Stroke-induced Muscular Changes and Their Relation to Clinical Impairments and Gait Recovery in the First 12 Weeks After Stroke.
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Stroke
- Sponsor
- Vrije Universiteit Brussel
- Enrollment
- 100
- Primary Endpoint
- Cross-sectional area (CSA)
- Status
- Not yet recruiting
- Last Updated
- 2 years ago
Overview
Brief Summary
The investigators will use 3D freehand ultrasound to investigate changes in muscle morphology of the paretic m. rectus femoris and m. gastrocnemius medialis during the first 3 months after stroke. Additionally, 2D ultrasound and surface EMG will be synchronized to examine muscle activation and morphological changes resulting from this activation. Clinical tests will be conducted on the same test occasions to objectify lower limb impairment and gait recovery. As such, the investigators will explore the relationship between the muscle specific changes and functional recovery.
Detailed Description
During this longitudinal study, patients who suffer their first-ever stroke will be included within the first week after their stroke (if the inclusion criteria are met). Thereafter, each participant will be assessed at four pre-determined time-points: week 1, 5, 8 and 12 after stroke. On each of the four time-points, the investigators will assess muscle specific parameters of the affected m. rectus femoris (RF) and m. gastrocnemius medialis (GM), together with clinical tests to assess lower limb impairment (Fugl-Meyer Assessment for the lower limb and the Tardieu scale) and gait parameters (10-meter walk test). Specifically, muscle specific parameters will be investigated using 3D freehand ultrasound (3DfUS) and combined dynamic 2D US and surface electromyography (sEMG). Such assessments will help us characterize the electromechanical properties of these muscles, their time-related trajectories and the relationship with the recovery of gait and lower limb function after stroke. At the end of the investigation period, after 3 months, patients who can walk independently will perform a 3D gait analysis. As such, the relationship between changes in muscle specific parameters and the eventual gait quality at the end of the investigation period will be investigated.
Investigators
Eva Swinnen
Assistant professor
Vrije Universiteit Brussel
Eligibility Criteria
Inclusion Criteria
- •Adults (≥ 18 years old)
- •Diagnosed with a first-ever stroke (as defined by WHO)
- •Stroke onset ≤ 1 week (± 3 days)
- •Able to provide written or verbal informed consent at admission
- •Presence of gait problems as a consequence of the stroke (FAC≤4)
Exclusion Criteria
- •Presence of other neurological or orthopedic problems present prior to, or not caused as a direct consequence of, the stroke leading to impaired gait.
- •Modified Ranking scale pre-stroke \> 1/6, meaning presence of slight disability before the stroke.
- •Presence of severe comorbidities (e.g. osteoporosis, cardiovascular instability or chronic obstructive pulmonary disease).
- •Cerebellar or bilateral stroke.
- •Presence of severe deficits in communication, memory or understanding precluding informed consent.
Outcomes
Primary Outcomes
Cross-sectional area (CSA)
Time Frame: Frequency: week 1, 5, 8 and 12 after stroke
Through 3D freehand ultrasound (3DfUS)
Change in cross-sectional area
Time Frame: Frequency: week 1, 5, 8 and 12 after stroke
Through dynamic 2D ultrasound
Change in fascicle length
Time Frame: Frequency: week 1, 5, 8 and 12 after stroke
Through dynamic 2D ultrasound
Peak root mean square (RMS)
Time Frame: Frequency: week 1, 5, 8 and 12 after stroke
Through surface electromyography (sEMG)
Tendon length
Time Frame: Frequency: week 1, 5, 8 and 12 after stroke
Through 3D freehand ultrasound (3DfUS)
Echo Intensity
Time Frame: Frequency: week 1, 5, 8 and 12 after stroke
Through 2D ultrasound
Dynamic muscle morphology
Time Frame: Frequency: week 1, 5, 8 and 12 after stroke
Dynamic 2D ultrasound used to investigate the changes in cross-sectional area (CSA) en fascicle length
Spasticity
Time Frame: Frequency: week 1, 5, 8 and 12 after stroke.
Assessed with the Tardieu Scale. Scores ranging from 0 (no resistance throughout passive movement) to 5 (immobile joint).
Functional Ambulation Categories (FAC)-score
Time Frame: Frequency: week 1, 5, 8 and 12 after stroke
Scores ranging from 0 (not able to walk) to 5 (independent ambulator who can walk freely on any surface)
Muscle tickness
Time Frame: Frequency: week 1, 5, 8 and 12 after stroke
Through 3D freehand ultrasound (3DfUS)
Muscle volume
Time Frame: Frequency: week 1, 5, 8 and 12 after stroke
Through 3D freehand ultrasound (3DfUS)
Fascicle length
Time Frame: Frequency: week 1, 5, 8 and 12 after stroke
Through 3D freehand ultrasound (3DfUS)
Average root mean square (RMS)
Time Frame: Frequency: week 1, 5, 8 and 12 after stroke
Through surface electromyography (sEMG)
Muscle strength
Time Frame: Frequency: week 1, 5, 8 and 12 after stroke
Assessed with a handheld dynamometer (Nm)
Gait quality
Time Frame: Frequency: only at week 12.
Gait profile score (index number in degrees (°)), calculated from the lower limbs' kinematics (3D gait analysis). A higher score means more deviation of the expected (normal) gait pattern.
Physiological cross-sectional area (pCSA)
Time Frame: Frequency: week 1, 5, 8 and 12 after stroke
Through 3D freehand ultrasound (3DfUS)
Muscle length
Time Frame: Frequency: week 1, 5, 8 and 12 after stroke
Through 3D freehand ultrasound (3DfUS)
Pennation angle
Time Frame: Frequency: week 1, 5, 8 and 12 after stroke
Through 2D ultrasound
Lower limb motor impairment
Time Frame: Frequency: week 1, 5, 8 and 12 after stroke.
Fugl-Meyer Assessment of the lower limb (FMA LL). Scores ranging from 0 to 34 (no impairment present).
Spatiotemporal gait parameters
Time Frame: Frequency: week 1, 5, 8 and 12 after stroke.
Patients will perform the 10-meter walk test while wearing the GaitUp sensors.
Secondary Outcomes
- Knee extension strength(Frequency: only during the first assessment (week 1).)
- Balance(Frequency: only during the first assessment (week 1))
- TWIST-score(Within first week after stroke)