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

Abstract

Objective: To correlate ultrasound characteristics of spastic muscles with clinical and functional measurements in chronic stroke survivors.Methods: Ultrasound assessment and clinical and functional assessments were performed in 28 ambulatory stroke survivors (12 females, mean age 57.8 ± 11.8 years, 76 ± 45 months after stroke).Results: Muscle thickness in the affected side was decreased compared with the contralateral side (p < 0.001). The decrease was more evident in the upper limb muscles. On the affected side, the Heckmatt scale score was lowest (closer to normal) in the rectus femoris (RF) muscle compared with other muscles (biceps brachii (BB), flexor carpi ulnaris (FCU) and medial gastrocnemius (MG)). Muscle thickness and echogenicity of spastic muscles did not correlate with spasticity, as measured with the modified Ashworth scale (MAS), Fugl-Meyer motor assessment scores, age, or time since stroke. There was a significant negative correlation between grip strength and percentage decrease in muscle thickness for the spastic FCU muscle (r = –0.49, p = 0.008). RF muscle thickness correlated with ambulatory function (Timed Up and Go test (r = 0.44, p = 0.021) and 6-metre walk test (r = 0.41, p = 0.032)). There was no significant correlation between echogenicity and functional assessments Conclusion: Ambulatory chronic stroke survivors had function-dependent changes in muscle thickness on the affected side. Muscle thickness and echogenicity of spastic muscles did not correlate with spasticity, Fugl-Meyer motor assessment scores, age, or time since stroke.

Does Spasticity Correlate With Motor Impairment in the Upper and Lower Limbs in Ambulatory Chronic Stroke Survivors?

“…This study is part of a larger project in chronic stroke survivors with spastic hemiplegia recruited from the outpatient clinic of the Institute for Rehabilitation and Research (TIRR) Memorial Hermann in Houston, Texas 16,17 . Inclusion criteria were (1) chronic stroke (at least 6 mos after stroke onset) with hemiplegia, (2) stroke confirmed with brain imaging (computed tomography or magnetic resonance imaging), (3) presence of spasticity in the affected UL and/or LL, and (4) at least household ambulation with or without an assistive device.…”

“…This study is part of a larger project in chronic stroke survivors with spastic hemiplegia recruited from the outpatient clinic of the Institute for Rehabilitation and Research (TIRR) Memorial Hermann in Houston, Texas. 16,17 Inclusion criteria were (1) chronic stroke (at least 6 mos after stroke onset) with hemiplegia, (2) stroke confirmed with brain imaging (computed tomography or magnetic resonance imaging), (3) presence of spasticity in the affected UL and/or LL, and (4) at least household ambulation with or without an assistive device. Exclusion criteria included inability to follow instructions, medical instability, pregnant women, a history of phenol injection within the last 2 yrs or a history of botulinum toxin injection in last 4 mos, a history of peripheral musculoskeletal disorders that affect grip strength or walking, or current use of intrathecal baclofen pumps.…”

Effect of ankle-foot orthosis on paretic gastrocnemius and tibialis anterior muscles contraction of stroke survivors during walking: a pilot study

“…Ultrasound imaging has gained attention for its ability to non-invasively and affordably assess muscles' internal morphology without ionizing radiation [20]. Monjo et al [21] and Gonzalez-Buonomo et al [22] have utilized ultrasound imaging and observed reduced muscle thickness in the paretic lower extremity of poststroke individuals. Nevertheless, previous technical constraints restricted these technologies to evaluating muscle contraction patterns and internal morphological changes only in static conditions (i.e., recumbent [21,22] or sitting [21] position) among participants.…”