Research Article| Volume 26, ISSUE 2, P438-441, February 2017

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Validity of Quadriceps Muscle Thickness Measurement in Patients with Subacute Stroke during Hospitalization for Assessment of Muscle Wasting and Physical Function


      Many patients with stroke have difficulty performing voluntary muscle contraction; thus, measurement of patients' muscle power or leg strength is challenging. We investigated the validity of quadriceps muscle thickness (QMT) measurement using ultrasonography (US) for the assessment of muscle wasting and physical function in patients with subacute stroke during hospitalization for convalescent rehabilitation.


      Participants included 52 men with ischemic or hemorrhagic stroke (mean age, 69 ± 11 years) who were hospitalized for inpatient convalescent rehabilitation. The QMT of both legs was measured using US, and functional outcome was assessed according to the modified Rankin Scale (mRS) score and the leg motor selectivity score (6 motor stages defined by Brunnstrom).


      There was a significant correlation between QMT and leg motor selectivity score (paretic limb: r = .60, P < .001; nonparetic limb: r = .54, P < .001). Additionally, there were significant interaction effects between the QMT of the paretic limb (mRS scores = 1 or 2, 3, 4, and 5 = 3.52 ± .84 cm, 3.19 ± .52 cm, 2.50 ± .46 cm, and 2.20 ± .71 cm, respectively; F = 11.2; P < .0001), the QMT of the nonparetic limb (mRS scores = 1 or 2, 3, 4, and 5 = 3.72 ± .82 cm, 3.16 ± .49 cm, 2.91 ± .54 cm, and 2.42 ± .82 cm, respectively; F = 8.3; P < .001), and functional outcome.


      QMT measurement is a valid method to assess muscle wasting and physical function in patients with subacute stroke during hospitalization for convalescent rehabilitation.

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        • English C.
        • McLennan H.
        • Thoirs K.
        • et al.
        Loss of skeletal muscle mass after stroke: a systematic review.
        Int J Stroke. 2010; 5: 395-402
        • Ryan A.S.
        • Dobrovolny C.L.
        • Smith G.V.
        • et al.
        Hemiparetic muscle atrophy and increased intramuscular fat in stroke patients.
        Arch Phys Med Rehabil. 2002; 83: 1703-1707
        • Jørgensen L.
        • Jacobsen B.K.
        Changes in muscle mass, fat mass, and bone mineral content in the legs after stroke: a 1 year prospective study.
        Bone. 2001; 28: 655-659
        • Kafri M.W.
        • Potter J.F.
        • Myint P.K.
        Multi-frequency bioelectrical impedance analysis for assessing fat mass and fat-free mass in stroke or transient ischaemic attack patients.
        Eur J Clin Nutr. 2014; 68: 677-682
        • English C.K.
        • Thoirs K.A.
        • Fisher L.
        • et al.
        Ultrasound is a reliable measure of muscle thickness in acute stroke patients, for some, but not all anatomical sites: a study of the intra-rater reliability of muscle thickness measures in acute stroke patients.
        Ultrasound Med Biol. 2012; 38: 368-376
        • Nozoe M.
        • Kanai M.
        • Kubo H.
        • et al.
        Changes in quadriceps muscle thickness in acute non-ambulatory stroke survivors.
        Top Stroke Rehabil. 2016; 23: 8-14
        • Nozoe M.
        • Kanai M.
        • Kubo H.
        • et al.
        Changes in quadriceps muscle thickness, disease severity, nutritional status, and C-reactive protein after acute stroke.
        J Stroke Cerebrovasc Dis. 2016; 25: 2470-2474
        • Brincks J.
        • Nielsen J.F.
        Increased power generation in impaired lower extremities correlated with changes in walking speeds in sub-acute stroke patients.
        Clin Biomech (Bristol, Avon). 2012; 27: 138-144
        • de Haart M.
        • Geurts A.C.
        • Huidekoper S.C.
        • et al.
        Recovery of standing balance in postacute stroke patients: a rehabilitation cohort study.
        Arch Phys Med Rehabil. 2004; 85: 886-895
        • Vahlberg B.
        • Zetterberg L.
        • Lindmark B.
        • et al.
        Functional performance, nutritional status, and body composition in ambulant community-dwelling individuals 1-3 years after suffering from a cerebral infarction or intracerebral bleeding.
        BMC Geriatr. 2016; 16: 48
        • Kim H.
        • Hirano H.
        • Edahiro A.
        • et al.
        Sarcopenia: prevalence and associated factors based on different suggested definitions in community-dwelling older adults.
        Geriatr Gerontol Int. 2016; 16: 110-122
        • Seino S.
        • Shinkai S.
        • Iijima K.
        • et al.
        Reference values and age differences in body composition of community-dwelling older Japanese men and women: a pooled analysis of four cohort studies.
        PLoS ONE. 2015; 10 (e0131975)
        • Agyapong-Badu S.
        • Warner M.
        • Samuel D.
        • et al.
        Anterior thigh composition measured using ultrasound imaging to quantify relative thickness of muscle and non-contractile tissue: a potential biomarker for musculoskeletal health.
        Physiol Meas. 2014; 35: 2165-2176
        • Fukumoto Y.
        • Ikezoe T.
        • Yamada Y.
        • et al.
        Skeletal muscle quality assessed from echo intensity is associated with muscle strength of middle-aged and elderly persons.
        Eur J Appl Physiol. 2012; 112: 1519-1525
        • Fischer A.
        • Spiegl M.
        • Altmann K.
        • et al.
        Muscle mass, strength and functional outcomes in critically ill patients after cardiothoracic surgery: does neuromuscular electrical stimulation help? The Catastim 2 randomized controlled trial.
        Crit Care. 2016; 20: 30
        • Yang Y.B.
        • Zhang J.
        • Leng Z.P.
        • et al.
        Evaluation of spasticity after stroke by using ultrasound to measure the muscle architecture parameters: a clinical study.
        Int J Clin Exp Med. 2014; 7: 2712-2717
        • Suzuki K.
        • Imada G.
        • Iwaya T.
        • et al.
        Determinants and predictors of the maximum walking speed during computer assisted gait training in hemiparetic stroke patients.
        Arch Phys Med Rehabil. 1999; 80: 179-182