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

Abstract

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

Ultrasound Assessment of Spastic Muscles in Ambulatory Chronic Stroke Survivors Reveals Function-Dependent Changes

“…Voluntary activation levels of the knee extensors have been shown to correlate with gait and balance, which are important determinants of performance in functional tests, such as the 6MWT and the TUG test ( 27 ). The current results and earlier reports ( 28 , 29 ) showing a significant correlation between RF muscle thickness and gait performance emphasize the functional relevance of the knee extensors in activities that require LL mobility. Furthermore, it is possible that activation of the knee extensors in stroke survivors could help to minimize muscle atrophy.…”

Utility of ultrasound as a promising diagnostic tool for stroke-related sarcopenia: A retrospective pilot study

“…A single sonographer performed ultrasonographic measurement with an E-CUBE 9 Diamond US system (Alpinion, Seoul, Korea) with a high density linear array transducer (3)(4)(5)(6)(7)(8)(9)(10)(11)(12). The physiatrist, who has had a 10-year experience in musculoskeletal US at the time of the investigation, reviewed all imaging findings.…”

Relationship between Energy Intake and Changes in Thigh Echo Intensity during the Acute Phase of Stroke in Older Patients with Hemiplegia

“…We assessed EI at the RF and VI (midway point between the anterior superior iliac spine and the proximal end of the patella [21]) in paralyzed and nonparalyzed limbs at admission and after 4 weeks using B-mode USA (SonoSite M-Turbo; Fujifilm, Tokyo, Japan) with an 8-MHz linear probe (HFL38x/13-6; Fujifilm, Tokyo, Japan). Transverse ultrasonography images of each patient were obtained with the following equipment setting: 8-MHz frequency, auto gain, 4.9-6 cm depth (adjusted according to the patient's muscle size [7]), and time-gain compensation in the neutral position. The measurements were obtained at rest and during maximal voluntary isometric muscle contraction with the patient in the supine position with hips and knees extended [22].…”

“…The measurements were obtained at rest and during maximal voluntary isometric muscle contraction with the patient in the supine position with hips and knees extended [22]. While the participants lay in a supine position with their lower limbs relaxed, a watersoluble transmission gel was applied to the skin surface of the thigh, and the probe was held perpendicular to the skin surface using the minimum pressure required to avoid deformation of the muscle and achieve a clear image [7]. All measurements were conducted by a single examiner.…”

“…However, echo intensity measured by ultrasound has been used in some reports as an indicator of poststroke muscle quality deterioration. Increased intramuscular adipose tissues of the rectus femoris (RF) and vastus intermedius (VI) inpatients with chronic stroke are related to the reduction of muscle strength [6], decrease of gait independence [7], and risk of diabetes [1]. These observations suggest that it is important to assess thigh echo intensity (TEI) in inpatients with stroke.…”