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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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He J, Luo A, Yu J, Qian C, Liu D, Hou M, Ma Y. Quantitative assessment of spasticity: a narrative review of novel approaches and technologies. Front Neurol 2023; 14:1121323. [PMID: 37475737 PMCID: PMC10354649 DOI: 10.3389/fneur.2023.1121323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Spasticity is a complex neurological disorder, causing significant physical disabilities and affecting patients' independence and quality of daily lives. Current spasticity assessment methods are questioned for their non-standardized measurement protocols, limited reliabilities, and capabilities in distinguishing neuron or non-neuron factors in upper motor neuron lesion. A series of new approaches are developed for improving the effectiveness of current clinical used spasticity assessment methods with the developing technology in biosensors, robotics, medical imaging, biomechanics, telemedicine, and artificial intelligence. We investigated the reliabilities and effectiveness of current spasticity measures employed in clinical environments and the newly developed approaches, published from 2016 to date, which have the potential to be used in clinical environments. The new spasticity scales, taking advantage of quantified information such as torque, or echo intensity, the velocity-dependent feature and patients' self-reported information, grade spasticity semi-quantitatively, have competitive or better reliability than previous spasticity scales. Medical imaging technologies, including near-infrared spectroscopy, magnetic resonance imaging, ultrasound and thermography, can measure muscle hemodynamics and metabolism, muscle tissue properties, or temperature of tissue. Medical imaging-based methods are feasible to provide quantitative information in assessing and monitoring muscle spasticity. Portable devices, robotic based equipment or myotonometry, using information from angular, inertial, torque or surface EMG sensors, can quantify spasticity with the help of machine learning algorithms. However, spasticity measures using those devices are normally not physiological sound. Repetitive peripheral magnetic stimulation can assess patients with severe spasticity, which lost voluntary contractions. Neuromusculoskeletal modeling evaluates the neural and non-neural properties and may gain insights into the underlying pathology of spasticity muscles. Telemedicine technology enables outpatient spasticity assessment. The newly developed spasticity methods aim to standardize experimental protocols and outcome measures and enable quantified, accurate, and intelligent assessment. However, more work is needed to investigate and improve the effectiveness and accuracy of spasticity assessment.
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Affiliation(s)
- Jian He
- Research Academy of Grand Health, Faculty of Sports Sciences, Ningbo University, Ningbo, China
| | - Anhua Luo
- Research Academy of Grand Health, Faculty of Sports Sciences, Ningbo University, Ningbo, China
| | - Jiajia Yu
- Research Academy of Grand Health, Faculty of Sports Sciences, Ningbo University, Ningbo, China
| | - Chengxi Qian
- Research Academy of Grand Health, Faculty of Sports Sciences, Ningbo University, Ningbo, China
| | - Dongwei Liu
- School of Information Management and Artificial Intelligence, Zhejiang University of Finance and Economics, Hangzhou, China
| | - Meijin Hou
- National Joint Engineering Research Centre of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Key Laboratory of Orthopaedics and Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fuzhou, China
| | - Ye Ma
- Research Academy of Grand Health, Faculty of Sports Sciences, Ningbo University, Ningbo, China
- National Joint Engineering Research Centre of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Key Laboratory of Orthopaedics and Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fuzhou, China
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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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García-Bernal MI, González-García P, Casuso-Holgado MJ, Cortés-Vega MD, Heredia-Rizo AM. Measuring Mechanical Properties of Spastic Muscles After Stroke. Does Muscle Position During Assessment Really Matter? Arch Phys Med Rehabil 2022; 103:2368-2374. [PMID: 35724753 DOI: 10.1016/j.apmr.2022.05.012] [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: 01/15/2022] [Revised: 05/04/2022] [Accepted: 05/08/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the influence of muscle position (relaxed vs stretched) on muscle mechanical properties and the ability of myotonometry to detect differences between sides, groups, and sites of testing in patients with stroke. We also analyzed the association between myotonometry and clinical measures of spasticity. DESIGN Cross-sectional study. SETTING Outpatient rehabilitation units including private and public centers. PARTICIPANTS Seventy-one participants (20 subacute stroke, 20 chronic stroke, 31 controls) were recruited (N=71). INTERVENTION Muscle mechanical properties were measured bilaterally with a MyotonPRO at muscle belly and musculotendinous sites during 2 protocols (muscle relaxed or in maximal bearable stretched position). MAIN OUTCOME MEASURES Muscle tone and stiffness of the biceps brachii and gastrocnemius. Poststroke spasticity was evaluated with the Modified Tardieu Scale (MTS). A mixed-model analysis of variance was used to detect differences in the outcome measures. RESULTS The analysis of variance showed a significant effect of muscle position on muscle mechanical properties (higher tone and stiffness with the muscle assessed in stretched position). Measurements with the stretched muscle could help discriminate between spastic and nonspastic sides, but only at the biceps brachii. Overall, there was a significant increase in tone and stiffness in the chronic stroke group and in myotendinous sites compared with muscle belly sites (all, P<.05). No correlations were found between myotonometry and the MTS. CONCLUSIONS Myotonometry assessment of mechanical properties with the muscle stretched improves the ability of myotonometry to discriminate between sides in patients after stroke and between people with and without stroke.
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Affiliation(s)
- María-Isabel García-Bernal
- Departmento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, Spain
| | - Paula González-García
- Departmento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, Spain.
| | - María Jesús Casuso-Holgado
- Departmento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, Spain; UMSS Research Group, Universidad de Sevilla, Sevilla, Spain
| | - María Dolores Cortés-Vega
- Departmento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, Spain
| | - Alberto Marcos Heredia-Rizo
- Departmento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, Spain; UMSS Research Group, Universidad de Sevilla, Sevilla, Spain
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Leigheb M, de Sire A, Colangelo M, Zagaria D, Grassi FA, Rena O, Conte P, Neri P, Carriero A, Sacchetti GM, Penna F, Caretti G, Ferraro E. Sarcopenia Diagnosis: Reliability of the Ultrasound Assessment of the Tibialis Anterior Muscle as an Alternative Evaluation Tool. Diagnostics (Basel) 2021; 11:diagnostics11112158. [PMID: 34829505 PMCID: PMC8624824 DOI: 10.3390/diagnostics11112158] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/16/2021] [Accepted: 11/20/2021] [Indexed: 12/28/2022] Open
Abstract
Sarcopenia is a skeletal muscle disorder characterized by reduced muscle mass, strength, and performance. Muscle ultrasound can be helpful in assessing muscle mass, quality, and architecture, and thus possibly useful for diagnosing or screening sarcopenia. The objective of this study was to evaluate the reliability of ultrasound assessment of tibialis anterior muscle in sarcopenia diagnosis. We included subjects undergoing total or partial hip replacement, comparing measures with a healthy control group. We measured the following parameters: tibialis anterior muscle thickness, echogenicity, architecture, stiffness, skeletal muscle index (SMI), hand grip strength, and sarcopenia related quality of life evaluated through the SarQoL questionnaire. We included 33 participants with a mean age of 54.97 ± 23.91 years. In the study group we found reduced tibialis anterior muscle thickness compared to the healthy control group (19.49 ± 4.92 vs. 28.94 ± 3.63 mm, p < 0.05) with significant correlation with SarQoL values (r = 0.80, p < 0.05), dynamometer hand strength (r = 0.72, p < 0.05) and SMI (r = 0.76, p < 0.05). Moreover, we found reduced stiffness (32.21 ± 12.31 vs. 27.07 ± 8.04 Kpa, p < 0.05). AUC measures of ROC curves were 0.89 predicting reduced muscle strength, and 0.97 predicting reduced SMI for tibialis anterior muscle thickness, while they were 0.73 and 0.85, respectively, for muscle stiffness. Our findings showed that ultrasound assessment of tibialis anterior muscle might be considered a reliable measurement tool to evaluate sarcopenia.
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Affiliation(s)
- Massimiliano Leigheb
- Orthopaedics and Traumatology Unit, “Maggiore della Carità” Hospital, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy; (M.L.); (M.C.)
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
- Correspondence: ; Tel.: +39-0961712819
| | - Matteo Colangelo
- Orthopaedics and Traumatology Unit, “Maggiore della Carità” Hospital, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy; (M.L.); (M.C.)
| | - Domenico Zagaria
- Radiology Unit, “Maggiore della Carità” Hospital, Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy; (D.Z.); (P.C.); (P.N.); (A.C.)
| | - Federico Alberto Grassi
- Orthopaedics and Traumatology Unit, IRCCS Policlinico San Matteo, Department of Clinical-Surgical, Diagnostics and Pediatrics Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Ottavio Rena
- Thoracic Surgery Unit, “Maggiore della Carità” Hospital, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy;
| | - Patrizio Conte
- Radiology Unit, “Maggiore della Carità” Hospital, Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy; (D.Z.); (P.C.); (P.N.); (A.C.)
| | - Pierluigi Neri
- Radiology Unit, “Maggiore della Carità” Hospital, Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy; (D.Z.); (P.C.); (P.N.); (A.C.)
| | - Alessandro Carriero
- Radiology Unit, “Maggiore della Carità” Hospital, Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy; (D.Z.); (P.C.); (P.N.); (A.C.)
| | | | - Fabio Penna
- Department of Clinical and Biological Sciences, University of Torino, 10125 Torino, Italy;
| | | | - Elisabetta Ferraro
- Cell and Developmental Biology Unit, Department of Biology, University of Pisa, 56127 Pisa, Italy;
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Hu G, Zhang H, Wang Y, Cong D. Non-pharmacological intervention for rehabilitation of post-stroke spasticity: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2021; 100:e25788. [PMID: 33950975 PMCID: PMC8104187 DOI: 10.1097/md.0000000000025788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Post-stroke spasticity (PSS) is a major worldwide health problem, and timely and effective rehabilitation is associated with the risk of diabetes development; there are a variety of non-pharmacological interventions applied to the rehabilitation of PSS in these treatments; however, the relative efficacy and safety of different therapies remain uncertain, and we will conduct a systematic review and network meta-analysis to evaluate different non-pharmacological interventions. The relative efficacy and safety of intervention in PSS rehabilitation, thus providing evidence to support the optimization of the PSS rehabilitation program. METHODS We searched the following databases electronically, including four English literature databases (i.e., PubMed, Medline, Embase, and Cochrane Library) and two Chinese literature databases (i.e., China National Knowledge Infrastructure and VIP). We will also search for randomized controlled trials on non-pharmacological interventions for post-stroke spasticity, and the search time limit is from its establishment to May 2020. Two reviewers working independently will screen the titles, abstracts, and full papers. Data extraction will be completed by two independent authors. The primary outcome was the motor function. The secondary outcome was the assessment of daily living ability. We will use RevMan V.5.3 software to compute the data synthesis carefully when a meta-analysis is allowed. We will conduct Bayesian network meta-analysis using the Markov Chain Monte Carlo random effects model in Aggregate Data Drug Information System version 1.16.8 (Drugis, Groningen, NL). RESULTS This study provides a high-quality synthesis to assess the effectiveness and safety of non-pharmacological interventions for patients with PSS. CONCLUSION The results of this study will provide evidence to judge whether non-pharmacological interventions are effective interventions for patients with post-stroke spasticity. ETHICS AND DISSEMINATION The results of this meta-analysis and meta-regression will be disseminated through publication in a peer-reviewed journal and presented at a relevant conference. The data used in the network meta-analysis did not contain individual patient data. Therefore, ethical approval was not required. INPLASY REGISTRATION NUMBER INPLASY202140059.
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