Ultrasound Assessment of Changes in Muscle Architecture of the Brachialis Muscle After Stroke—A Prospective Study

• Published in: Archives of rehabilitation research and clinical translation Vol. 4; no. 3; p. 100215
• Main Authors: Kong, Keng He, Shuen-Loong, Tham, Tay, Matthew Rong Jie, Lui, Wen Li, Rajeswaran, Deshan Kumar, Kim, Jongmoon
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2022; Elsevier
• Subjects: Hemiplegia; Neurologic disorders; Original Research; Rehabilitation; Skeletal muscle; Stroke; Ultrasonography; Stroke; AU; Ultrasonography; Hemiplegia; Rehabilitation; IQR; Neurologic disorders; Skeletal muscle; MAS; MRC; MRC, Medical Research Council; IQR, interquartile range; MAS, Modified Ashworth Scale; AU, arbitrary units
• ISSN: 2590-1095; 2590-1095
• DOI: 10.1016/j.arrct.2022.100215

To investigate changes in ultrasound-derived muscle architecture parameters of the brachialis and correlations in patients with subacute stroke.
Prospective longitudinal observational study.
Tertiary inpatient rehabilitation center.
Fifty adult patients (N=50) who were recruited within the first month poststroke. The patients had a mean age of 57.2±12.3 years and 68.0% were male. The majority of patients had significant upper limb weakness with a low mean Motricity Index of 18.5±24.7 and median elbow flexor strength of grade 0.
Not applicable.
Ultrasound of the intact and hemiparetic brachialis was performed at 3-time intervals: within 1 month of stroke onset and at 1 and 6 months after first assessment. Clinical variables captured included upper limb motor power and elbow flexor spasticity.
Compared to the intact brachialis, there was reduced muscle thickness (1.93 cm vs 2.07 cm, 1.86 cm vs 2.08 cm, 1.85 cm vs 2.05 cm; P=.022) and increased echo intensity (63.3 arbitrary units [AU] vs 56.8 AU, 69.4 AU vs 56.6 AU, 77.4 AU vs 58.2 AU; P<.001) in the hemiparetic brachialis at all assessment intervals (baseline, 1 month, 6 months). Reduction in muscle mass was greater in older patients, with the correlation coefficient ranging from −0.30 (P=.03) at baseline to −0.50 (P<.001) at 6 months. Presence of elbow flexor spasticity at 1-month assessment interval was associated with lower muscle mass reduction (1.93 cm vs 1.74 cm; P=.017), lower echo intensity (65.1 AU vs 75.1 AU; P=.023), and longer fascicle lengths (12.92 cm vs 9.83 cm; P=.002).
Changes including decreased muscle thickness and increased echo intensity of the hemiparetic brachialis were noted over time. Elbow flexor spasticity at 1-month assessment interval appears to mitigate against these changes.