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

Agreement and reliability of lower limb muscle architecture measurements using a portable ultrasound device

High end ultrasonography devices lack in portability and are expensive. We investigated the agreement and reliability of a handheld and portable ultrasound system for human lower limb muscle architecture measurements. We captured ultrasound images of the rectus femoris (RF), vastus lateralis (VL) and gastrocnemius medialis (GM) in 36 active healthy participants (15 female, 21 male) at 50% of muscle length using the handheld Lumify (L12-4, linear-array 37 mm, Philips Healthcare, Amsterdam, Netherlands) and a high-end laboratory device (ACUSON Juniper, linear-array 54 mm, 12L3, SIEMENS Healthineers, Erlangen, Germany). We compared measurements of muscle fascicle length, pennation angle and thickness. To assess inter-session reliability of the Lumify system, participants were measured twice within 1 week. Comparing RF architecture measurements of both devices resulted in intra-class correlations (ICCs) ranging from 0.46–0.82 and standardized mean difference (SMDs) ranging from −0.45–0.05. For VL, ICCs ranged from 0.60–0.89 and SMDs ranged from −0.11–0.13. ICCs and SMDs for the GM ranged from 0.82–0.86 and −0.07–0.07. Calculating inter-session reliability for RF resulted in ICCs ranging from 0.44–0.76 and SMDs ranging from −0.38–0.15. For VL, ICCs and SMDs ranged from 0.57–0.75 and −0.13–0.02. ICCs for GM ranged from 0.75–0.92 and SMDs ranged from −0.15–0.16. Measurement of muscle thickness demonstrated the highest agreement (ICC ≥0.82) and reliability (ICC ≥0.75) across all muscles. The Lumify system was comparable to a high-end device and reliable for GM measurements. However, agreement and reliability were lower for the RF and VL. Of all evaluated architectural parameters, muscle thickness exhibited highest agreement and reliability.

Muscle architecture and clinical parameters in stroke patients: An ultrasonographic study

PURPOSE

To compare the lower extremity muscle architecture on both the affected side and healthy sides using ultrasound (US) imaging and examine the relationship between these measurements and clinical parameters in stroke patients.

METHODS

A cross-sectional analysis of 125 stroke patients (64 M, 61 F) was performed in this study. Timed up and go (TUG) test was used to evaluate balance, Fugl-Meyer assessment of lower extremity (FMA-LE) was used to evaluate motor function, functional independence measurement (FIM) was used to evaluate functional status. Muscle thicknesses (MT) of rectus femoris (RF), vastus intermedius (VI), vastus medialis (VM), vastus lateralis (VL), soleus, medial gastrocnemius (GC) muscles, the PA and the FL of GC were obtained using ultrasound (US) imaging.

RESULTS

The muscle thickness, PA and FL of the affected side decreased significantly compared to the healthy side (p = .0001) in stroke patients. Another clear result was that soleus and GC muscle thicknesses and PA of GC muscle were found to be associated with balance, motor function, and functional status.

CONCLUSION

The properties of muscles evaluated with US may provide recommendations for clinical assessments and also potentially contribute to clinicians designing a rehabilitation intervention program for stroke patients.

A wearable electromyography-controlled functional electrical stimulation system improves balance, gait function, and symmetry in older adults

BACKGROUND

Wearable technologies have been developed for healthy aging. The technology for electromyography (EMG)-controlled functional electrical stimulation (FES) systems has been developed, but research on how helpful it is in daily life has been insufficient.

OBJECTIVE

The purpose of this study was to investigate the effect of the EMG-controlled FES system on muscle morphology, balance, and gait in older adults.

METHODS

Twenty-nine older adults were evaluated under two randomly assigned conditions (non-FES and FES assists). Muscle morphology, balance, gait function, and muscle effort during gait were measured using ultrasonography, a physical test, a gait analysis system, and EMG.

RESULTS

The EMG-controlled FES system improved gait speed by 11.1% and cadence by 15.6% (P< 0.01). The symmetry ratio of the bilateral gastrocnemius was improved by 9.9% in the stance phase and 11.8% in the swing phase (P< 0.05). The degrees of coactivation of the knee and ankle muscles were reduced by 45.1% and 50.5%, respectively (P< 0.05). Balance improved by 6-10.7% (P< 0.01).

CONCLUSION

The EMG-controlled FES system is useful for balance and gait function by increasing muscle symmetry and decreasing muscle coactivation during walking in older adults.

Contralateral seventh cervical nerve transfer can affect the pennation angle of the lower limb in spastic hemiplegia patients: An observational case series study

INTRODUCTION

We previously reported transferring seventh cervical (C7) nerve from unaffected side to affected side in patients with spastic hemiplegia due to chronic cerebral injury, to improve function and reduce spasticity of paralyzed upper limb. In the clinics, some patients also reported changes of spasticity in their lower limb, which could not be detected by routine physical examinations. Pennation angle of muscle can indirectly reflect the condition of spasticity. The purpose of this study was to evaluate whether this upper limb procedure may affect spasticity of lower limb, using ultrasonography to detect changes of muscle pennation angle (PA).

METHODS

Twelve spastic hemiplegia patients due to cerebral injury including stroke, cerebral palsy, and traumatic brain injury, who underwent C7 nerve transfer procedure, participated in this study. B-mode ultrasonography was used to measure PA of the gastrocnemius medialis (GM) muscle at rest preoperatively and postoperatively. The plantar load distribution of the lower limbs was evaluated using a Zebris FDM platform preoperatively and postoperatively.

RESULTS

The PA of the GM was significantly smaller on the affected side than that of unaffected side before surgery. On the affected side, the postoperative PA was significantly larger than preoperative PA. On the unaffected side, the postoperative PA was not significantly different compared to preoperative PA. The postoperative plantar load distribution of the affected forefoot was significantly smaller than preoperative load distribution, which was consistent with ultrasonography results.

CONCLUSIONS

This study indicates that C7 nerve transfer surgery for improving upper limb function can also affect muscle properties of lower limb in spastic hemiplegia patients, which reveals a link between the upper and lower limbs. The interlimb interactions should be considered in rehabilitation physiotherapy, and the regular pattern and mechanism need to be further studied.