Relationships between muscle mass, intramuscular adipose and fibrous tissues of the quadriceps, and gait independence in chronic stroke survivors: a cross-sectional study

Akazawa, Naoki; Harada, Kazuhiro; Okawa, Naomi; Tamura, Kimiyuki; A, Hayase; Moriyama, Hideki

doi:10.1016/j.physio.2017.08.009

Cited by 50 publications

(128 citation statements)

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“…These parameters, measured by US, are correlated with MVC strength [12] in healthy subjects and chronic stroke survivors [7]. In these reports, it has been shown that stroke survivors and older inpatients with smaller MT and higher EI of the quadriceps femoris need assistance for gait [9,18]. One study reported that MT of both limbs in nonindependent walkers after hemiparetic stroke (with an average Fugl-Meyer lower extremity assessment score of 21.8) was approximately 20-30% smaller than that in healthy subjects [9].…”

Section: Introductionmentioning

confidence: 96%

“…These changes can induce locomotor dysfunction after stroke [6,7]. Quadriceps strength is closely related to gait independence [8,9]. A recent study revealed that gait independence after stroke can be explained by maximal voluntary contraction (MVC) strength during isometric knee extension produced by the quadriceps, pro-DOI: 10.1159/000507548 posing a cutoff value of MVC strength for explaining gait independence [8].…”

Section: Introductionmentioning

confidence: 99%

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

Maeda

Imada²,

Ishida

et al. 2020

Eur Neurol

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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.

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Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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

Maeda

Imada²,

Ishida

et al. 2020

Eur Neurol

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“…The quality of the quadriceps femoris in post-stroke patients has been assessed using medical imaging modalities such as magnetic resonance imaging [5], computed tomography [6], and ultrasonography (US) [17]. A higher ratio of intramuscular fat to muscle tissue generally represents lower muscle quality [18][19][20], and one study showed that this ratio in the paretic limb was 4.9% higher than that in the nonparetic limb with statistical significance [6].…”

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confidence: 99%

“…US is an ideal technique for the measurement of muscle quality and quantity, which are frequently assessed according to the muscle thickness (MT) and echo intensity (EI) [9,17,20,21,[24][25][26][27]. The advantages of US are that it is noninvasive as well as less expensive and more portable than other medical imaging modalities such as magnetic resonance imaging, computed tomography, and dual-energy X-ray absorptiometry.…”

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confidence: 99%

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Relationship of Quadriceps Muscle Thickness with Motor Paralysis and Muscle Echo Intensity in Post-Stroke Patients

Maeda

Imada²,

Ishida

et al. 2019

Eur Neurol

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Introduction: Quadriceps muscle atrophy and quality loss, defined as an increased ratio of intramuscular fat and/or connective tissue, are often observed especially in the paretic limb of post-stroke patients. This study was performed to examine the relationship of quadriceps muscle thickness (MT) with muscle echo intensity (EI) and the severity of motor paralysis after stroke. Methods: Thirty-six hemiparetic subacute post-stroke patients were enrolled. We examined the MT (index of muscle quantity) and the EI (index of muscle quality) at the anterior mid-thigh in both limbs. We also assessed the Brunnstrom stage (BR stage), subcutaneous adipose tissue thickness, time since stroke, age, body weight, sex, number of medications, and nutritional and inflammation status. Results: The MT in the paretic limb was explained by the BR stage (β = –0.26, p < 0.01), body weight (β = 0.68, p < 0.01), and serum albumin (β = 0.34, p < 0.01), with an adjusted R² of 0.81. The MT in the non-paretic limb was explained by the muscle EI (β = –0.55, p < 0.01) and age (β = –0.40, p < 0.01), with an adjusted R² of 0.69. The muscle EI was explained by the MT in the paretic limb (β = –0.34, p < 0.01) and non-paretic limb (β = –0.69, p < 0.01). Conclusions: Our results suggest that motor paralysis, aging, and malnutrition contribute to quadriceps atrophy in post-stroke patients. Moreover, a potential countermeasure to diminish muscle quality loss is maintenance of muscle quantity.

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Intramuscular adipose tissue in the quadriceps is more strongly related to recovery of activities of daily living than muscle mass in older inpatients

Akazawa

Kishi

Hino

et al. 2021

J cachexia sarcopenia muscle

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Background The relationship between intramuscular adipose tissue at admission and recovery of activities of daily living (ADL) remains unclear. This study aimed to examine the relationship between intramuscular adipose tissue in the quadriceps at admission and recovery of ADL in older inpatients. Methods This prospective study included 404 inpatients aged ≥65 years (54.7% female). Recovery of ADL during hospital stay was assessed using the Barthel Index (BI) score at discharge, BI score change, and BI efficiency. Higher BI at discharge, BI score change, and BI efficiency indicate more improvement in ADL. Intramuscular adipose tissue and muscle mass of the quadriceps were assessed using echo intensity and muscle thickness on ultrasound images, respectively. Multiple regression analysis was performed to identify factors independently associated with BI score at discharge, BI score change, and BI efficiency. The independent variables were BI score at admission, echo intensity and muscle thickness of the quadriceps, age, sex, number of medications, C‐reactive protein concentration, updated Charlson Comorbidity Index score, Food Intake Level Scale, Geriatric Nutritional Risk Index score, days from onset disease, length of hospital stay, number of units of rehabilitation therapy, and subcutaneous fat thickness of the thigh. Results The medians (inter‐quartile range) of the BI score at discharge, BI score change, and BI efficiency were 60.0 (35.0–80.0), 10.0 (0.0–25.0), and 0.11 (0.00–0.37), respectively. The median (inter‐quartile range) of the length of hospital stay (days) and days from onset disease were 58.0 (39.0–92.0) and 79.0 (49.0–112.0), respectively. Quadriceps echo intensity was independently and significantly associated with the BI score at discharge (β = −0.13, P < 0.01), BI score change (β = −0.23, P < 0.01), and BI efficiency (β = −0.21, P < 0.01). Quadriceps thickness was not independently and significantly associated with the BI score at discharge (β = −0.02, P = 0.68), BI score change (β = −0.02, P = 0.79), and BI efficiency (β = 0.03, P = 0.67). Conclusions Our study indicates that greater intramuscular adipose tissue in the quadriceps at admission is more strongly related to worse recovery of ADL than less muscle mass in older inpatients. Greater intramuscular adipose tissue in the quadriceps in older inpatients is considered to be a predictor of worse recovery of ADL, and intervening for greater intramuscular adipose tissue may be important for improving ADL in older inpatients.

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Relationships between muscle mass, intramuscular adipose and fibrous tissues of the quadriceps, and gait independence in chronic stroke survivors: a cross-sectional study

Cited by 50 publications

References 36 publications

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

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

Relationship of Quadriceps Muscle Thickness with Motor Paralysis and Muscle Echo Intensity in Post-Stroke Patients

Intramuscular adipose tissue in the quadriceps is more strongly related to recovery of activities of daily living than muscle mass in older inpatients

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