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Devis M, Lecouvet F, Lejeune T, Stoquart G. Noninvasive analysis of overactive muscle structure and elasticity after botulinum toxin type A injection: a systematic review and meta-analysis. Eur J Phys Rehabil Med 2024; 60:567-580. [PMID: 38958691 DOI: 10.23736/s1973-9087.24.08029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
INTRODUCTION Injections of botulinum toxin type A (BoNT-A) are the first-line treatment for spastic muscle overactivity (MO). Some authors observed that BoNT-A injections lead to changes in muscle structure and muscle elasticity that are probably not completely reversible. This possible effect is critical, as it could lead to negative impacts on the effectiveness of BoNT-A interventions. Our study aimed to evaluate the current literature regarding changes in muscle elasticity and structure after BoNT-A injection, by diagnostic imaging, in neurological populations with MO. Our second objective was to pool all articles published on this topic in order to provide a quantitative synthesis of the data. EVIDENCE ACQUISITION A systematic search was conducted between October 2021 and April 2023 using different databases in accordance with PRISMA guidelines. Two independent reviewers screened articles for inclusion, extracted data, and evaluated methodological quality of the studies. A meta-analysis was performed to compare muscle elasticity and structure before and after BoNT-A injections. EVIDENCE SYNTHESIS A sample of 34 studies was selected for qualitative review and 19 studies for quantitative review. Meta-analysis of pre-post studies demonstrated significant improvement with a medium effect size (standardized mean difference=0.74; 95% CI 0.46-1.02; P<0.001) of muscle elasticity assessed by ultrasound elastography (USE) 4 weeks after BoNT-A injection. No statistically significant difference was found for muscle thickness, pennation angle, and muscle echo-intensity assessed by magnetic resonance imaging and/or ultrasonography at short-term. On the other hand, normalized muscle volume decreased with a small effect size (standardized mean difference = -0.17; 95% CI -0.25 - -0.09; P<0.001) 6 months after BoNT-A injection. CONCLUSIONS Muscle elasticity measured by USE improves with a temporary effect at short-term following BoNT-A injections. Synthesis of studies that assesses muscle structure is hindered by methodological differences between studies. However, based on a small amount of data, normalized muscle volume seems to decrease at long-term after BoNT-A injections in children with CP suggesting that the timing of re-injection should be considered with caution in this population. Further work should focus on the long-term effect of repeated injections on muscle structure and elasticity in neurological populations.
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Affiliation(s)
- Marine Devis
- Department of Health Sciences, Institute of Experimental and Clinical Research, Neuromusculoskeletal Lab (NMSK), Catholic University of Louvain, Brussels, Belgium -
| | - Frédéric Lecouvet
- Department of Health Sciences, Institute of Experimental and Clinical Research, IMAG lab, Catholic University of Louvain, Brussels, Belgium
- Department of Radiology, Saint-Luc University Clinic, Brussels, Belgium
| | - Thierry Lejeune
- Department of Health Sciences, Institute of Experimental and Clinical Research, Neuromusculoskeletal Lab (NMSK), Catholic University of Louvain, Brussels, Belgium
- Department of Physical Medicine and Rehabilitation, Saint-Luc University Clinic, Brussels, Belgium
| | - Gaëtan Stoquart
- Department of Health Sciences, Institute of Experimental and Clinical Research, Neuromusculoskeletal Lab (NMSK), Catholic University of Louvain, Brussels, Belgium
- Department of Physical Medicine and Rehabilitation, Saint-Luc University Clinic, Brussels, Belgium
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Boissonnault È, Jeon A, Munin MC, Filippetti M, Picelli A, Haldane C, Reebye R. Assessing muscle architecture with ultrasound: implications for spasticity. Eur J Transl Myol 2024; 34:12397. [PMID: 38818772 PMCID: PMC11264226 DOI: 10.4081/ejtm.2024.12397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/21/2024] [Indexed: 06/01/2024] Open
Abstract
Botulinum Neurotoxin Type A (BoNT-A) injections using Ultrasound (US) guidance have led to research evaluating changes in muscle architecture. Controversy remains as to what constitutes increased Echo-Intensity (EI) in spastic muscles and whether this may affect outcomes. We aim to provide a narrative review of US muscle architecture changes following Central Nervous System (CNS) lesions and explore their relationship to spasticity. Medline, CINAHL, and Embase databases were searched with keywords: ultrasonography, hypertonia, spasticity, fibrosis, and Heckmatt. Three physicians reviewed the results of the search to select relevant papers. Reviews identified in the search were used as a resource to identify additional studies. A total of 68 papers were included. Four themes were identified, including histopathological changes in spastic muscle, effects of BoNT-A on the muscle structure, available US modalities to assess the muscle, and utility of US assessment in clinical spasticity. Histopathological studies revealed atrophic and fibro-fatty changes after CNS lesions. Several papers described BoNT-A injections contributing to those modifications. These changes translated to increased EI. The exact significance of increased muscle EI remains unclear. The Modified Heckmatt Scale (MHS) is a validated tool for grading muscle EI in spasticity. The use of the US may be an important tool to assess muscle architecture changes in spasticity and improve spasticity management. Treatment algorithms may be developed based on the degree of EI. Further research is needed to determine the incidence and impact of these EI changes in spastic muscles.
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Affiliation(s)
- Ève Boissonnault
- Faculty of Medicine, Université de Montréal, Montreal, Canada; Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston.
| | - April Jeon
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, Canada; Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh School of Medicine, Pittsburgh.
| | - Michael C Munin
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, Canada; Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh School of Medicine, Pittsburgh.
| | - Mirko Filippetti
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, Canada; Physical and Rehabilitation Medicine section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona.
| | - Alessandro Picelli
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, Canada; Physical and Rehabilitation Medicine section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona.
| | - Chloe Haldane
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, Canada; Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver.
| | - Rajiv Reebye
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, Canada; Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver.
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Han X, Zhang Y, Shi G, Liu G, Ai S, Wang Y, Zhang Q, He X. Quantitative assessment of corneal elasticity distribution after FS-LASIK using optical coherence elastography. JOURNAL OF BIOPHOTONICS 2024; 17:e202300441. [PMID: 38221644 DOI: 10.1002/jbio.202300441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/12/2023] [Accepted: 01/04/2024] [Indexed: 01/16/2024]
Abstract
Quantifying corneal elasticity after femtosecond laser-assisted in situ keratomileusis (FS-LASIK) procedure plays an important role in improving surgical safety and quality, since some latent complications may occur ascribing to changes in postoperative corneal biomechanics. Nevertheless, it is suggested that current research has been severely constrained due to the lack of an accurate quantification method to obtain postoperative corneal elasticity distribution. In this paper, an acoustic radiation force optical coherence elastography system combined with the improved phase velocity algorithm was utilized to realize elasticity distribution images of the in vivo rabbit cornea after FS-LASIK under various intraocular pressure levels. As a result, elasticity variations within and between the regions of interest could be identified precisely. This is the first time that elasticity imaging of in vivo cornea after FS-LASIK surgery was demonstrated, and the results suggested that this technology may hold promise in further exploring corneal biomechanical properties after refractive surgery.
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Affiliation(s)
- Xiao Han
- School of Instrument Science and Opto-electronics Engineering, Beihang University, Beijing, P. R. China
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang, P. R. China
| | - Yubao Zhang
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang, P. R. China
| | - Gang Shi
- School of Mathematics and Physics, University of Science and Technology Beijing, Beijing, China
| | - Guo Liu
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang, P. R. China
| | - Sizhu Ai
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang, P. R. China
| | - Yidi Wang
- School of Instrument Science and Opto-electronics Engineering, Beihang University, Beijing, P. R. China
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang, P. R. China
| | - Qin Zhang
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang, P. R. China
| | - Xingdao He
- School of Instrument Science and Opto-electronics Engineering, Beihang University, Beijing, P. R. China
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang, P. R. China
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Tavakkoli M, Bahrpeyma F. Elastic Modulus of Suboccipital Muscles, Cervical Range of Motion, and Forward Head Posture in Cervicogenic Headache. J Biomed Phys Eng 2023; 13:463-470. [PMID: 37868938 PMCID: PMC10589696 DOI: 10.31661/jbpe.v0i0.2104-1298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 09/10/2021] [Indexed: 10/24/2023]
Abstract
Background Although stiffness of neck muscles, the limitation of cervical range of motion (ROM), and forward head posture (FHP) are proposed as clinical characteristics of cervicogenic headache (CGH), adequate consistent data failed to support these characteristics. Objective This study aims to compare the elastic modulus of suboccipital muscles, cervical ROM, and FHP between individuals suffering from CGH and healthy controls. Material and Methods In this cross-sectional study, 20 individuals with a history of CGH and 20 normal individuals participated. Sonography images and a universal goniometer (UG) were used to assess elastic modulus and cervical ROM, respectively. In addition, FHP was assessed based on measuring craniovertebral angle (CVA) using a digital imaging technique and also the distance of anterior tragus of the ear with the vertical line passed from anterior of lateral malleolus according to the Kendall and McCreary method. Results Elastic modulus of suboccipital muscles in the CGH group was significantly higher than that of the normal group (P=0.008). The two groups were not significantly different in terms of FHP. Moreover, ROM of cervical extension (P=0.035), right rotation (P=0.046), and left rotation (P=0.018) showed a significant reduction in the CGH group compared to the control group. Conclusion Suboccipital muscles are stiffer and ROM of cervical rotation and extension is smaller in CGH patients than the healthy controls, but FHP is not different between the groups, leading to diagnosing CGH and treatment.
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Affiliation(s)
- Mahdi Tavakkoli
- Department of Physical Therapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Farid Bahrpeyma
- Department of Physical Therapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Liu W, Wu HD, Ling YT, Shea QTK, Nazari V, Zheng YP, Ma CZH. Reliability and validity of assessing lower-limb muscle architecture of patients with cerebral palsy (CP) using ultrasound: A systematic review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1212-1222. [PMID: 37334435 DOI: 10.1002/jcu.23498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/11/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023]
Abstract
AIMS To investigate the reliability, validity, and level of evidence of applying ultrasound in assessing the lower-limb muscles of patients with cerebral palsy (CP). METHOD Publications in Medline, PubMed, Web of Science, and Embase were searched on May 10, 2023, to identify and examine relevant studies investigating the reliability/validity of ultrasound in evaluating the architecture of CP lower-limb muscles systematically, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines. RESULTS Out of 897 records, 9 publications with 111 CP participants aged 3.8-17.0 years were included (8 focused on intra-rater and inter-rater reliability, 2 focused on validity, and 4 were with high quality). The ultrasound-based measurements of muscle thickness (intra-rater only), muscle length, cross-sectional area, muscle volume, fascicle length, and pennation angle showed high reliability, with the majority of intraclass correlation coefficient (ICC) values being larger than 0.9. Moderate-to-good correlations between ultrasound and magnetic resonance imaging measurements existed in muscle thickness and cross-sectional area (0.62 ≤ ICC ≤ 0.82). INTERPRETATION Generally, ultrasound has high reliability and validity in evaluating the CP muscle architecture, but this is mainly supported by moderate and limited levels of evidence. More high-quality future studies are needed.
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Affiliation(s)
- Wei Liu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Prosthetic and Orthotic Engineering, School of Rehabilitation, Kunming Medical University, Kunming, China
| | - Hui Dong Wu
- Department of Prosthetic and Orthotic Engineering, School of Rehabilitation, Kunming Medical University, Kunming, China
| | - Yan To Ling
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Queenie Tsung Kwan Shea
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Vaheh Nazari
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Christina Zong-Hao Ma
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong, China
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Varol U, Valera-Calero JA, Fernández-de-las-Peñas C, Buffet-García J, Plaza-Manzano G, Navarro-Santana MJ. Body Composition and Demographic Features Do Not Affect the Diagnostic Accuracy of Shear Wave Elastography. Bioengineering (Basel) 2023; 10:904. [PMID: 37627789 PMCID: PMC10451656 DOI: 10.3390/bioengineering10080904] [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: 05/26/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
Shear-wave elastography (SWE) is an imaging method that can be used to estimate shear wave speed and the Young's modulus based on the measured shear wave speed under certain conditions. Up to date, no research has analyzed whether body composition factors contribute to ultrasound attenuation, refraction, reflection, and, consequently, SWE measurement errors. Therefore, this study aimed to analyze the association between demographic and body composition features with SWE errors for assessing the anterior scalene stiffness (which is a key structure in patients with neck pain and nerve compressive syndromes). Demographic (sex, age, height, weight, and body mass index), body composition (water volume, fat mass, and lean mass), and anterior scalene muscle stiffness (Young's modulus and shear wave speed) data were collected from a sample of asymptomatic subjects. After calculating the absolute SWE differences between trials and the reliability estimates, a correlation matrix was generated to quantify the association among all the variables. A total of 34 asymptomatic subjects (24 males) were included in the analyses. Test-retest reliability was excellent for assessing the Young's modulus and shear wave velocity (ICC = 0.912 and 0.923, respectively). No significant associations were found between age, height, weight, body mass index, body fat, lean mass, or water volume with SWE errors (p > 0.05). However, the Young's modulus error was associated with the stiffness properties (p < 0.01), whereas shear wave speed was associated with none of them (all, p > 0.05). A detailed procedure can reliably assess the AS muscle stiffness. None of the sociodemographic or body composition features assessed were correlated with SWE errors. However, baseline stiffness seems to be associated with Young's modulus error.
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Affiliation(s)
- Umut Varol
- Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
| | - Juan Antonio Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain; (G.P.-M.); (M.J.N.-S.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - César Fernández-de-las-Peñas
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Jorge Buffet-García
- Faculty of Health Sciences, Universidad Francisco de Vitoria, 28223 Pozuelo de Alarcón, Spain;
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain; (G.P.-M.); (M.J.N.-S.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Marcos José Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain; (G.P.-M.); (M.J.N.-S.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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Lin MT, Yang SM, Wu HW, Chen YH, Wu CH. Utility of Ultrasound Elastography to Evaluate Poststroke Spasticity and Therapeutic Efficacy: A Narrative Review. J Med Ultrasound 2023; 31:171-177. [PMID: 38025006 PMCID: PMC10668905 DOI: 10.4103/jmu.jmu_106_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/11/2022] [Indexed: 12/01/2023] Open
Abstract
Poststroke spasticity (PSS) is a common complication that affects function and daily self-care. Conservative PSS treatments include traditional rehabilitation, botulinum toxin injection, and extracorporeal shock wave therapy. Currently, the Modified Ashworth Scale and Modified Tardieu Scale are widely used tools to clinically evaluate spasticity, but the best tool for PSS assessment remained controversial. Ultrasound elastography (UE), including shear wave and strain image as the emerging method to evaluate soft tissue elasticity, became popular in clinical applications. Spastic biceps and gastrocnemius muscles were reported to be significantly stiffer compared to nonparetic muscles or healthy control using shear wave or strain elastography. More studies investigated the utility, reliability, and validity of UE in patients with PSS, but the contemporary consensus for the utility of UE in the measurement and therapeutic follow-up of PSS remained lacking. Therefore, this narrative review aimed to appraise the literature on the shear wave and strain elastography on PSS and summarize the roles of UE in assessing the therapeutic efficacy of different PSS interventions.
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Affiliation(s)
- Meng-Ting Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shu-Mei Yang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Hao-Wei Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Yen-Hua Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Chueh-Hung Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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Jardon M, Nguyen J, Casaletto E, Ko L, Wolff A, Daluiski A, Nwawka OK. Utilization of shear wave elastography to quantify and predict response to upper extremity botulinum toxin injections in patients with cerebral palsy: A pilot study. Clin Neurol Neurosurg 2023; 230:107798. [PMID: 37236005 DOI: 10.1016/j.clineuro.2023.107798] [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: 01/15/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Shear wave elastography (SWE) was used to quantify change in upper extremity muscle stiffness in patients with unilateral spastic cerebral palsy (USCP) following botulinum toxin A (BTX-A) therapy. We hypothesized that SWE measures would decrease following ultrasound-guided BTX-A injection, and correlate with functional improvement. METHODS SWE measures of BTX-A treated muscles were recorded immediately pre-injection, and at 1-, 3- and 6-months post-injection. At the same timepoints, functional assessment was performed using the Modified Ashworth Scale (MAS), and passive and active range of motion (PROM and AROM) measures. Correlation of SWE with MAS, PROM and AROM, as well as the relationship between change in SWE and change in MAS, PROM and AROM was determined using Spearman's rank correlation coefficient and generalized estimating equation modeling. RESULTS 16 muscles were injected and longitudinally assessed. SWE and MAS scores decreased following BTX-A injection (p = 0.030 and 0.004, respectively), reflecting decreased quantitative and qualitative muscle stiffness. Decreased SWE reached statistical significance at 1- and 3-months, and 1-, 3- and 6-months for MAS. When comparing relative change in SWE to relative change in AROM, larger change in SWE strongly correlated with positive change in AROM (p-value range:<0.001-0.057). BTX-A responders also demonstrated lower baseline SWE (1.4 m/s) vs. non-responders (1.9 m/s), p = 0.035. CONCLUSION Ultrasound-guided BTX-A injections in patients with USCP resulted in decreased quantitative and qualitative muscle stiffness. Strong correlation between change in SWE and AROM, as well as the significant difference in baseline SWE for BTX-A responders and non-responders, suggests SWE may provide a useful tool to predict and monitor BTX-A response.
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Affiliation(s)
- Meghan Jardon
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Joseph Nguyen
- Biostatistics Core, Research Administration, Hospital for Special Surgery, New York, NY, USA
| | - Emily Casaletto
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Lydia Ko
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Aviva Wolff
- Leon Root, MD Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Aaron Daluiski
- Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA.
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Paley CT, Knight AE, Jin FQ, Moavenzadeh SR, Pietrosimone LS, Hobson-Webb LD, Rouze NC, Palmeri ML, Nightingale KR. Repeatability of Rotational 3-D Shear Wave Elasticity Imaging Measurements in Skeletal Muscle. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:750-760. [PMID: 36543617 PMCID: PMC10065087 DOI: 10.1016/j.ultrasmedbio.2022.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/15/2022] [Accepted: 10/16/2022] [Indexed: 06/17/2023]
Abstract
Shear wave elasticity imaging (SWEI) usually assumes an isotropic material; however, skeletal muscle is typically modeled as a transversely isotropic material with independent shear wave speeds in the directions along and across the muscle fibers. To capture these direction-dependent properties, we implemented a rotational 3-D SWEI system that measures the shear wave speed both along and across the fibers in a single 3-D acquisition, with automatic detection of the muscle fiber orientation. We tested and examined the repeatability of this system's measurements in the vastus lateralis of 10 healthy volunteers. The average coefficient of variation of the measurements from this 3-D SWEI system was 5.3% along the fibers and 8.1% across the fibers. When compared with estimated respective 2-D SWEI values of 16.0% and 83.4%, these results suggest using 3-D SWEI has the potential to improve the precision of SWEI measurements in muscle. Additionally, we observed no significant difference in shear wave speed between the dominant and non-dominant legs along (p = 0.26) or across (p = 0.65) the muscle fibers.
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Affiliation(s)
| | - Anna E Knight
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Felix Q Jin
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | | | - Laura S Pietrosimone
- Physical Therapy Division, Department of Orthopaedics, Duke University, Durham, North Carolina, USA
| | - Lisa D Hobson-Webb
- Neuromuscular Division, Department of Neurology, Duke University, Durham, North Carolina, USA
| | - Ned C Rouze
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Mark L Palmeri
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
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García-Bernal MI, González-García P, Madeleine P, Casuso-Holgado MJ, Heredia-Rizo AM. Characterization of the Structural and Mechanical Changes of the Biceps Brachii and Gastrocnemius Muscles in the Subacute and Chronic Stage after Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1405. [PMID: 36674159 PMCID: PMC9864550 DOI: 10.3390/ijerph20021405] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
The objective of this study was to characterize the changes of muscle tone, stiffness, and thickness of upper and lower limb muscles in stroke survivors. Forty patients with subacute or chronic stroke and 31 controls were included and measured using myotonometry (MyotonPRO), with multiple site assessments at muscle belly (MB) and musculotendinous (MT) locations of the biceps brachii and gastrocnemius muscles. Muscle thickness (ultrasonography) was obtained for each muscle. Upper and lower limb motor performance was evaluated with the Fugl−Meyer Assessment for Upper Extremity and the Functional Ambulance Category. Overall, muscle tone and stiffness were significantly higher at MT than at MB sites. Among stroke patients, differences between the paretic and nonparetic limb were found for the biceps brachii, with lower muscle tone, stiffness, and thickness of the paretic side (all, p < 0.05). There were weak to moderate correlations between mechanical (myotonometry) and structural (ultrasound) muscular changes, regardless of the post-stroke stage. This suggests that myotonometry and ultrasonography assess similar, although different, constructs and can be combined in the clinical setting. Their discriminative ability between the paretic and nonparetic sides and between participants with and without stroke differs depending on the muscle, the functional level, and the stroke stage.
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Affiliation(s)
- María Isabel García-Bernal
- Departmento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, 41009 Sevilla, Spain
- Instituto de Biomedicina de Sevilla (IBIS), 41013 Sevilla, Spain
| | - Paula González-García
- Departmento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, 41009 Sevilla, Spain
- Instituto de Biomedicina de Sevilla (IBIS), 41013 Sevilla, Spain
| | - Pascal Madeleine
- Sport Sciences—Performance and Technology, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| | - María Jesús Casuso-Holgado
- Departmento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, 41009 Sevilla, Spain
- Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Universidad de Sevilla, 41009 Sevilla, Spain
| | - Alberto Marcos Heredia-Rizo
- Departmento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, 41009 Sevilla, Spain
- Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Universidad de Sevilla, 41009 Sevilla, Spain
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11
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Roots J, Trajano GS, Drovandi C, Fontanarosa D. Variability of Biceps Muscle Stiffness Measured Using Shear Wave Elastography at Different Anatomical Locations With Different Ultrasound Machines. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:398-409. [PMID: 36266142 DOI: 10.1016/j.ultrasmedbio.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Shear wave elastography is an emerging diagnostic tool used to assess for changes in the stiffness of muscle. Each region of the muscle may have a different stiffness; therefore, the anatomical region should be carefully selected. Machine vendors each have unique methods for calculating the returned stiffness values and, consequently, a high level of agreement in measurement between machines (quantified using the intraclass correlation coefficient [ICC] and Bland-Altman analysis) will allow research findings to be translated to the clinic. This study assessed three locations within the biceps muscle (50% and 75% of the distance between the acromioclavicular joint and antecubital fossa, and superior to distal myotendinous junction [MTJ]) of 32 healthy volunteers with two different machines, the Canon Aplio i600 and SuperSonic Imagine Aixplorer (SSI), to compare the reported shear wave velocities and the variability by coefficient of variation (CV) and ICC. There was no difference in the CV between machines, but a significant difference in the CV at muscle regions, with the 75% location having a 40.2% reduction in CV. The 75% location had the highest ICC values with good posterior mean ICCs of 0.84 on the Canon and 0.83 on the SSI. The 50% and MTJ locations had poor ICC values. The 75% location provided the lowest CV and highest ICC and should be used for future stiffness assessments.
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Affiliation(s)
- Jacqueline Roots
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Gabriel S Trajano
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Christopher Drovandi
- Centre of Data Science, Queensland University of Technology, Brisbane, Queensland, Australia; School of Mathematical Sciences, Faculty of Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Davide Fontanarosa
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
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12
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Matsumoto-Miyazaki J, Sawamura S, Nishibu Y, Okada M, Ikegame Y, Asano Y, Yano H, Shinoda J. Spastic muscle stiffness evaluated using ultrasound elastography and evoked electromyogram in patients following severe traumatic brain injury: an observational study. Brain Inj 2022; 36:1331-1339. [PMID: 36317245 DOI: 10.1080/02699052.2022.2140196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine the relationship between muscle stiffness assessed using ultrasound shear wave elastography, spinal motor neuron excitability assessed using the F wave, and clinical findings of spasticity in patients with spastic muscle overactivity following severe traumatic brain injury. METHODS This study enrolled 17 inpatients with severe traumatic brain injury and 20 healthy volunteers. Biceps brachii muscle stiffness was then evaluated using ultrasound shear wave speed. Spinal motor neuron excitability was evaluated using the F/M ratio recorded from abductor pollicis brevis muscle. Clinical parameters, such as the modified Ashworth scale and modified Tardieu scale, were assessed in the patient with traumatic brain injury. RESULTS The patients with traumatic brain injury group had a significantly higher shear wave speed and F/M ratio compared with the healthy group. A higher shear wave speed was correlated with higher clinical spastic severity in patients with traumatic brain injury. The F/M ratio was not significantly correlated with clinical spastic severity. CONCLUSION Ultrasound shear wave elastography might be helpful for assessing muscle stiffness in patients with spastic muscle overactivity following severe traumatic brain injury. Further studies comprising larger cohorts are warranted.
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Affiliation(s)
- Jun Matsumoto-Miyazaki
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo, Japan.,Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Shogo Sawamura
- Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Gifu, Japan.,Department of Rehabilitation, Heisei College of Health Sciences, Gifu, Japan
| | - Yumiko Nishibu
- Department of Radiation Technology, Kizawa Memorial Hospital, Minokamo, Japan
| | - Maki Okada
- Department of Clinical Examination, Kizawa Memorial Hospital, Minokamo, Japan
| | - Yuka Ikegame
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo, Japan
| | - Yoshitaka Asano
- Department of Emergency Medicine, Kizawa Memorial Hospital, Minokamo, Japan
| | - Hirohito Yano
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo, Japan.,Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Jun Shinoda
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo, Japan.,Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Gifu, Japan
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13
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Campanella W, Corazza A, Puce L, Privitera L, Pedrini R, Mori L, Boccuni L, Turtulici G, Trompetto C, Marinelli L. Shear wave elastography combined with electromyography to assess the effect of botulinum toxin on spastic dystonia following stroke: A pilot study. Front Neurol 2022; 13:980746. [PMID: 36299267 PMCID: PMC9589110 DOI: 10.3389/fneur.2022.980746] [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: 06/28/2022] [Accepted: 09/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Shear wave elastography (SWE) is a method for carrying out a quantitative assessment of the mechanical properties of soft tissues in terms of stiffness. In stroke survivors, the paretic muscles may develop hypertonia due to both neural-mediated mechanisms and structural alterations with consequent muscular fibrous-fatty remodeling. Methods Fourteen adult patients with spastic dystonia following stroke were recruited. Muscle hypertonia was assessed using the modified Ashworth scale (MAS). Muscle activation was measured by surface electromyography (sEMG) with the selected muscle in shortened (spastic dystonia) and stretched (dynamic stretch reflex) positions. SWE was performed on a selected paretic muscle and on the contralateral non-paretic one to calculate shear wave velocities (SWV) along and across muscular fibers. The modified Heckmatt scale (MHS) pattern was also determined. All evaluations were performed shortly before BoNT-A injections (T0) and one month later (T1). Results All SWV on paretic muscles were higher than contralateral non-paretic ones (p < 0.01). After BoNT-A injection, a significant reduction in MAS (p = 0.0018), spastic dystonia (p = 0.0043), and longitudinal SWE measurements, both in shortened (p = 0.001) and in stretched muscular conditions (p = 0.0029), was observed. No significant changes in SWV on non-paretic muscles were observed. Higher SWV resulted along the direction of muscular fibers vs. across them (p = 0.001). No changes resulted from the MHS evaluations after BoNT-A. There was a positive correlation between MHS scores and SWV values while the muscle was in the shortened position, but not with spastic dystonia recorded by sEMG. Conclusions This is the first study evaluating the effect of BoNT-A on muscle hypertonia following stroke, assessed by both SWE and sEMG. These findings support SWE as a useful method to disclose intrinsic muscular remodeling, independently of the effect of spastic dystonia, in particular, while muscles were assessed in a neutral position. SWE measurements of muscle stiffness cannot tell apart neural-mediated and intrinsic muscle hypertonia. Interestingly, when sEMG activity is very limited, as in spastic muscles kept in a shortened position, SWE can provide a measurement of stiffness due almost completely to intrinsic muscle changes. Alongside sEMG, SWE could aid clinicians in the assessment of responses to treatments.
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Affiliation(s)
- William Campanella
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Department of Neuroscience, Division of Neurorehabilitation, Genova, Italy
| | - Angelo Corazza
- Unità di Radiologia Diagnostica ed Interventistica Istituto Ortopedico Galeazzi di Milano, Milan, Italy
| | - Luca Puce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Laura Privitera
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Riccardo Pedrini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Laura Mori
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Department of Neuroscience, Division of Neurorehabilitation, Genova, Italy
| | - Leonardo Boccuni
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Giovanni Turtulici
- S.C. Radiodiagnostica Ospedale Evangelico Internazionale di Genova, Genova, Italy
| | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Department of Neuroscience, Division of Neurorehabilitation, Genova, Italy
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Department of Neuroscience, Division of Clinical Neurophysiology, Genova, Italy
- *Correspondence: Lucio Marinelli
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14
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Huang M, Miller T, Fu SN, Ying MTC, Pang MYC. Structural and passive mechanical properties of the medial gastrocnemius muscle in ambulatory individuals with chronic stroke. Clin Biomech (Bristol, Avon) 2022; 96:105672. [PMID: 35617816 DOI: 10.1016/j.clinbiomech.2022.105672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 04/08/2022] [Accepted: 05/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aimed to investigate the structural, morphological and passive mechanical properties of the medial gastrocnemius muscle among ambulating chronic stroke survivors using a computational model previously established in healthy individuals without stroke. METHODS Individuals with chronic stroke (n = 14, age = 63.4 ± 6.0 years) and healthy controls (n = 15, age = 59.6 ± 8.4 years) participated in the study. The mechanical properties of the medial gastrocnemius were measured during continuous passive ankle motion using ultrasound elastography and a corresponding muscle mechanical property-angle curve was estimated where slack angle and elasticity were determined. Muscle thickness, fascicle length, pennation angle, and echo intensity were also assessed using B-mode ultrasound. FINDINGS No significant differences in slack angle (paretic: -16.2° ± 6.13°, non-paretic: -16.93° ± 6.80°, p = 0.82), or slack elasticity (paretic: 4.36 ± 1.94 kPa, non-paretic: 4.54 ± 1.24 kPa, p = 0.64) were found between sides or groups. Lower muscle pennation angle (paretic: 13.6 ± 2.9°, non-paretic: 15.9 ± 2.0°, p = 0.019) and higher echo intensity (paretic: 80.5 ± 13.6, non-paretic: 63.4 ± 17.1, p = 0.003) were observed for paretic muscles. No significant between-sides differences were found for muscle thickness (paretic: 1.5 ± 0.3 cm, non-paretic: 1.6 ± 0.2 cm, p = 0.255) or fascicle length (paretic: 6.6 ± 1.9 cm, non-paretic: 7.1 ± 2.2 cm, p = 0.216). Significant between-groups difference was also observed for fascicle length [non-dominant side (control): 6.2 ± 0.8 cm, paretic side (stroke): 6.6 ± 1.9 cm, p = 0.017]. INTERPRETATION Although muscle mechanical properties increased exponentially over the slack ankle, measures between paretic and non-paretic sides were similar in ambulating participants with chronic stroke. Side-to-side differences in structural and morphological measures suggest the impact of stroke was relatively more pronounced for these muscle parameters than for passive mechanical properties.
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Affiliation(s)
- Meizhen Huang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
| | - Tiev Miller
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
| | - Siu Ngor Fu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
| | - Michael T C Ying
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong.
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
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15
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Ren AL, Digby RJ, Needham EJ. Neurological update: COVID-19. J Neurol 2021; 268:4379-4387. [PMID: 33929617 PMCID: PMC8085652 DOI: 10.1007/s00415-021-10581-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/22/2021] [Accepted: 04/24/2021] [Indexed: 12/15/2022]
Abstract
Coronavirus Disease 2019 is predominantly a disorder of the respiratory system, but neurological complications have been recognised since early in the pandemic. The major pathophysiological processes leading to neurological damage in COVID-19 are cerebrovascular disease, immunologically mediated neurological disorders and the detrimental effects of critical illness on the nervous system. It is still unclear whether direct invasion of the nervous system by the Severe Acute Respiratory Syndrome Coronavirus 2 occurs; given the vast numbers of people infected at this point, this uncertainty suggests that nervous system infection is unlikely to represent a significant issue if it occurs at all. In this review, we explore what has been learnt about the neurological complications of COVID-19 over the course of the pandemic, and by which mechanisms these complications most commonly occur.
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Affiliation(s)
- A L Ren
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - R J Digby
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - E J Needham
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
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16
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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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