale (TIS), Berg Balance Scale (BBS), 10 meters distance walk test (10 MWT), Functional Independence Measure (FIM) and instrumental gait analysis were performed before and after both treatment cycles. RESULTS: Significant changes were observed in TIS and 10 MWT after the two treatment cycles. However, after treatment cycle B, BBS and FIM score showed an additional improvement. Whereas, after treatment cycle A gate analysis did not relevantly changed, but after cycle B a significant improvement was registered in velocity, cadence and percentage of stance in the gait cycle. CONCLUSIONS: In our patients, the training for selective activation of the trunk muscles had led to a consistent improvement of gate analysis parameters, and hemiparesis-related disability in stance and activities of daily living.

scholarly journals Effects of Constraint-Induced Therapy Versus Bilateral Arm Training on Motor Performance, Daily Functions, and Quality of Life in Stroke Survivors

2008 ◽  
Vol 23 (5) ◽  
pp. 441-448 ◽  
Author(s):  
Keh-chung Lin ◽  
Ya-fen Chang ◽  
Ching-yi Wu ◽  
Yi-an Chen
Keyword(s):  
Quality Of Life ◽  
Motor Performance ◽  
Functional Independence Measure ◽  
Proximal Part ◽  
Functional Independence ◽  
Control Group ◽  
Intensive Training ◽  
Hemiparetic Stroke ◽  
Bilateral Arm Training

Background and Objective. This study investigated the relative effects of distributed constraint-induced therapy (CIT) and bilateral arm training (BAT) on motor performance, daily function, functional use of the affected arm, and quality of life in patients with hemiparetic stroke. Methods. A total of 60 patients were randomized to distributed CIT, BAT, or a control intervention of less specific but active therapy. Each group received intensive training for 2 hours/day, 5 days/week, for 3 weeks. Pretreatment and posttreatment measures included the Fugl—Meyer Assessment (FMA), Functional Independence Measure (FIM), Motor Activity Log (MAL), and Stroke Impact Scale (SIS). The proximal and distal scores of FMA were used to examine separate upper limb (UL) elements of movement. Results . The distributed CIT and BAT groups showed better performance in the overall and the distal part score of the FMA than the control group. The BAT group exhibited greater gains in the proximal part score of the FMA than the distributed CIT and control groups. Enhanced performance was found for the distributed CIT group in the MAL, the subtest of locomotion in the FIM, and certain domains of the SIS (eg, ADL/IADL). Conclusion. BAT may uniquely improve proximal UL motor impairment. In contrast, distributed CIT may produce greater functional gains for the affected UL in subjects with mild to moderate chronic hemiparesis.

scholarly journals ADL Assessment for Hemiparetic Stroke Patients Based on the Functional Independence Measure.

1996 ◽  
Vol 8 (1) ◽  
pp. 9-12 ◽  
Author(s):  
Junichi Katoh ◽  
Gorou Ohsaka ◽  
Yasuhisa Hara ◽  
Kenzou Ishihara ◽  
Hiroshi Taniguchi ◽  
...  
Keyword(s):  
Functional Independence Measure ◽  
Functional Independence ◽  
Stroke Patients ◽  
Hemiparetic Stroke

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 Similar Muscular Adaptations in Resistance Training Performed Two Versus Three Days Per Week

2019 ◽  
Vol 68 (1) ◽  
pp. 135-143 ◽  
Author(s):  
Thiago Lasevicius ◽  
Brad Jon Schoenfeld ◽  
Jozo Grgic ◽  
Gilberto Laurentino ◽  
Lucas Duarte Tavares ◽  
...  
Keyword(s):  
Resistance Training ◽  
Muscular Strength ◽  
Muscle Thickness ◽  
Quadriceps Femoris ◽  
Muscle Size ◽  
Group Differences ◽  
Elbow Flexors ◽  
Post Intervention ◽  
Muscular Adaptations ◽  
Muscle Groups

AbstractThe purpose of the present study was to compare changes in muscle strength and hypertrophy between volume-equated resistance training (RT) performed 2 versus 3 times per week in trained men. Thirty-six resistance-trained men were randomly assigned to one of the two experimental groups: a split-body training routine (SPLIT) with muscle groups trained twice per week (n = 18) over four weekly sessions, or a total-body routine (TOTAL), with muscle groups being trained three times per week (n = 18) over three weekly sessions. The training intervention lasted 10 weeks. Testing was carried out pre- and post-study to assess maximal muscular strength in the back squat and bench press, and hypertrophic adaptations were assessed by measuring muscle thickness of the elbow flexors, elbow extensors, and quadriceps femoris. Twenty-eight subjects completed the study. Significant pre-to-post intervention increases in upper and lower-body muscular strength occurred in both groups with no significant between-group differences. Furthermore, significant pre-to-post intervention increases in muscle size of the elbow extensors and quadriceps femoris occurred in both groups with no significant between-group differences. No significant pre-to-post changes were observed for the muscle size of elbow flexors both in the SPLIT or TOTAL group. In conclusion, a training frequency of 2 versus 3 days per week produces similar increases in muscular adaptations in trained men over a 10-week training period. Nonetheless, effect size differences favored SPLIT for all hypertrophy measures, indicating a potential benefit for training two versus three days a week when the goal is to maximize gains in muscle mass.

scholarly journals Relationships of Balance, Gait Performance, and Functional Outcome in Chronic Stroke Patients: A Comparison of Left and Right Lesions

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Priscila Garcia Lopes ◽  
José Augusto Fernandes Lopes ◽  
Christina Moran Brito ◽  
Fábio Marcon Alfieri ◽  
Linamara Rizzo Battistella
Keyword(s):  
Stride Length ◽  
Center Of Pressure ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Chronic Stroke ◽  
Lower Limbs ◽  
Gait Velocity ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Hemiparetic Stroke

Introduction. This study compared the balance by center of pressure (COP) and its relationship with gait parameters and functional independence in left (LH) and right (RH) chronic stroke patients.Methods. In this cross-sectional study, twenty-one hemiparetic stroke patients were assessed for Functional Independence Measure (FIM), balance with a force platform, and gait in the Motion Analysis Laboratory.Results. The amplitudes of the COP in the anteroposterior and mediolateral directions were similar in both groups. The anteroposterior direction was greater than the mediolateral direction. Only the temporal parameters showed any statistically significant differences. The LH showed a significant correlation between stride length, step length, and gait velocity with COP velocity sway for the healthy and paretic lower limbs. In both groups, the area of COP was significantly correlated with stride length. Motor FIM was significantly correlated with the COP in the LH group.Conclusion. There was no difference in the performance of balance, gait, and functional independence between groups. The correlation of the COP sway area with stride length in both groups can serve as a guideline in the rehabilitation of these patients where training the static balance may reflect the improvement of the stride length.

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