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Tanaka S, Kimura Y, Terao Y, Kojima I, Suzuki M, Kita R, Suzukawa K, Moriya M, Yamada M. Relationship between progressive improvement in gait ability one year after discharge and skeletal muscle characteristics of stroke survivors. Clin Neurol Neurosurg 2024; 243:108401. [PMID: 38936176 DOI: 10.1016/j.clineuro.2024.108401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/20/2024] [Accepted: 06/16/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND The clinical importance of skeletal muscle characteristics for improving gait ability of stroke survivors is increasing. We aimed to examine the association between muscle quantity and quality at discharge and changes in gait independence at the time of 1 year after discharge in patients with stroke. METHODS This prospective observational study included 100 patients with stroke who were admitted to a convalescent rehabilitation ward. We defined muscle quantity and quality operationally as muscle thickness and echo intensity observed in ultrasonography images, respectively, and measured quadriceps muscle on the paretic and non-paretic sides at the time of discharge. The outcome measured in our study was changes in gait independence 1 year after discharge, as assessed by the Functional Independence Measure gait assessment tool score. RESULTS Among the study participants, 23 (23.0 %) were assessed to have reduced gait independence, while 77 (77.0 %) were evaluated to have improved or maintained gait independence. Our multivariate logistic regression analysis revealed that only muscle quantity on the paretic side was significantly associated with an improvement or maintenance of gait independence (odds ratios 3.32; 95 % confidence interval 1.01-10.95; p = 0.049). CONCLUSIONS Our findings revealed that an improvement in gait independence 1 year after discharge was influenced by quadriceps muscle quantity on the paretic side at the time of discharge in patients with subacute stroke. This finding highlights the importance of lower limb muscle quantity on the paretic side as a clinically significant factor that influences the improvement in gait ability after hospital discharge.
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Affiliation(s)
- Shu Tanaka
- Major of Physical Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, 5-23-22 Nishikamata, Ota-ku, Tokyo 144-8535, Japan; Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan.
| | - Yosuke Kimura
- Faculty of Life Sciences, Department of Biomedical Engineering, Toyo University, 48-1 Oka, Asaka, Saitama 351-0007, Japan
| | - Yusuke Terao
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Iwao Kojima
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Mizue Suzuki
- Faculty of Allied Health Sciences, Yamato University, 2-5-1, Katayama-cho, Suita-shi, Osaka 564-0082, Japan
| | - Ryosuke Kita
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Katsumi Suzukawa
- Department of Rehabilitation, Musashimurayama Hospital, Social Medical Corporation, Yamatokai Foundation, 1-1-5 Enoki, Musashimurayama, Tokyo 208-0022, Japan
| | - Megumi Moriya
- Department of Rehabilitation, Musashimurayama Hospital, Social Medical Corporation, Yamatokai Foundation, 1-1-5 Enoki, Musashimurayama, Tokyo 208-0022, Japan
| | - Minoru Yamada
- Faculty of Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
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Tanaka S, Yamauchi K, Hayashi Y, Kumagae K, Goto K, Harayama E, Arakawa S. Factors influencing the reduction in quadriceps muscle thickness in the paretic limbs of patients with acute stroke. Clin Nutr ESPEN 2024; 60:173-178. [PMID: 38479907 DOI: 10.1016/j.clnesp.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/08/2023] [Accepted: 01/16/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND & AIMS Muscle atrophy is an early event that occurs after stroke, but there are few reports on the changes in skeletal muscle thickness in acute stroke. This study investigated the factors contributing to reduced muscle thickness in patients with acute stroke. METHODS In total, 51 patients with stroke and the National Institute of the Health Stroke Scale (NIHSS) > 3 were included in our study. They were admitted to our hospital between July 2017 and May 2020. The quadriceps muscle thickness was measured with an ultrasound device within 2 days after admission and 14 days later. The collected data included age, sex, body mass index, stroke type, neuromuscular electrical stimulation, NIHSS, serum albumin at admission, start of enteral nutrition, Functional Oral Intake Scale (FOIS), start of mobilization and ambulation, number of physical and occupational therapy units, C-reactive protein at admission and whether surgery had been performed. These data were retrospectively retrieved from medical documents. A dietician calculated energy intake, protein intake, and energy adequacy. Multiple regression analysis was used to identify the factors associated with reduced quadriceps muscle thickness. The independent variables were NIHSS, date of start of enteral feeding, protein intake, FOIS, date of mobilization, and date of start of ambulation training. RESULTS The rate of change in quadriceps muscle thickness of the paretic limb was -15.3 % (interquartile range, -46.1-14.8 %). Multiple regression analysis showed that the factors responsible for the decrease in muscle thickness on the paretic side were FOIS (β: 0.376; 95 % Cl, 0.999 to 4.541) and the start date of ambulation (β: -0.378; 95 % Cl, -2.575 to -0.543), with a multiple correlation coefficient of 0.456. CONCLUSION The FOIS and the start date of ambulation after acute stroke were related to the rate of reduction in muscle thickness on the paretic side.
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Affiliation(s)
- Shota Tanaka
- Department of Rehabilitation, Steel Memorial Yawata Hospital, 1-1-1 Harunomachi, Yahata Higashi Ward, Kitakyushu City, Fukuoka, Japan.
| | - Kota Yamauchi
- Department of Rehabilitation, Steel Memorial Yawata Hospital, 1-1-1 Harunomachi, Yahata Higashi Ward, Kitakyushu City, Fukuoka, Japan.
| | - Yuri Hayashi
- Department of Rehabilitation, Kyushu University Hospital, 3-1-1, Maidashi, Higashi Ward, Fukuoka City, Fukuoka, Japan.
| | - Kenichi Kumagae
- Department of Rehabilitation, Steel Memorial Yawata Hospital, 1-1-1 Harunomachi, Yahata Higashi Ward, Kitakyushu City, Fukuoka, Japan.
| | - Kei Goto
- Department of Rehabilitation, Steel Memorial Yawata Hospital, 1-1-1 Harunomachi, Yahata Higashi Ward, Kitakyushu City, Fukuoka, Japan.
| | - Eisei Harayama
- Department of Rehabilitation, Steel Memorial Yawata Hospital, 1-1-1 Harunomachi, Yahata Higashi Ward, Kitakyushu City, Fukuoka, Japan.
| | - Shuji Arakawa
- Department of Cerebrovascular Medicine, Stroke Center, Steel Memorial Yawata Hospital, 1-1-1 Harunomachi, Yahata Higashi Ward, Kitakyushu City, Fukuoka, Japan.
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Liu X, Yang Y, Jia J. Respiratory muscle ultrasonography evaluation and its clinical application in stroke patients: A review. Front Neurosci 2023; 17:1132335. [PMID: 37090789 PMCID: PMC10115993 DOI: 10.3389/fnins.2023.1132335] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
Background Respiratory muscle ultrasound is a widely available, highly feasible technique that can be used to study the contribution of the individual respiratory muscles related to respiratory dysfunction. Stroke disrupts multiple functions, and the respiratory function is often significantly decreased in stroke patients. Method A search of the MEDLINE, Web of Science, and PubMed databases was conducted. We identified studies measuring respiratory muscles in healthy and patients by ultrasonography. Two reviewers independently extracted and documented data regarding to the criteria. Data were extracted including participant demographics, ultrasonography evaluation protocol, subject population, reference values, etc. Result A total of 1954 participants from 39 studies were included. Among them, there were 1,135 participants from 19 studies on diaphragm, 259 participants from 6 studies on extra-diaphragmatic inspiratory muscles, and 560 participants from 14 studies on abdominal expiratory muscles. The ultrasonic evaluation of diaphragm and abdominal expiratory muscle thickness had a relatively typically approach, while, extra-diaphragmatic inspiratory muscles were mainly used in ICU that lack of a consistent paradigm. Conclusion Diaphragm and expiratory muscle ultrasound has been widely used in the assessment of respiratory muscle function. On the contrary, there is not enough evidence to assess extra-diaphragmatic inspiratory muscles by ultrasound. In addition, the thickness of the diaphragm on the hemiplegic side was lower than that on the non-hemiplegic side in stroke patients. For internal oblique muscle (IO), rectus abdominis muscle (RA), transversus abdominis muscle (TrA), and external oblique muscle (EO), most studies showed that the thickness on the hemiplegic side was lower than that on the non-hemiplegic side.Clinical Trial Registration: The protocol of this review was registered in the PROSPERO database (CRD42022352901).
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Affiliation(s)
- Xiaoman Liu
- Department of Rehabilitation Medicine, The People’s Hospital of Suzhou New District, Suzhou, China
| | - Ying Yang
- Department of Rehabilitation Medicine, The People’s Hospital of Suzhou New District, Suzhou, China
| | - Jie Jia
- Department of Rehabilitation Medicine, Fudan University Huashan Hospital, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Fudan University Huashan Hospital, Shanghai, China
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Ogawa M, Matsumoto T, Harada R, Yoshikawa R, Ueda Y, Takamiya D, Sakai Y. Reliability and Validity of Quadriceps Muscle Thickness Measurements in Ultrasonography: A Comparison with Muscle Mass and Strength. Prog Rehabil Med 2023; 8:20230008. [PMID: 36909302 PMCID: PMC9998244 DOI: 10.2490/prm.20230008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 02/14/2023] [Indexed: 03/12/2023] Open
Abstract
Objectives Measurement of skeletal muscle using ultrasonography (US) has received considerable attention as an alternative method of muscle assessment. However, intra- and inter-rater reliability remains controversial. Furthermore, there is no consensus regarding the relationship between muscle assessment using US and muscle mass or physical assessment. We aimed to verify the validity and reliability of muscle measurements using US and its relationships with muscle strength and physical assessment. Methods The 22 participants were all healthy men. Quadriceps muscle thickness was measured by US by three different raters. Intraclass correlation coefficient (ICC) was used to assess inter- and intra-rater reliability. The maximum isokinetic strength of the quadriceps and handgrip strength were used as measures of lower and upper muscle strength, respectively. Leg muscle mass was assessed using the leg skeletal muscle index (SMI), measured by body impedance analysis, and calf circumference. Results The intra-rater reliability was excellent which the ICC(1,1) ranges 0.957-0.993, and ICC(1,3) ranges 0.985-0.998. For inter-rater reliability, the values of 0.904 for ICC(2,1) and 0.966 for ICC(2,3) indicated excellent reliability. Leg SMI was significantly correlated with quadriceps thickness (r=0.36). Maximum isokinetic strength and handgrip strength showed weak but statistically significant correlations with quadriceps thickness (r=0.20, r=0.30, respectively). The correlation between quadriceps thickness and calf circumference was not statistically significant. Conclusions Quadriceps muscle assessment using US is a valid and reliable technique for healthy individuals. Quadriceps muscle thickness was significantly positively correlated with upper and lower muscle strength and leg SMI. Muscle thickness assessment could replace full body muscle assessment in clinical settings.
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Affiliation(s)
- Masato Ogawa
- Division of Rehabilitation Medicine, Kobe University Hospital, Kobe, Japan.,Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Tsuyoshi Matsumoto
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Risa Harada
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryo Yoshikawa
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuya Ueda
- Department of Rehabilitation Medicine, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Daiki Takamiya
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshitada Sakai
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Abe T, Ozaki H, Abe A, Loenneke JP. Impact of forearm pronation on ultrasound-measured forearm muscle thickness in children and adolescents. IMAGING 2022. [DOI: 10.1556/1647.2022.00074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AbstractBackground and AimIt was unknown whether ultrasound-measured forearm muscle thickness was impacted by pronation of the forearm. The aim of this study was to investigate the influence of forearm pronation on two forearm muscle thicknesses (MT-ulna and MT-radius).Participants and MethodsFourteen healthy children and adolescents sat on a chair with their right arm comfortably on a table, and their hands were fixed to the board with elastic bands. The probe was placed perpendicularly over the forearm, and the angle of the board was then pronated in 5° increments from −10° to 30°. The average value of the two measures at each angle was used.ResultsThere was evidence that MT-ulna differed across measurement sites (F = 51.086, P < 0.001). For example, the values of the MT-ulna were 2.58 (SD 0.40) cm in standard position (0°), 2.56 (SD 0.41) in −10°, 2.62 (SD 0.41) in 10°, 2.65 (SD 0.42) in 20°, and 2.71 (SD 0.43) in 30°. Follow-up tests found that all sites differed from each other except for −10° and −5° (P = 0.155) and 10° and 15° (P = 0.075). There was also evidence that the MT-radius differed across measurement sites (F = 22.07, P < 0.001). Follow-up tests found that many but not all sites differed from each other.ConclusionOur results suggest that MT-ulna increases and MT-radius decreases due to forearm pronation from the standard position (0°). When determining the forearm position using the 95% limits of agreement, we recommend the forearm position within ±5° of the standard forearm position when measuring forearm MT.
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Affiliation(s)
- Takashi Abe
- Graduate School of Health and Sports Science & Institute of Health and Sports Science and Medicine, Juntendo University, Inzai, Chiba 270-1695, Japan
- Division of Children's Health and Exercise Research, Institute of Trainology, Sawara, Fukuoka, Fukuoka 814-0001, Japan
| | - Hayao Ozaki
- School of Sport and Health Sciences, Tokai Gakuen University, Miyoshi, Aichi 470-0207, Japan
| | - Akemi Abe
- Division of Children's Health and Exercise Research, Institute of Trainology, Sawara, Fukuoka, Fukuoka 814-0001, Japan
| | - Jeremy P. Loenneke
- Department of Health, Exercise Science, & Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS 38677, USA
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Inter- and Intra-Rater Reliability of Ultrasound Measurements of Superficial and Deep Fasciae Thickness in Upper Limb. Diagnostics (Basel) 2022; 12:diagnostics12092195. [PMID: 36140596 PMCID: PMC9497800 DOI: 10.3390/diagnostics12092195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
Ultrasound (US) imaging is increasingly the most used tool to measure the thickness of superficial and deep fasciae, but there are still some doubts about its reliability in this type of measurement. The current study sets out to assess the inter-rater and intra-rater reliability of US measurements of superficial and deep fasciae thicknesses in the arm and forearm. The study involved two raters: the first (R1) is an expert in skeletal–muscle US imaging and, in particular, the US assessment of fasciae; the second (R2) is a radiologist resident with 1 year’s experience in skeletal–muscle US imaging. R2, not having specific competence in the US imaging of fasciae, was trained by R1. R1 took US images following the protocol by Pirri et al. 2021, and the US-recorded images were analyzed separately by the two raters in different sessions. Each rater measured both types of fasciae at different regions and levels of the arm and forearm. Intra- and inter-rater reliability was excellent for the deep fascia and good and excellent for the superficial fascia according to the different regions/levels (for example for the anterior region of the arm: deep fascia: Ant 1: ICC2,2 = 0.95; 95% CI = 0.81–0.98; superficial fascia: Ant 1: ICC2,2 = 0.85, 95% CI = 0.79–0.88). These findings confirm that US imaging is a reliable and cost-effective tool for evaluating both fasciae, superficial and deep.
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Wong V, Song JS, Abe T, Spitz RW, Yamada Y, Bell ZW, Kataoka R, Kang M, Loenneke JP. Muscle thickness assessment of the forearm via ultrasonography: is experience level important? Biomed Phys Eng Express 2022; 8. [PMID: 35051910 DOI: 10.1088/2057-1976/ac4d42] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/20/2022] [Indexed: 11/11/2022]
Abstract
It is suggested that experience is needed in order to capture valid estimates of muscle size with ultrasound. However, it is unknown whether there is a large degree of skill needed to analyze the images once they are captured.Objective:To determine if less experienced raters could accurately analyze ultrasound images of the forearm by comparing their estimates with those of a very experienced ultrasonographer (criterion).Approach:50 muscle thickness images were captured by one experienced ultrasonographer (also Rater 1). Those images were saved and were then measured by four raters with different levels of experience. The rater who captured the images was very experienced (criterion), the second rater was also experienced and provided 5 minutes of instruction for Rater 3 (minimal experience) and Rater 4 (no experience). Test-retest reliability was also determined for Rater 3 and 4.Main Results:The average muscle thickness value for the criterion was 3.73 cm. The constant error for Rater 2, 3, and 4 was -0.003 (0.02) cm (p=0.362), -0.07 (0.04) cm (p<0.001), and 0.02 (0.09) cm (p=0.132), respectively. The SD for Rater 4 was greater, resulting in wider limits of agreement compared to Rater 2 and 3. Absolute error was 0.01 cm for Rater 2, whilst it was 0.07 cm and 0.03 cm for the two inexperienced raters (Rater 3 and 4). The error for Rater 3 was systematic and post-hoc assessment found that this rater was using a different border than the other three raters (but consistent across time). For the test-retest reliability, the minimal difference for Rater 3 was 0.08 cm (relative minimal difference of 2%) and 0.17 cm (relative minimal difference of 4%) for Rater 4.Significance:Less experienced raters were able to accurately and reliably analyze already captured muscle thickness images of the forearm with low absolute errors.
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Affiliation(s)
- Vickie Wong
- Department of Health, Exercise Science, and Recreation Management, University of Mississippi, PO Box 1848, University Park, Mississippi, 38677, UNITED STATES
| | - Jun Seob Song
- Department of Health, Exercise Science, and Recreation Management, University of Mississippi, PO Box 1848, University Park, Mississippi, 38677, UNITED STATES
| | - Takashi Abe
- Juntendo University, Japan, Bunkyo-ku, Tokyo, NA, JAPAN
| | - Robert W Spitz
- Department of Health, Exercise Science, and Recreation Management, University of Mississippi, PO Box 1848, University Park, Mississippi, 38677, UNITED STATES
| | - Yujiro Yamada
- Department of Health, Exercise Science, and Recreation Management, University of Mississippi, PO Box 1848, University Park, Mississippi, 38677, UNITED STATES
| | - Zachary W Bell
- Department of Health, Exercise Science, and Recreation Management, University of Mississippi, PO Box 1848, University Park, Mississippi, 38677, UNITED STATES
| | - Ryo Kataoka
- Department of Health, Exercise Science, and Recreation Management, University of Mississippi, PO Box 1848, University Park, Mississippi, 38677, UNITED STATES
| | - Minsoo Kang
- Department of Health, Exercise Science, and Recreation Management, University of Mississippi, PO Box 1848, University Park, Mississippi, 38677, UNITED STATES
| | - Jeremy P Loenneke
- Department of Health, Exercise Science, and Recreation Management, University of Mississippi, PO Box 1848, University Park, Mississippi, 38677, UNITED STATES
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Kim JM, Tay MRJ, Rajeswaran DK, Tham SL, Lui WL, Kong KH. Changes in muscle architecture on ultrasound in patients early after stroke. NeuroRehabilitation 2021; 49:565-572. [PMID: 34806627 DOI: 10.3233/nre-210257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Early muscle changes are believed to occur in patients with stroke. However, there are insufficient data on the changes in muscle mass and architecture of these patients. OBJECTIVES This study investigates differences in ultrasound-derived muscle architecture parameters of the hemiplegic upper and lower limbs in patients with subacute stroke. METHODS This is a prospective observational study, which recruited 40 adult patients who had experienced a first ever unilateral stroke (ischemic or hemorrhagic), with a duration of < 1 month post stroke. The brachialis, vastus lateralis and medial gastrocnemius on both the hemiplegic and normal side were evaluated via ultrasound. We recorded clinical variables including Motricity Index, Modified Ashworth Scale (MAS) and Functional Independence Measure (FIM)-walk. RESULTS We found reduced mean muscle thickness (p < 0.001) and increased echo intensity (p < 0.001) in the brachialis muscle, increased echo intensity (p = 0.002) in the vastus lateralis muscle, and reduced muscle thickness (p < 0.001) with increased echo intensity (p < 0.001) in the medial gastrocnemius muscle compared to the normal side. There were no significant correlations between ultrasound findings and Motricity Index. CONCLUSIONS We report changes in ultrasound-derived muscle architecture in the hemiplegic limbs of patients with subacute stroke, with consistent findings of decreased muscle mass and increased echo intensity.
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Affiliation(s)
- Jong Moon Kim
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital Rehabilitation Centre, Singapore
| | - Matthew Rong Jie Tay
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital Rehabilitation Centre, Singapore
| | - Deshan Kumar Rajeswaran
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital Rehabilitation Centre, Singapore
| | - Shuen-Loong Tham
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital Rehabilitation Centre, Singapore
| | - Wen Li Lui
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital Rehabilitation Centre, Singapore
| | - Keng He Kong
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital Rehabilitation Centre, Singapore
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Miller T, Ying MTC, Chung RCK, Pang MYC. Convergent Validity and Test-Retest Reliability of Multimodal Ultrasonography and Related Clinical Measures in People With Chronic Stroke. Arch Phys Med Rehabil 2021; 103:459-472.e4. [PMID: 34695388 DOI: 10.1016/j.apmr.2021.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the test-retest reliability of diagnostic ultrasonography measurements of the bilateral biceps brachii (BB), brachial artery, medial gastrocnemius (MG), and popliteal artery in survivors of stroke and their convergent validity with related clinical comparators. DESIGN Cross-sectional study. SETTING All procedures were conducted in a university laboratory. PARTICIPANTS Sixty-five community dwelling adults (N=65; 26 women, 39 men) with an average age of 60.9±7.7 years and stroke duration of 5.7±3.9 years participated in this study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Measures of muscle structure (ie, thickness, cross-sectional area, fascicle length, pennation angle), stiffness, and intramuscular blood perfusion were conducted using B-mode, elastography and color flow Doppler ultrasonography modes, respectively. Convergent validity was assessed by examining correlations between ultrasonography measures and assessments of related constructs (ie, dynamic stiffness, isometric peak torque, spasticity, and systemic vascular function using myotonometry, dynamometry, the Composite Spasticity Scale, and the Ankle-Brachial Index, respectively). A 2-way random-effects intraclass correlation coefficient (ICC) model (ICC2,3) was used to determine agreement between intersession measures among a smaller cohort of participants with stroke (n=20). RESULTS ICC estimates ranged from moderate to excellent for muscle stiffness (paretic: ICC=0.74-0.89; nonparetic: ICC=0.66-0.88), structure (paretic: ICC=0.87-0.99; nonparetic: ICC=0.81-0.98), and blood perfusion measures (paretic: ICC=0.74-0.84; nonparetic: ICC=0.73-0.88). Weak to moderate associations were found between myotonometry and elastography measures of the bilateral BB (r=0.29-0.52, P≤.05) and MG muscles (r=0.31-0.69, P≤.05). The correlations between elastography measures and spasticity scores for the paretic upper (r=0.35-0.63, P≤.05) and lower limbs (r=0.25-0.37, P≤.05) were also weak to moderate. CONCLUSIONS Elastography demonstrated mostly weak to moderate correlation with measures of stiffness using myotonometry as well as scores of paretic upper and lower limb spasticity. The results also indicate acceptable intersession reliability for muscle and vascular measures using several ultrasonography modalities among individuals with chronic stroke.
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Affiliation(s)
- Tiev Miller
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom
| | - Michael T C Ying
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR
| | - Raymond C K Chung
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom.
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How reliably can ultrasound help determine muscle and adipose tissue thickness in clinical settings? An assessment of intra- and inter-examiner reliability in the USVALID study. Eur J Clin Nutr 2021; 76:401-409. [PMID: 34226675 DOI: 10.1038/s41430-021-00955-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/15/2021] [Accepted: 05/27/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES Ultrasound is used to measure muscle and adipose tissue thickness at the bedside. This study was aimed at determining the intra- and inter-examiner reliability for marking points to measure adipose tissue and muscle thickness and assessing it in terms of the performance and evaluation of the corresponding ultrasound scans. SUBJECTS/METHODS Intra- and inter-examiner reliability was tested in 120 patients. Limb lengths were measured to mark three and two measuring points on both the thighs and upper arms, respectively. Ultrasound scans were performed at each measuring point to evaluate muscle and adipose tissue thickness. RESULTS Regarding the marking of the measuring points, intra- and inter-examiner reliability were high to very high, with correlation coefficients ranging from 0.74 to 0.96. In the performance and evaluation of adipose tissue thickness, all measuring points showed a high to very high reliability, with correlation coefficients ranging from 0.70 to 0.97. In the performance and evaluation of muscle thickness, the ventral measuring point on the thigh and the anterior measuring point on the upper arm showed the best reliability, with high to very high correlation coefficients ranging from 0.77 to 0.93. CONCLUSIONS In terms of intra- and inter-examiner reliability, the ventral measuring point on the thigh and the anterior measuring point on the upper arm can be strongly recommended for ultrasound measurements of muscle and adipose tissue thickness.
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Tanaka S, Ito D, Kimura Y, Ishiyama D, Suzuki M, Koyama S, Narita Y, Masuda H, Suzukawa K, Yamada M. Relationship between longitudinal changes in skeletal muscle characteristics over time and functional recovery during intensive rehabilitation of patients with subacute stroke. Top Stroke Rehabil 2021; 29:356-365. [PMID: 34180362 DOI: 10.1080/10749357.2021.1940724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Stroke is a disease that easily impairs skeletal muscle characteristics, resulting in low quantity, low quality, and poor strength. However, the recovery process of skeletal muscles in patients with stroke is not well established. OBJECTIVES We aimed to determine the longitudinal changes in skeletal muscle characteristics in patients with stroke during intensive rehabilitation and examine their relationship with functional recovery. METHODS Eighty-five patients with stroke were prospectively recruited. We defined muscle quantity and quality as ultrasonographic muscle thickness and echo intensity, respectively, and muscle strength as knee extension strength. These skeletal muscle characteristics were compared at four time points: on admission, after 2 weeks, after 4 weeks, and at discharge. We also explored the relationship between changes in skeletal muscle characteristics and functional recovery. RESULTS Non-paretic knee extension torque (F = 5.838, P = .001), paretic quadriceps thickness (F = 2.943, P = .039), and paretic tibialis anterior thickness (F = 4.654, P = .004) improved over time, and changes in the paretic side quadriceps thickness were significantly associated with recovery for balance ability (odds ratio, 1.05; 95% confidence interval, 1.00-1.09; P = .048). CONCLUSIONS The present study revealed that knee extension muscle strength on the non-paretic side and quadriceps and tibialis anterior thickness on the paretic side significantly improved over time and that changes in the paretic side quadriceps thickness were associated with the recovery of balance ability.
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Affiliation(s)
- Shu Tanaka
- Department of Rehabilitation, Musashimurayama Hospital, Social Medical Corporation, Yamatokai Foundation, Tokyo, Japan.,Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Daisuke Ito
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Yosuke Kimura
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan.,Department of Electrical Engineering, Health and Sports Technology Course, Kanto Gakuin University, Yokohama, Japan
| | - Daisuke Ishiyama
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Mizue Suzuki
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Shingo Koyama
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Yuya Narita
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Hiroaki Masuda
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Katsumi Suzukawa
- Department of Rehabilitation, Musashimurayama Hospital, Social Medical Corporation, Yamatokai Foundation, Tokyo, Japan
| | - Minoru Yamada
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
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12
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Nakanishi N, Okura K, Okamura M, Nawata K, Shinohara A, Tanaka K, Katayama S. Measuring and Monitoring Skeletal Muscle Mass after Stroke: A Review of Current Methods and Clinical Applications. J Stroke Cerebrovasc Dis 2021; 30:105736. [PMID: 33756264 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105736] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/16/2021] [Accepted: 02/28/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Muscle mass at admission is important to survive stroke, and stroke-induced sarcopenia is a serious problem because of its poor prognosis. Muscle mass measurement and monitoring are essential for appropriate rehabilitation and nutrition management. However, few reviews are available about the muscle mass measurement and monitoring after stroke. MATERIAL AND METHODS Several methods are used to assess skeletal muscle mass in stroke, such as computed tomography (CT), ultrasound, bioelectrical impedance analysis, dual-energy X-ray absorptiometry, biomarkers, and anthropometrics. We summarized the current methods and clinical applications in stroke. RESULTS In stroke, a head CT is used to estimate muscle mass by measuring the temporal muscle. However, it can be conducted retrospectively due to radiation exposure. After stroke, limb muscle atrophy and diaphragm dysfunction are observed using ultrasound. However, ultrasound requires an understanding of the methods and skill. A bioelectrical impedance analysis can be used to assess muscle mass in patients after a stroke unless they have dynamic fluid changes. Dual-energy X-ray absorptiometry is used for follow-up after hospital discharge. Urinary titin N-fragment and serum C-terminal agrin fragment reflect muscle atrophy after stroke. Anthropometrics may be useful with limited resources. CONCLUSIONS We summarized the features of each measurement and proved the recent evidence to properly measure and monitor skeletal muscle mass after stroke.
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Affiliation(s)
- Nobuto Nakanishi
- Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima 770-8503, Japan.
| | - Kazuki Okura
- Department of Rehabilitation, Akita University Hospital, 44-2 Hasunuma, Aza, Hiroomote, Akita 010-8543, Japan
| | - Masatsugu Okamura
- Department of Rehabilitation, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan
| | - Keishi Nawata
- Department of Rehabilitation, University Hospital of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-nishi, Kitakyushu, Fukuoka 807-8556, Japan
| | - Ayato Shinohara
- Department of Rehabilitation, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan
| | - Kohei Tanaka
- Department of Rehabilitation Medicine, Osaka Police Hospital, 10-31 Kitayama, Tennouji, Osaka 543-0035, Japan
| | - Sho Katayama
- Department of Rehabilitation Medicine, Okayama University Hospital, 2-5-1 shikata, Kitaku, Okayama 700-8558, Japan
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13
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Ultrasound method of the USVALID study to measure subcutaneous adipose tissue and muscle thickness on the thigh and upper arm: An illustrated step-by-step guide. CLINICAL NUTRITION EXPERIMENTAL 2020. [DOI: 10.1016/j.yclnex.2020.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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14
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Nozoe M, Kubo H, Kanai M, Yamamoto M, Shimada S, Mase K. Peripheral motor nerve conduction abnormality, muscle strength, and muscle wasting in patients with acute stroke: A pilot study. J Clin Neurosci 2020; 75:80-84. [DOI: 10.1016/j.jocn.2020.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/09/2020] [Indexed: 01/11/2023]
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15
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Xie H, Lu K, Lyu G, Kang G, Huang Q, Liu S, Huo M, Onoda K, Maruyama H, Nobori H. Reliability of ultrasonographic measurement of the supraspinatus thickness at different angles of shoulder abduction in patients with stroke. J Phys Ther Sci 2020; 32:257-259. [PMID: 32184543 PMCID: PMC7064348 DOI: 10.1589/jpts.32.257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 12/24/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The primary purpose of this study was to evaluate the usefulness of the
intraclass correlation coefficient for evaluating the reliability of the measurement of
the supraspinatus thickness on shoulder ultrasonography at different angles in a resting
position in patients with stroke. [Participants and Methods] The study included 20
patients with stroke. The supraspinatus thickness was measured on both sides on
ultrasonography, with the participants’ shoulders in abduction at 3 testing angles (0°,
30°, and 60° abduction). Each measurement was performed three times, and the average of
the three measurements was recorded. The intraclass correlation coefficient was
calculated, with the supraspinatus thickness measured twice at an interval of 24 hours as
the factor. [Results] All intraclass correlation coefficients for the hemiplegic and
normal sides were greater than 0.93 when the shoulders were at the three testing angles.
[Conclusion] In this investigation, the reliability of measuring the supraspinatus
thickness on shoulder ultrasonography at each angle for 3 times was evaluated and was
found to be excellent.
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Affiliation(s)
- Hualong Xie
- Department of Physical Therapy, International University of Health and Welfare: 2600-1 Kitakanemaru, Otawara City, Tochigi 324-8501, Japan
| | - Kuan Lu
- Beijing Chaoyang Integrative Medicine Emergency Medical Center, China
| | - Guochen Lyu
- Beijing Chaoyang Integrative Medicine Emergency Medical Center, China
| | - Guoxin Kang
- Beijing Chaoyang Integrative Medicine Emergency Medical Center, China
| | - Qiuchen Huang
- Capital Medical University, School of Rehabilitation Medicine, China.,China Rehabilitation Research Center, China
| | - Shan Liu
- Department of Physical Therapy, International University of Health and Welfare: 2600-1 Kitakanemaru, Otawara City, Tochigi 324-8501, Japan
| | - Ming Huo
- Department of Physical Therapy, Faculty of Medical Health, Himeji Dokkyo University, Japan
| | - Ko Onoda
- Department of Physical Therapy, International University of Health and Welfare: 2600-1 Kitakanemaru, Otawara City, Tochigi 324-8501, Japan
| | - Hitoshi Maruyama
- Department of Physical Therapy, International University of Health and Welfare: 2600-1 Kitakanemaru, Otawara City, Tochigi 324-8501, Japan
| | - Hiroshi Nobori
- Department of Judo Therapy, Teikyo University of Science, Japan
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16
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Ultrasonography to assess body composition: Relevance of training. Nutrition 2020; 70:110523. [DOI: 10.1016/j.nut.2019.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 12/31/2022]
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17
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Kokura Y, Kato M, Taniguchi Y, Kimoto K, Okada Y. Energy intake during the acute phase and changes in femoral muscle thickness in older hemiplegic inpatients with stroke. Nutrition 2020; 70:110582. [DOI: 10.1016/j.nut.2019.110582] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 08/24/2019] [Accepted: 08/25/2019] [Indexed: 10/26/2022]
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18
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Jensen A, Stigall AN, Evans KD, Lopez G, Nahikian-Nelms M. Using Sonography to Objectively Gauge Muscle Wasting: A Multiple Case Report. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020. [DOI: 10.1177/8756479319884248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
End-stage renal disease (ESRD) is a prevalent disease that results from kidney failure in the last stage of chronic kidney disease. This disease has many chronic and debilitating symptoms, including muscle wasting. Unfortunately, current methods to diagnose muscle wasting, in this patient population, are rather imprecise and/or expensive. To develop a better method, this study examined the use of sonography across four separate patients with ESRD in a typical clinical setting. Multiple muscle measurements were taken in the patients’ upper arm via sonography, which were compared to laboratory test results and skinfold measurements. This multiple case comparison demonstrates the feasibility of using sonography to measure subcutaneous tissue and muscle mass in this patient population. It also has the potential to correlate with or support other clinical measures of disease severity. Further study is recommended to examine these correlations and to identify clinical implications for sonographic measurement of overall muscle wasting.
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Affiliation(s)
- Amanda Jensen
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - A. Nicole Stigall
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Kevin D. Evans
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Gabriella Lopez
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Marcia Nahikian-Nelms
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA
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19
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Thielman G, Yourey L. Ultrasound imaging of upper extremity spastic muscle post-stroke and the correlation with function: A pilot study. NeuroRehabilitation 2019; 45:213-220. [PMID: 31498134 DOI: 10.3233/nre-192742] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND With increased practice of real-time ultrasound imaging in the physical therapy profession, it is essential to evaluate the utility of its use post stroke. OBJECTIVE Evaluate relationship of spastic brachialis muscle architectural parameters with clinical measures of upper extremity function and spasticity. METHODS Eleven post stroke individuals with spasticity of the upper limb had their brachialis muscle pennation angle and fascicle length measured in the affected and unaffected upper arm, at rest. Involved side upper extremity Fugl-Meyer, Modified Ashworth Scale, and grip strength were collected and compared to muscle architectural parameters of affected and unaffected brachialis muscles. RESULTS Affected side brachialis pennation angle was significantly greater than the unaffected side, and affected fascile length was significantly shorter than the unaffected side. Function levels were found to be significantly higher in those with greater fascile lengths and lower pennation angles. Higher Fugl-Meyer scores of the affected upper extremity were inversely correlated with lower Modified Ashworth Scale scores. CONCLUSIONS An objective method of quantifying spasticity can assist in determining if functional gains made post stroke are due to compensations in movement, or due to physiological changes. Ultrasound imaging may be used as an alternative to the Modified Ashworth score to quantify muscular parameters in spastic muscles post stroke.
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Affiliation(s)
| | - Lucas Yourey
- University of the Sciences, Philadelphia, PA, USA
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20
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Nozoe M, Kamo A, Shimada S, Mase K. Neuromuscular electrical stimulation is ineffective for treating quadriceps muscle wasting with ruptured aneurysm: A case report. Ann Med Surg (Lond) 2018; 35:90-94. [PMID: 30294437 PMCID: PMC6170208 DOI: 10.1016/j.amsu.2018.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/31/2018] [Accepted: 09/15/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction Neuromuscular electrical stimulation (NMES) is a preventive intervention for muscle wasting in patients with aneurysms during the acute phase; however, its efficacy still remains unclear. In this case study, we report the effects of NMES on quadriceps muscle wasting for a patient with ruptured middle cerebral artery aneurysms during the acute phase. Presentation of case A 66-year-old woman was admitted because of a ruptured middle cerebral artery aneurysm resulting from intracerebral hematoma with subarachnoid hemorrhage. The following day, the patient started undergoing 60–120-min NMES treatment for both her quadriceps muscles, which was continued for 10 days in 2 weeks. Quadriceps muscle thickness as measured by ultrasonography was decreased in both sides (26% and 35% for the right and left sides, respectively). The compound muscle action potential (CMAP) amplitude in the peroneal nerve was also decreased in both sides (73% vs 76%). Discussion The lack of efficacy of NMES in preventing muscle wasting is the decreased CMAP amplitude in this patient, which showed the possibility of existence of critical illness polyneuropathy. Conclusion NMES had no effect on quadriceps muscle wasting in a patient with ruptured middle cerebral artery aneurysms who had decreased CMAP amplitude in the peroneal nerve during the acute phase. NMES is not effective for patients with peripheral nerve conduction abnormalities. NMES is not effective for preventing muscle wasting and disability. NMES is not effective for patients with peripheral nerve conduction abnormalities. The efficacy of NMES is dependent on whether conduction abnormalities exist.
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Key Words
- CIM, critical illness myopathy
- CINM, CIP and CIM
- CIP, critical illness polyneuropathy
- CMAP, compound muscle action potential
- CSD, cross sectional diameter
- Case report
- Critical illness
- EDB, extensor digitorum brevis
- Electric stimulation therapy
- FSS-ICU, Functional Status Score for the ICU
- GCS, Glasgow coma scale
- ICU-AW, ICU-acquired weakness
- MCVs, motor conduction velocities
- MRC sum score, Medical Research Council sum score
- Muscle weakness
- NCV, nerve conduction velocity
- NMES, Neuromuscular electrical stimulation
- QMT, quadriceps muscle thickness
- RF, rectus femoris
- VI, vastus intermedius
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Affiliation(s)
- Masafumi Nozoe
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Japan
| | - Arisa Kamo
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Shinichi Shimada
- Department of Neurosurgery, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Kyoshi Mase
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Japan
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21
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Musculoskeletal Ultrasonography Assessment of Functional Magnetic Stimulation on the Effect of Glenohumeral Subluxation in Acute Poststroke Hemiplegic Patients. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6085961. [PMID: 30065941 PMCID: PMC6051292 DOI: 10.1155/2018/6085961] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/19/2018] [Accepted: 03/19/2018] [Indexed: 12/18/2022]
Abstract
Background Glenohumeral subluxation (GHS) is common in patients with acute hemiplegia caused by stroke. GHS and upper limb function are closely related. Objective Using musculoskeletal ultrasonography (MSUS) to objectively evaluate the efficacy of functional magnetic stimulation (FMS) in the treatment of GHS in acute hemiplegic patients after stroke. Methods The study used prospective case control study. Stroke patients with GHS were recruited and assigned to control group and FMS group. Control group received electrode stimulation at the supraspinatus and deltoid muscles of the hemiplegic side, while FMS group was stimulated at the same locations. Before and after treatment, the distances of the acromion-greater tuberosity (AGT), acromion-lesser tuberosity (ALT), acromiohumeral distance (AHD), supraspinatus thickness (SST), and deltoid muscle thickness (DMT) in patients' bilateral shoulder joint were measured by MSUS, respectively. Meanwhile, Fugl-Meyer Assessment (FMA) was used to evaluate the improvement of upper limb function. Results 30 patients were recruited. After FMS treatment, there was a significant decrease in the difference value between ipsilateral side and contralateral side of AGT [t = 8.595, P < 0.01], ALT [t = 11.435, P < 0.01], AHD [t = 8.375, P < 0.01], SST [t = 15.394, P < 0.01], and DMT [t = 24.935, P < 0.01], and FMA score increased [t = −13.315, P < 0.01]. Compared with control group, FMS group decreased more significantly in the difference value between ipsilateral side and contralateral side of AGT [t = 2.161, P < 0.05], ALT [t = 3.332, P < 0.01], AHD [t = 8.768, P < 0.01], SST [t = 6.244, P < 0.01], and the DMT [t = 3.238, P < 0.01], and FMA score increased more significantly in FMS group [t = 7.194, P < 0.01]. Conclusion The study preliminarily shows that the MSUS can objectively and dynamically evaluate the treatment effect of GHS in hemiplegic patients. Meanwhile, compared with control group, the FMS is more effective and has fewer side effects, and the long-term effect of FMS is worth further study. This trial is registered with ChiCTR1800015352.
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22
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Nozoe M, Kanai M, Kubo H, Takeuchi Y, Kobayashi M, Yamamoto M, Furuichi A, Yamazaki M, Shimada S, Mase K. Efficacy of neuromuscular electrical stimulation for preventing quadriceps muscle wasting in patients with moderate or severe acute stroke: A pilot study. NeuroRehabilitation 2018; 41:143-149. [PMID: 28527228 DOI: 10.3233/nre-171466] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Stroke-related muscle wasting is one of the factors leading to long-term disability and functional dependency. No study has reported an effective therapeutic intervention for such muscle wasting. OBJECTIVE The purpose of this study was to investigate the effects of neuromuscular electrical stimulation (NMES) on quadriceps muscle mass preservation in patients with acute moderate or severe stroke by using ultrasonography (US). METHODS Twenty patients with acute, moderate, or severe stroke (age: 68±11 years) were divided into usual care group (control group) and intervention groups (NMES group), respectively. Patients in the NMES group underwent NMES treatment for bilateral quadriceps muscles for 2 weeks in addition to the usual care. Quadriceps muscle thickness was measured on admission and 2 weeks after the first measurement. RESULTS The quadriceps muscle thickness on the paretic and non-paretic sides in the NMES group (-12.4% ±12.7%, -5.5% ±15.3%, respectively) significantly decreased to a lesser degree than that in the control group (-29.5% ±12.1%, P = 0.004; and -22.0% ±16.8%, P = 0.04, respectively). CONCLUSIONS NEMS seemed to have preserved the quadriceps muscle mass in patients with moderate or severe acute stroke.
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Affiliation(s)
- Masafumi Nozoe
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Morikita-machi, Higashinada-ku, Kobe, Japan.,Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Masashi Kanai
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Hiroki Kubo
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Yuka Takeuchi
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Miki Kobayashi
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Miho Yamamoto
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Asami Furuichi
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Makoto Yamazaki
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Shinichi Shimada
- Department of Neurosurgery, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Kyoshi Mase
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Morikita-machi, Higashinada-ku, Kobe, Japan
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23
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Nozoe M, Kanai M, Kubo H, Kobayashi M, Yamamoto M, Shimada S, Mase K. Quadriceps muscle thickness changes in patients with aneurysmal subarachnoid hemorrhage during the acute phase. Top Stroke Rehabil 2017; 25:209-213. [PMID: 29216792 DOI: 10.1080/10749357.2017.1413762] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening condition that often leads to severe disability in relatively young and healthy people. This disability is physical in many aSAH survivors, so muscle dysfunction may be an important factor in the functional level of these patients. Thus, measuring muscle thickness represents a suitable method for determining muscle function in patients with acute aSAH, because the disordered consciousness often experienced during the acute phase causes active movement to be difficult for these patients. Objectives We investigated changes in quadriceps muscle thickness in patients with aneurysmal subarachnoid hemorrhage to determine whether muscle dysfunction during the acute phase relates to (or predicts) the outcome of aSAH. Methods Seventeen patients with aSAH (mean age = 66 ± 11, men/women = 4/13) were enrolled, and their quadriceps muscle thickness measured ultrasonographically upon admission and again 2 weeks later. Results Quadriceps muscle thickness significantly decreased from admission (mean = 3.00 ± 0.72 cm) to the second measurement (2.67 ± 0.74 cm, p = 0.001). The relative differences in quadriceps muscle thickness were correlated with the Hunt and Hess grade (r = -0.72, p = 0.001) and the modified Rankin Scale score at 90 days (r = -0.78, p = 0.0002). Conclusions Our results indicate that quadriceps muscle thickness decreases in patients with acute aneurysmal subarachnoid hemorrhage, particularly in patients with poor Hunt and Hess grade or marked disability.
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Affiliation(s)
- Masafumi Nozoe
- a Faculty of Nursing and Rehabilitation, Department of Physical Therapy , Konan Women's University , Kobe , Japan
| | - Masashi Kanai
- b Department of Rehabilitation , Itami Kousei Neurosurgical Hospital , Itami , Japan
| | - Hiroki Kubo
- b Department of Rehabilitation , Itami Kousei Neurosurgical Hospital , Itami , Japan
| | - Miki Kobayashi
- b Department of Rehabilitation , Itami Kousei Neurosurgical Hospital , Itami , Japan
| | - Miho Yamamoto
- b Department of Rehabilitation , Itami Kousei Neurosurgical Hospital , Itami , Japan
| | - Shinichi Shimada
- c Department of Neurosurgery , Itami Kousei Neurosurgical Hospital , Itami , Japan
| | - Kyoshi Mase
- a Faculty of Nursing and Rehabilitation, Department of Physical Therapy , Konan Women's University , Kobe , Japan
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24
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Akazawa N, Harada K, Okawa N, Tamura K, Hayase A, Moriyama H. Relationships between muscle mass, intramuscular adipose and fibrous tissues of the quadriceps, and gait independence in chronic stroke survivors: a cross-sectional study. Physiotherapy 2017; 104:438-445. [PMID: 29290379 DOI: 10.1016/j.physio.2017.08.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 08/12/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To examine the relationships between muscle mass, intramuscular adipose and fibrous tissues of the quadriceps, and gait independence in chronic stroke survivors. DESIGN Cross-sectional study. SETTING Hospital-based research. PARTICIPANTS Seventeen chronic stroke survivors who were unable to walk independently (non-independent walker group) and 11 chronic stroke survivors who were able to walk independently (independent walker group) participated in this study. In addition, 25 healthy older adults (healthy group) were enrolled. INTERVENTIONS None. MAIN OUTCOME MEASURES The muscle mass and intramuscular adipose and fibrous tissues of the rectus femoris and vastus intermedius were assessed based on muscle thickness and echo intensity of ultrasound images, respectively. RESULTS The thicknesses of the rectus femoris and vastus intermedius on the paretic and non-paretic sides in the non-independent walker group were significantly lower than those in the healthy group (mean difference -0.5 to -0.2cm; P<0.001-0.037). The paretic side in the non-independent walker group had significantly higher rectus femoris and vastus intermedius echo intensity compared with the healthy group (mean difference 15.8-17.4; P=0.007-0.025). The thickness of the rectus femoris on the non-paretic side was significantly lower in the independent walker group than in the healthy group (mean difference -0.3cm; P=0.001). CONCLUSIONS These results suggest that chronic stroke survivors who are unable to walk independently are likely to experience secondary changes in skeletal muscle on both the paretic and non-paretic sides.
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Affiliation(s)
- Naoki Akazawa
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Boji 180, Nishihama, Yamashiro-cho, Tokushima, Tokushima 770-8514, Japan.
| | - Kazuhiro Harada
- Department of Physical Therapy, Faculty of Health, Medical Care and Welfare, Kibi International University, Takahashi, Okayama, Japan
| | - Naomi Okawa
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Kimiyuki Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Atsushi Hayase
- Department of Rehabilitation, Tsuyama Chuo Hospital, Tsuyama, Okayama, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan
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Salavati M, Akhbari B, Ebrahimi Takamjani I, Ezzati K, Haghighatkhah H. Reliability of the Upper Trapezius Muscle and Fascia Thickness and Strain Ratio Measures by Ultrasonography and Sonoelastography in Participants With Myofascial Pain Syndrome. J Chiropr Med 2017; 16:316-323. [PMID: 29276464 DOI: 10.1016/j.jcm.2017.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/20/2017] [Accepted: 06/28/2017] [Indexed: 01/26/2023] Open
Abstract
Objective The purpose of this study was to assess the intra- and interexaminer reliability of the upper trapezius muscle and fascia thickness measured by ultrasonography imaging and strain ratio by sonoelastography in participants with myofascial pain syndrome. Methods Thirty-two upper trapezius muscles were assessed. Two examiners measured the upper trapezius thickness and strain ratio 3 times by ultrasonography and sonoelastography independently in the test session. The retest session was completed 6 to 8 days later. Results A total of 87.5% of participants had trigger points on the right side, and 22.5% had trigger points on the left side. For the test session, the average upper trapezius thickness, fascia thickness, and strain ratio measured by first and second examiners were 11.86 mm and 11.56 mm, 1.23 mm and 1.25 mm, and 0.94 and 0.99, respectively. For the retest session, the previously mentioned parameters obtained by first and second examiners were 11.76 mm and 11.39 mm, 1.27 mm and 1.29 mm, and 0.96 and 0.99, respectively. The intraclass correlation coefficients indicated good to excellent reliability for both within-intraexaminer (0.78-0.96) and between-intraexaminer (0.75-0.98) measurements. Also, the intraclass correlation coefficients and standard errors of measurement of interexaminer reliability ranged between 0.88 to 0.93 and 0.05 to 0.44 for both muscle and fascia thickness and 0.70 to 0.75 and 0.04 to 0.20 for strain ratio of upper trapezius, respectively. Conclusion Upper trapezius thickness measurements by ultrasonography and strain ratio by sonoelastography are reliable methods in participants with myofascial pain syndrome.
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Affiliation(s)
- Mahyar Salavati
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Behnam Akhbari
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ismail Ebrahimi Takamjani
- Physiotherapy Department, Rehabilitation Faculty of Iran University of Medical Sciences, Tehran, Iran
| | - Kamran Ezzati
- Physiotherapy Department, Guilan University of Medical Sciences, Rasht, Iran
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Cho JE, Cho KH, Yoo JS, Lee SJ, Lee WH. Reliability and validity of a dual-probe personal computer-based muscle viewer for measuring the pennation angle of the medial gastrocnemius muscle in patients who have had a stroke. Top Stroke Rehabil 2017; 25:6-12. [DOI: 10.1080/10749357.2017.1383723] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ji-Eun Cho
- Department of Physical Therapy, Graduate School, Sahmyook University, Seoul, Republic of Korea
| | - Ki Hun Cho
- Department of Physical Therapy, Uiduk University, Gyeongbuk, Republic of Korea
| | - Jun sang Yoo
- Department of Physical Therapy, Graduate School, Sahmyook University, Seoul, Republic of Korea
| | - Su Jin Lee
- Department of Physical Therapy, Graduate School, Sahmyook University, Seoul, Republic of Korea
| | - Wan-Hee Lee
- College of Health Science, Department of Physical Therapy, Sahmyook University, Seoul, Republic of Korea
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27
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Nijholt W, Scafoglieri A, Jager-Wittenaar H, Hobbelen JSM, van der Schans CP. The reliability and validity of ultrasound to quantify muscles in older adults: a systematic review. J Cachexia Sarcopenia Muscle 2017; 8:702-712. [PMID: 28703496 PMCID: PMC5659048 DOI: 10.1002/jcsm.12210] [Citation(s) in RCA: 235] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/27/2017] [Accepted: 03/20/2017] [Indexed: 11/06/2022] Open
Abstract
This review evaluates the reliability and validity of ultrasound to quantify muscles in older adults. The databases PubMed, Cochrane, and Cumulative Index to Nursing and Allied Health Literature were systematically searched for studies. In 17 studies, the reliability (n = 13) and validity (n = 8) of ultrasound to quantify muscles in community-dwelling older adults (≥60 years) or a clinical population were evaluated. Four out of 13 reliability studies investigated both intra-rater and inter-rater reliability. Intraclass correlation coefficient (ICC) scores for reliability ranged from -0.26 to 1.00. The highest ICC scores were found for the vastus lateralis, rectus femoris, upper arm anterior, and the trunk (ICC = 0.72 to 1.000). All included validity studies found ICC scores ranging from 0.92 to 0.999. Two studies describing the validity of ultrasound to predict lean body mass showed good validity as compared with dual-energy X-ray absorptiometry (r2 = 0.92 to 0.96). This systematic review shows that ultrasound is a reliable and valid tool for the assessment of muscle size in older adults. More high-quality research is required to confirm these findings in both clinical and healthy populations. Furthermore, ultrasound assessment of small muscles needs further evaluation. Ultrasound to predict lean body mass is feasible; however, future research is required to validate prediction equations in older adults with varying function and health.
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Affiliation(s)
- Willemke Nijholt
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Aldo Scafoglieri
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Harriët Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes S M Hobbelen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Cees P van der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Health Psychology Research, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Ultrasonic Measurement of Dynamic Muscle Behavior for Poststroke Hemiparetic Gait. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8208764. [PMID: 28232945 PMCID: PMC5292389 DOI: 10.1155/2017/8208764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/10/2016] [Accepted: 12/21/2016] [Indexed: 11/18/2022]
Abstract
Quantitative evaluation of the hemiparesis status for a poststroke patient is still challenging. This study aims to measure and investigate the dynamic muscle behavior in poststroke hemiparetic gait using ultrasonography. Twelve hemiparetic patients walked on a treadmill, and EMG, joint angle, and ultrasonography were simultaneously recorded for the gastrocnemius medialis muscle. Pennation angle was automatically extracted from ultrasonography using a tracking algorithm reported previously. The characteristics of EMG, joint angle, and pennation angle in gait cycle were calculated for both (affected and unaffected) sides of lower limbs. The results suggest that pennation angle could work as an important morphological index to continuous muscle contraction. The change pattern of pennation angle between the affected and unaffected sides is different from that of EMG. These findings indicate that morphological parameter extracted from ultrasonography can provide different information from that provided by EMG for hemiparetic gait.
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Nozoe M, Kubo H, Furuichi A, Kanai M, Takashima S, Shimada S, Mase K. Validity of Quadriceps Muscle Thickness Measurement in Patients with Subacute Stroke during Hospitalization for Assessment of Muscle Wasting and Physical Function. J Stroke Cerebrovasc Dis 2017; 26:438-441. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/22/2016] [Accepted: 10/10/2016] [Indexed: 11/29/2022] Open
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Paris MT, Mourtzakis M, Day A, Leung R, Watharkar S, Kozar R, Earthman C, Kuchnia A, Dhaliwal R, Moisey L, Compher C, Martin N, Nicolo M, White T, Roosevelt H, Peterson S, Heyland DK. Validation of Bedside Ultrasound of Muscle Layer Thickness of the Quadriceps in the Critically Ill Patient (VALIDUM Study). JPEN J Parenter Enteral Nutr 2016; 41:171-180. [PMID: 26962061 DOI: 10.1177/0148607116637852] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND In critically ill patients, muscle atrophy is associated with long-term disability and mortality. Bedside ultrasound may quantify muscle mass, but it has not been validated in the intensive care unit (ICU). Here, we compared ultrasound-based quadriceps muscle layer thickness (QMLT) with precise quantifications of computed tomography (CT)-based muscle cross-sectional area (CSA). METHODS Patients ≥18 years old with abdominal CT scans performed for clinical reasons were recruited from 9 ICUs for an ultrasound assessment of the quadriceps. CT scans of the third lumbar vertebra, performed <24 hours before or <72 hours after ICU admission, were analyzed for CSA. Low muscularity was defined as 170 cm2 for men and 110 cm2 for women. The ultrasound probe was maximally compressed against the skin and QMLT was measured on 2 sites of each quadriceps <72 hours of the CT scan. RESULTS Mean CT-derived muscle CSA was 109 ± 25 cm2 for women and 168 ± 37 cm2 for men, where 58% of patients exhibited low muscularity; only 2.7% patients were underweight according to body mass index. QMLT was positively correlated with CT CSA ( r = 0.45, P < .001). Based on logistic regression to predict low muscularity, QMLT independently generated a concordance index ( c) of 0.67 ( P < .002), which increased to 0.77 ( P < .001) when age, sex, body mass index, Charlson Comorbidity Index, and admission type (surgical vs medical) were added. CONCLUSIONS Our results suggest that QMLT alone with our current protocol may not accurately identify patients with low muscle mass.
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Affiliation(s)
- Michael T Paris
- 1 Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Andrew Day
- 2 Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
| | - Roger Leung
- 2 Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
| | - Snehal Watharkar
- 1 Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Carrie Earthman
- 4 Food Science and Nutrition, University of Minnesota, St Paul, Minnesota, USA
| | - Adam Kuchnia
- 4 Food Science and Nutrition, University of Minnesota, St Paul, Minnesota, USA
| | - Rupinder Dhaliwal
- 2 Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
| | - Lesley Moisey
- 1 Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Charlene Compher
- 5 School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,6 Clinical Nutrition Support Services, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Niels Martin
- 7 Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michelle Nicolo
- 7 Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tom White
- 8 Surgery, Intermountain Medical Center, Murray, Utah, USA
| | - Hannah Roosevelt
- 9 Food and Nutrition, Rush University Medical Center, Chicago, Illinois, USA
| | - Sarah Peterson
- 9 Food and Nutrition, Rush University Medical Center, Chicago, Illinois, USA
| | - Daren K Heyland
- 2 Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
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Nozoe M, Kanai M, Kubo H, Kitamura Y, Yamamoto M, Furuichi A, Takashima S, Mase K, Shimada S. Changes in Quadriceps Muscle Thickness, Disease Severity, Nutritional Status, and C-Reactive Protein after Acute Stroke. J Stroke Cerebrovasc Dis 2016; 25:2470-4. [PMID: 27388709 DOI: 10.1016/j.jstrokecerebrovasdis.2016.06.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 05/27/2016] [Accepted: 06/12/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Lower leg muscle wasting is common in stroke patients; however, patient characteristics in the acute phase are rarely studied. This study aimed to examine the relationship between changes in quadriceps muscle thickness and disease severity, nutritional status, and C-reactive protein (CRP) levels after acute stroke. METHODS Thirty-one consecutive patients with acute intracerebral hemorrhage or ischemic stroke had quadriceps muscle thickness measured in the paretic and nonparetic limbs within 1 week after admission (first week) and 2 weeks after the first examination (last week) using ultrasonography. We also determined the relationship between the percentage change in muscle thickness and disease severity, nutritional status, and CRP levels on admission. RESULTS There was a significant correlation between changes in muscle thickness for both paretic and nonparetic sides and National Institutes of Health Stroke Scale (NIHSS) scores (paretic limb: r = -.46, P = .01; nonparetic limb: r = -.54, P = .002, respectively); however, there was no significant correlation with nutritional status on admission. Quadriceps muscle thickness was reduced more in the CRP-positive (≥.3 mg/dL) patients than in the CRP-negative (<.3 mg/dL) patients in the nonparetic limb (positive: -21.4 ± 12.1, negative: -11.4 ± 16.4%; P = .039), but not in the paretic limb (positive: -23.4 ± 9.0, negative: -19.1 ± 15.7; P = .27). CONCLUSIONS A high NIHSS score and a positive CRP on admission were both significantly correlated with decreased quadriceps muscle thickness after acute stroke. Nutritional status on admission was not correlated with changes in quadriceps muscle thickness for these patients.
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Affiliation(s)
- Masafumi Nozoe
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan; Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan.
| | - Masashi Kanai
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Hiroki Kubo
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Yuka Kitamura
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Miho Yamamoto
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Asami Furuichi
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Sachie Takashima
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan
| | - Kyoshi Mase
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan
| | - Shinichi Shimada
- Department of Neurosurgery, Itami Kousei Neurosurgical Hospital, Itami, Japan
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32
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Sarwal A, Parry SM, Berry MJ, Hsu FC, Lewis MT, Justus NW, Morris PE, Denehy L, Berney S, Dhar S, Cartwright MS. Interobserver Reliability of Quantitative Muscle Sonographic Analysis in the Critically Ill Population. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1191-200. [PMID: 26112621 DOI: 10.7863/ultra.34.7.1191] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES There is growing interest in the use of quantitative high-resolution neuromuscular sonography to evaluate skeletal muscles in patients with critical illness. There is currently considerable methodological variability in the measurement technique of quantitative muscle analysis. The reliability of muscle parameters using different measurement techniques and assessor expertise levels has not been examined in patients with critical illness. The primary objective of this study was to determine the interobserver reliability of quantitative sonographic measurement analyses (thickness and echogenicity) between assessors of different expertise levels and using different techniques for selecting the region of interest. METHODS We conducted a cross-sectional observational study in neurocritical care and mixed surgical-medical intensive care units from 2 tertiary referral hospitals. RESULTS Twenty diaphragm and 20 quadriceps images were evaluated. Images were obtained by using standardized imaging acquisition techniques. Quantitative sonographic measurements included muscle thickness and echogenicity analysis (either by the trace or square technique). All images were analyzed twice independently by 4 assessors of differing expertise levels. Excellent interobserver reliability was obtained for all measurement techniques regardless of expertise level (intraclass correlation coefficient, >0.75 for all comparisons). There was less variability between assessors for echogenicity values when the square technique was used for the quadriceps muscle and the trace technique for the diaphragm. CONCLUSIONS Excellent interobserver reliability exists regardless of expertise level for quantitative analysis of muscle parameters on sonography in the critically ill population. On the basis of these findings, it is recommended that echogenicity analysis be performed using the square technique for the quadriceps and the trace technique for the diaphragm.
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Affiliation(s)
- Aarti Sarwal
- Departments of Neurology (A.S., M.S.C.), Anesthesiology, Section on Critical Care Medicine (A.S.), Biostatistical Sciences, Division of Public Health Sciences (F.-C.H.), and Internal Medicine, Section on Critical Care Medicine (P.E.M., S.D.), Wake Forest School of Medicine, Winston-Salem, North Carolina USA; Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia (S.M.P., S.B.); University of Melbourne, Melbourne, Victoria, Australia (S.M.P., L.D.); and Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina USA (M.J.B., M.T.L., N.W.J.).
| | - Selina M Parry
- Departments of Neurology (A.S., M.S.C.), Anesthesiology, Section on Critical Care Medicine (A.S.), Biostatistical Sciences, Division of Public Health Sciences (F.-C.H.), and Internal Medicine, Section on Critical Care Medicine (P.E.M., S.D.), Wake Forest School of Medicine, Winston-Salem, North Carolina USA; Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia (S.M.P., S.B.); University of Melbourne, Melbourne, Victoria, Australia (S.M.P., L.D.); and Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina USA (M.J.B., M.T.L., N.W.J.)
| | - Michael J Berry
- Departments of Neurology (A.S., M.S.C.), Anesthesiology, Section on Critical Care Medicine (A.S.), Biostatistical Sciences, Division of Public Health Sciences (F.-C.H.), and Internal Medicine, Section on Critical Care Medicine (P.E.M., S.D.), Wake Forest School of Medicine, Winston-Salem, North Carolina USA; Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia (S.M.P., S.B.); University of Melbourne, Melbourne, Victoria, Australia (S.M.P., L.D.); and Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina USA (M.J.B., M.T.L., N.W.J.)
| | - Fang-Chi Hsu
- Departments of Neurology (A.S., M.S.C.), Anesthesiology, Section on Critical Care Medicine (A.S.), Biostatistical Sciences, Division of Public Health Sciences (F.-C.H.), and Internal Medicine, Section on Critical Care Medicine (P.E.M., S.D.), Wake Forest School of Medicine, Winston-Salem, North Carolina USA; Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia (S.M.P., S.B.); University of Melbourne, Melbourne, Victoria, Australia (S.M.P., L.D.); and Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina USA (M.J.B., M.T.L., N.W.J.)
| | - Marc T Lewis
- Departments of Neurology (A.S., M.S.C.), Anesthesiology, Section on Critical Care Medicine (A.S.), Biostatistical Sciences, Division of Public Health Sciences (F.-C.H.), and Internal Medicine, Section on Critical Care Medicine (P.E.M., S.D.), Wake Forest School of Medicine, Winston-Salem, North Carolina USA; Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia (S.M.P., S.B.); University of Melbourne, Melbourne, Victoria, Australia (S.M.P., L.D.); and Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina USA (M.J.B., M.T.L., N.W.J.)
| | - Nicholas W Justus
- Departments of Neurology (A.S., M.S.C.), Anesthesiology, Section on Critical Care Medicine (A.S.), Biostatistical Sciences, Division of Public Health Sciences (F.-C.H.), and Internal Medicine, Section on Critical Care Medicine (P.E.M., S.D.), Wake Forest School of Medicine, Winston-Salem, North Carolina USA; Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia (S.M.P., S.B.); University of Melbourne, Melbourne, Victoria, Australia (S.M.P., L.D.); and Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina USA (M.J.B., M.T.L., N.W.J.)
| | - Peter E Morris
- Departments of Neurology (A.S., M.S.C.), Anesthesiology, Section on Critical Care Medicine (A.S.), Biostatistical Sciences, Division of Public Health Sciences (F.-C.H.), and Internal Medicine, Section on Critical Care Medicine (P.E.M., S.D.), Wake Forest School of Medicine, Winston-Salem, North Carolina USA; Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia (S.M.P., S.B.); University of Melbourne, Melbourne, Victoria, Australia (S.M.P., L.D.); and Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina USA (M.J.B., M.T.L., N.W.J.)
| | - Linda Denehy
- Departments of Neurology (A.S., M.S.C.), Anesthesiology, Section on Critical Care Medicine (A.S.), Biostatistical Sciences, Division of Public Health Sciences (F.-C.H.), and Internal Medicine, Section on Critical Care Medicine (P.E.M., S.D.), Wake Forest School of Medicine, Winston-Salem, North Carolina USA; Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia (S.M.P., S.B.); University of Melbourne, Melbourne, Victoria, Australia (S.M.P., L.D.); and Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina USA (M.J.B., M.T.L., N.W.J.)
| | - Sue Berney
- Departments of Neurology (A.S., M.S.C.), Anesthesiology, Section on Critical Care Medicine (A.S.), Biostatistical Sciences, Division of Public Health Sciences (F.-C.H.), and Internal Medicine, Section on Critical Care Medicine (P.E.M., S.D.), Wake Forest School of Medicine, Winston-Salem, North Carolina USA; Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia (S.M.P., S.B.); University of Melbourne, Melbourne, Victoria, Australia (S.M.P., L.D.); and Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina USA (M.J.B., M.T.L., N.W.J.)
| | - Sanjay Dhar
- Departments of Neurology (A.S., M.S.C.), Anesthesiology, Section on Critical Care Medicine (A.S.), Biostatistical Sciences, Division of Public Health Sciences (F.-C.H.), and Internal Medicine, Section on Critical Care Medicine (P.E.M., S.D.), Wake Forest School of Medicine, Winston-Salem, North Carolina USA; Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia (S.M.P., S.B.); University of Melbourne, Melbourne, Victoria, Australia (S.M.P., L.D.); and Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina USA (M.J.B., M.T.L., N.W.J.)
| | - Michael S Cartwright
- Departments of Neurology (A.S., M.S.C.), Anesthesiology, Section on Critical Care Medicine (A.S.), Biostatistical Sciences, Division of Public Health Sciences (F.-C.H.), and Internal Medicine, Section on Critical Care Medicine (P.E.M., S.D.), Wake Forest School of Medicine, Winston-Salem, North Carolina USA; Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia (S.M.P., S.B.); University of Melbourne, Melbourne, Victoria, Australia (S.M.P., L.D.); and Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina USA (M.J.B., M.T.L., N.W.J.)
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Nozoe M, Kanai M, Kubo H, Kitamura Y, Shimada S, Mase K. Changes in quadriceps muscle thickness in acute non-ambulatory stroke survivors. Top Stroke Rehabil 2015; 23:8-14. [DOI: 10.1179/1945511915y.0000000002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Baek IH, Kim BJ. The effects of horse riding simulation training on stroke patients' balance ability and abdominal muscle thickness changes. J Phys Ther Sci 2014; 26:1293-6. [PMID: 25202200 PMCID: PMC4155239 DOI: 10.1589/jpts.26.1293] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 02/22/2014] [Indexed: 12/20/2022] Open
Abstract
[Purpose] The purpose of this study was to assess the effects of horse riding simulation training on changes in balance ability and abdominal muscle thicknesses of stroke patients. [Subjects] Thirty stroke patients with hemiplegia were recruited, and they were randomly assigned to a control or experimental group. [Methods] The experimental group performed horse riding simulation training, whereas the control group performed trunk exercises for 8 weeks. Balance ability was measured using a BioRescue system. The thicknesses of subjects' external oblique, internal oblique, and transversus abdominis muscles were measured by ultrasonic imaging. [Results] In the experimental group, balance ability was significantly improved after training. Similarly, the thickness of the abdominal muscles on the affected side changed after training in the experimental group, whereas the control group showed no statistically significant changes. [Conclusion] We suggest that horse riding simulation training is more effective than trunk exercises at reducing the center of pressure path length and travel speed and improving the asymmetry of the abdominal muscles of stroke patients.
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Affiliation(s)
- Il-Hun Baek
- Department of Physical Therapy, Dong-Eui Institute of Technology, Republic of Korea
| | - Byeong Jo Kim
- Department of Physical Therapy, Dong-Eui University, Republic of Korea
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35
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Kim HD, You JM, Han N, Eom MJ, Kim JG. Ultrasonographic measurement of transverse abdominis in stroke patients. Ann Rehabil Med 2014; 38:317-26. [PMID: 25024954 PMCID: PMC4092171 DOI: 10.5535/arm.2014.38.3.317] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 10/17/2013] [Indexed: 11/17/2022] Open
Abstract
Objective To compare transverse abdominis (TrA) contractility in stroke patients with hemiparesis and healthy adults using musculoskeletal ultrasonography. Methods Forty-seven stroke patients with hemiparesis and 25 age-matched healthy control subjects participated in this study. Stroke patients were divided into three groups on the basis of their degree of ambulation. Group A consisted of 9 patients with wheelchair ambulation, group B of 23 patients with assisted ambulation, and group C of 15 patients with independent ambulation. Inter-rater reliability regarding ultrasonographic measurement of abdominal muscle thickness in the control group was assessed by two examiners. The TrA contraction ratio (TrA contracted thickness/TrA resting thickness) was measured during abdominal drawing-in maneuver and was compared between the patients and the control group and between the ambulation groups. Results The inter-rater reliability ranged from 0.900 to 0.947. The TrA contraction ratio was higher in the non-paretic side than in the paretic side (1.40±0.62 vs. 1.14±0.35, p<0.01). The TrA contraction ratio of the patient group was lower in the non-paretic side as well as in the paretic side than that of the control group (right 1.85±0.29, left 1.92±0.42; p<0.001). No difference was found between the ambulation regarding the TrA contraction ratio. Conclusion The TrA contractility in hemiparetic stroke patients is significantly decreased in the non-paretic side as well as in the paretic side compared with that of healthy adults. Ultrasonographic measurement can be clinically used in the evaluation of deep abdominal muscles in stroke patients.
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Affiliation(s)
- Hyun Dong Kim
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jun Myeong You
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Nami Han
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Mi Ja Eom
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jong Gil Kim
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Jizhou Li, Yongjin Zhou, Yi Lu, Guangquan Zhou, Lei Wang, Yong-Ping Zheng. The Sensitive and Efficient Detection of Quadriceps Muscle Thickness Changes in Cross-Sectional Plane Using Ultrasonography: A Feasibility Investigation. IEEE J Biomed Health Inform 2014; 18:628-35. [DOI: 10.1109/jbhi.2013.2275002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Ling S, Zhou Y, Chen Y, Zhao YQ, Wang L, Zheng YP. Automatic Tracking of Aponeuroses and Estimation of Muscle Thickness in Ultrasonography: A Feasibility Study. IEEE J Biomed Health Inform 2013; 17:1031-8. [PMID: 24240721 DOI: 10.1109/jbhi.2013.2253787] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Han P, Chen Y, Ao L, Xie G, Li H, Wang L, Zhou Y. Automatic thickness estimation for skeletal muscle in ultrasonography: evaluation of two enhancement methods. Biomed Eng Online 2013; 12:6. [PMID: 23339544 PMCID: PMC3626569 DOI: 10.1186/1475-925x-12-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 01/14/2013] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Ultrasonography is a convenient technique to investigate muscle properties and has been widely used to look into muscle functions since it is non-invasive and real-time. Muscle thickness, a quantification which can effectively reflect the muscle activities during muscle contraction, is an important measure for musculoskeletal studies using ultrasonography. The traditional manual operation to read muscle thickness is subjective and time-consuming, therefore a number of studies have focused on the automatic estimation of muscle fascicle orientation and muscle thickness, to which the speckle noises in ultrasound images could be the major obstacle. There have been two popular methods proposed to enhance the hyperechoic regions over the speckles in ultrasonography, namely Gabor Filtering and Multiscale Vessel Enhancement Filtering (MVEF). METHODS A study on gastrocnemius muscle is conducted to quantitatively evaluate whether and how these two methods could help the automatic estimation of the muscle thickness based on Revoting Hough Transform (RVHT). The muscle thickness results obtained from each of the two methods are compared with the results from manual measurement, respectively. Data from an aged subject with cerebral infarction is also studied. RESULTS It's shown in the experiments that, Gabor Filtering and MVEF can both enable RVHT to generate comparable results of muscle thickness to those by manual drawing (mean ± SD, 1.45 ± 0.48 and 1.38 ± 0.56 mm respectively). However, the MVEF method requires much less computation than Gabor Filtering. CONCLUSIONS Both methods, as preprocessing procedure can enable RVHT the automatic estimation of muscle thickness and MVEF is believed to be a better choice for real-time applications.
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Affiliation(s)
- Pan Han
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Science, Shenzhen, China
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