Side Of Stroke Patients Research Articles

Lower limb muscle strength of the affected side in stroke patients is an accurate predictor of the need for a KAFO.

Accurate prediction of recovery is essential to determine whether a knee-ankle-foot orthosis (KAFO) is required in the subacute phase of stroke. However, there are currently no reliable methods to predict such recovery. This study aimed to determine whether muscle strength of the affected lower limb (affected side LL strength) in stroke patients in the subacute phase who cannot walk without a KAFO can be used to predict the continuous need for a KAFO, using a hand-held dynamometer. We enrolled patients with severe hemiplegia (n = 51) who were unable to walk without a KAFO for 10 days after stroke onset. They were divided into two groups depending on the continuous need for a KAFO at 1 month after onset; the KAFO and non-KAFO groups. Logistic regression analysis was used to investigate whether the affected side LL strength was a predictor of the continuous need for a KAFO at 1 month after onset. In addition, significant predictors were analyzed using receiver operating characteristic (ROC) curves. The KAFO and non-KAFO groups included 23 (45.10%) and 28 (54.90%) patients, respectively. The affected side LL strength and pusher syndrome severity were identified as predictors of the continuous need for a KAFO. The predictor with the highest predictive ability was the affected side LL strength, with an area under the ROC curve of 0.80 (95% CI, 0.68-0.93). Affected side LL strength may be a highly accurate predictor of the need for a KAFO in the subacute phase of stroke.

Respiratory muscle ultrasonography evaluation and its clinical application in stroke patients: A review.

Respiratory muscle ultrasound is a widely available, highly feasible technique that can be used to study the contribution of the individual respiratory muscles related to respiratory dysfunction. Stroke disrupts multiple functions, and the respiratory function is often significantly decreased in stroke patients. A search of the MEDLINE, Web of Science, and PubMed databases was conducted. We identified studies measuring respiratory muscles in healthy and patients by ultrasonography. Two reviewers independently extracted and documented data regarding to the criteria. Data were extracted including participant demographics, ultrasonography evaluation protocol, subject population, reference values, etc. A total of 1954 participants from 39 studies were included. Among them, there were 1,135 participants from 19 studies on diaphragm, 259 participants from 6 studies on extra-diaphragmatic inspiratory muscles, and 560 participants from 14 studies on abdominal expiratory muscles. The ultrasonic evaluation of diaphragm and abdominal expiratory muscle thickness had a relatively typically approach, while, extra-diaphragmatic inspiratory muscles were mainly used in ICU that lack of a consistent paradigm. Diaphragm and expiratory muscle ultrasound has been widely used in the assessment of respiratory muscle function. On the contrary, there is not enough evidence to assess extra-diaphragmatic inspiratory muscles by ultrasound. In addition, the thickness of the diaphragm on the hemiplegic side was lower than that on the non-hemiplegic side in stroke patients. For internal oblique muscle (IO), rectus abdominis muscle (RA), transversus abdominis muscle (TrA), and external oblique muscle (EO), most studies showed that the thickness on the hemiplegic side was lower than that on the non-hemiplegic side.Clinical Trial Registration: The protocol of this review was registered in the PROSPERO database (CRD42022352901).

Cortical mapping of active and passive upper limb training in stroke patients and healthy people: A functional near-infrared spectroscopy study

Active exercise for upper limb training has been widely used to improve hemiplegic upper limb function, and its effect may be boosted by extrinsic visual feedback. The passive movement of the hemiplegic upper limb is also commonly used. We conducted a functional near-infrared spectroscopy experiment to compare cortical activation during the following three conditions: active left upper limb movement (on the hemiplegic sides in stroke patients), with or without extrinsic motor performance visual feedback (LAV, LAnV), and passive left upper limb movement (hemiplegic sides in stroke patients) (LP) in stroke patients and healthy controls. Twenty patients with right hemispheric stroke and 20 healthy controls were recruited for this study. Hemodynamic changes were detected during left upper limb movements (on the hemiplegic sides in stroke patients) under the above three conditions in the sensorimotor cortex (SMC), supplementary motor area (SMA), and premotor cortex (PMC). There was no significant difference in the level of cortical activation between patients with stroke and healthy subjects during the three conditions. Both the LAV and LAnV induced significantly higher activation in the contralateral SMA and PMC than in the LP. Extrinsic visual feedback led to additional activation in the contralateral PMC and SMA, but this was not statistically significant. Our study indicates that active upper-limb movement appears to induce higher cortical activation than that elicited by passive movement in both stroke patients and the healthy population. Extrinsic motor performance in the form of visual feedback provided during active movement may facilitate sensorimotor areas over the contralateral hemisphere.

Evaluation of supraspinatus muscle changes in the shoulder joint of stroke patients with hemiplegic and shoulder subluxation using ultrasonography: comparison between affected and unaffected sides.

[Purpose] The shoulder joint has a very unstable structure yet a significantly wide range of motion. Weakness of the muscles around the shoulder joint may cause shoulder joint subluxation. This study aimed to determine changes in supraspinatus muscle thickness between different shoulder abduction angles using ultrasonography and to compare differences in supraspinatus muscle thickness changes between the affected and unaffected sides depending on shoulder joint subluxation. [Participants and Methods] Forty hemiplegic patients with stroke were recruited (20 patients with and 20 without shoulder subluxation). Using ultrasonography, we measured supraspinatus muscle thickness at three shoulder joint abduction angles and calculated the differences in supraspinatus muscle thickness. Depending on subluxation, we separately analyzed the thickness and variations in the supraspinatus muscle on both the affected and unaffected sides. [Results] In stroke patients with shoulder subluxation, the difference in supraspinatus muscle thickness was significantly less in the affected side than in the unaffected side. [Conclusion] The thickness and rate of supraspinatus muscle thickness change was significantly less in the affected side than in the unaffected side in stroke patients with shoulder subluxation.

Does muscle strength decrease on the unaffected side in stroke patients?

Does muscle strength decrease on the unaffected side in stroke patients?

Comparison of gait recovery patterns according to the paralyzed side in stroke patients: An observational study based on a retrospective chart review (STROBE compliant).

Gait rehabilitations have been abundantly performed for post-stroke patients, because gait is the most important factor for the return of post-stroke patients to daily life. However, conventional uniform gait rehabilitations tend to be tedious and reduce motivation. The aim of this study was to contribute to the development of personalized rehabilitation of gait by identifying differences in gait recovery pattern according to the paralyzed side of post-stroke patients.The gait analysis was performed on stroke patients who are right-handed and can walk independently. We retrospectively analyzed the results of pelvic movements and displacement of center of pressure (COP) during gait using corresponding equipments. To show the difference of gait recovery pattern according to the paralyzed side, we divided subjects into two groups, right (n = 19) and left (n = 20) hemiparesis group. The measured variables were as follows: tilt, obliquity, and rotation symmetries of pelvis; area, velocity, and lateral symmetry of COP.First, in the left hemiparesis group, obliquity (P < .01) and rotation (P < .01) symmetries of the movement of the pelvis were significantly improved in the follow-up compared to the initial gait analysis. In the right hemiparesis group, tilt (P < .001), obliquity (P < .001), and rotation (P < .05) symmetries were significantly improved in the follow-up compared to the initial gait analysis. Second, COP area and COP velocity values in the follow-up were significantly smaller than those in the initial gait analysis in the left (P < .001, P < .05) and right (P < .001, P < .01) hemiparesis groups. The positive value of lateral symmetry increased, although not a significant difference statistically, as walking ability improved in both groups. In the correlation analysis among variables obtained using Treadmill, there were significant positive linear relationships between the lateral symmetry and the COP area (P < .05), and between the COP velocity and the lateral symmetry (P < .001) of the follow-up gait analysis in the right hemiparesis group.It was confirmed that the gait recovery pattern differs according to the paralyzed side of post-stroke patients and the role of the intact side, such as moving the COP to the intact side, is important for the improvement of gait function in both groups.This study was registered with the Clinical Research Information Service (CRIS) of the Korea National Institute of Health (NIH), Republic of Korea (KCT0002984) and was approved by the Institutional Review Board (IRB) of the WKUGH (WKIRB [2018-25], November 28, 2018).

Acute effects of contrast bath on sympathetic skin response in patients with poststroke complex regional pain syndrome

Purpose Complex regional pain syndrome (CRPS) is one of the common complications in stroke patients. Sympathetic dysfunction is usually considered underlying pathology. The evidence for contrast bath (CB) used in the treatment of CRPS is limited. The aim of the study is to investigate the possible effects of CB on the sympathetic activity in poststroke CRPS. Materials and methods Stroke patients with CRPS (CRPS group) and without CRPS (control group) were included in the study. Age, gender, duration of stroke, aetiology, plegic side, dominant hand, spasticity level, Brunnstrom stages, and comorbidities were recorded. CB was performed for one session to the plegic side of the CRPS and control groups. Sympathetic skin responses (SSR) was recorded from the plegic and healthy hands of participants at pre-CB and post-CB. Results Each group consisted of 20 participants. No significant difference was detected in stroke duration, aetiology, and Brunnstrom stages between groups. Elbow spasticity level was significantly higher in CRPS group (p = .034). SSR amplitudes of plegic hands were significantly decreased after CB in CRPS and control groups (p = .0002, p = .013 respectively). Also, CB reduced the SSR amplitude of healty side in CRPS group (p = .003). There was no statistically significant change in SSR latency or percentage changes of SSR amplitude and latency after CB in both groups. Conclusion CB leads to a significant reduction in sympathetic activity of plegic side of stroke patients. Also, CB to the plegic side has an inhibitory effect on sympathetic activity of healty side in poststroke CRPS. ClinicalTrials.gov ID: NCT04198532

Effects of visual feedback training using transient Fresnel prism glasses on balance ability in stroke patients without hemispatial neglect.

The center of mass of the body in patients with stroke was oriented toward the nonparetic side. Abnormal weight shift increases the risk of falls. Therefore, many therapists make an effort to help their functional recovery through balance training. Our aim was to investigate the effect of visual feedback intervention using a Fresnel prism on static and dynamic balance in stroke patients without hemispatial neglect. Participants were assigned to control group (n=10) and experimental group (n=9). In the control group, neurodevelopmental therapy was performance for 30 min. In the experimental group, Fresnel prism glasses were applied with neurodevelopmental therapy for 30 min. We executed motor-free visual perception test for visual perception, balancia for static balance ability, and functional reach test and Berg balance test for dynamic balance ability, respectively. All tests were measured immediately after intervention. The visual perception function showed significant difference between unaffected side performance behaviors and visual perceptual processing time (P<0.05). In the static balance, there was a significant difference in sway velocity and sway distances (P<0.05). Dynamic balance was also significant different between groups (P<0.05). Visual feedback using Fresnel prism helps to control the static and dynamic balance ability by inducing weight shift toward the affected side in stroke patients. Therefore, a Fresnel prism may be suggested as an intervention tool to assist weight training for patients with stroke.

Change in radial artery pulse wave in stroke hemiplegic patients: Protocol for a case-control study.

Introduction:About 55% to 75% of stroke survivors have motor disorders and problems that affect their quality of life. The prevention of secondary neurological damages through relapse prevention and the rehabilitation of stroke patients suffering from morbidities are crucial to improve the prognosis of patients with stroke. Pulse examinations can be used to determine the stroke progression. This study will investigate the differences and changes in radial artery pressure-pulse waves during the treatment of hemiplegia caused by stroke.Methods/design:This study protocol is for a prospective matched case-control study. A total of 84 participants will be recruited, 56 patients with hemiplia caused by stroke, and 28 control patients matched by age, gender, and body mass index. The primary outcome of this study will be the differences and changes in the radial augmentation index.Discussion:The results of the study will help to determine the differences and changes in radial artery pressure-pulse waves during the treatment of hemiplegia caused by stroke. The findings will provide information about the physiological and hemodynamic mechanisms.Conclusion:This will be the first study to analyze the pulse wave of the radial artery (PWRA) on the affected side and on the normal side in stroke patients with hemiplegia. This study will clarify whether the radial artery pressure pulse wave can be used to evaluate the result of stroke treatment objectively. The results of the study will be available in February 2019. The version of the protocol is v1.6 written in March 7, 2016.Ethics and dissemination:Written informed consent will be obtained from all participants. This study has been approved by the Institutional Review Board (IRB) of Wonkwang University Gwangju Hospital, Gwangju, Republic of Korea (WKIRB-2016/8). The study findings will be published in peer-reviewed journals and presented at national and international conferences.Trial registration number:This trial was registered with the Clinical Research Information Service (CRIS) of the Korea National Institute of Health (NIH), Republic of Korea (KCT0002147).

The Effects of Scapula Setting Intervention on the ADL and gait in the Stroke Patients

Background/Objectives: In this study, we assessed the effects of scapula setting intervention on the ADL and gait in the stroke patients with hemiplegia. Methods/Statistical analysis: Thirty subjects with stroke patients participated. Subjects were randomly divided into scapula setting intervention group (n=15) and general physical therapy group (n=15) both therapy was applied for 30mins in a day and 3times in a week for 4 weeks. The TUG and MBI was used to evaluate gait, ADL by paretic side in stroke patients. To compare the treatments, we used paired t-test and independent sample t-test. Findings The scapula setting intervention group and general physical therapy group showed statically significant differences before and after the gait. The experimental group showed a more significant difference compared with the control group when TUG. However, there was no statistically significant difference MBI. Improvements/Applications: The scapula setting intervention was helpful more than the general physical therapy to improve in the stroke patients.

Diaphragm Thickness and Inspiratory Muscle Functions in Chronic Stroke Patients.

BackgroundThe aims of this study are to investigate the difference between the diaphragm thickness at end expiration and the thickness at total lung capacity (TLC), and to examine differences in inspiratory muscle function between stroke patients and healthy individuals.Material/MethodsForty-five stroke patients and 49 healthy volunteers were included in this study. Diaphragm thickness was measured at end expiration and at TLC by ultrasonography. The maximal inspiratory pressure (MIP), peak inspiratory flow (PIF), vital capacity (VC), and inspiratory muscle endurance (IME) were assess to evaluate inspiratory muscle function.ResultsIn stroke patients, the diaphragm was significantly thinner on the affected side than the less affected side at end expiration and at TLC. The change between the thickness at end expiration and at TLC were also significant on both sides. Between groups, the difference in diaphragm thickness at end expiration was not significant, but at TLC, the diaphragms were significantly thicker in healthy individuals than on either side in stroke patients, and the change in diaphragm thickness was significantly greater for healthy individuals. Inspiratory muscle functions were also significantly greater in healthy individuals. MIP, PIF, and VC were positively correlated with the change in thickness in healthy individuals, and MIP was positively correlated with the change in thickness and IME in stroke patients.ConclusionsStroke patients showed decreases in the thickening ability of the diaphragm at TLC and in inspiratory muscle function. The change between the diaphragm thickness at end expiration and at TLC was positively correlated with MIP, PIF, and VC.

The immediate effect of diaphragm taping with breathing exercise on muscle tone and stiffness of respiratory muscles and SpO2 in stroke patient.

[Purpose] This study aimed to examine the immediate effects of diaphragm taping with breathing exercise on the tone and stiffness in the respiratory muscles of patient with stroke. [Subjects and Methods] A total of 28 subjects, 14 in the diaphragm taping with breathing exercise group and 14 in the breathing exercise group, were administered respective intervention methods. Subsequently, the muscle tone and stiffness in upper trapezius, scalene, external oblique abdominal and ractus abdominis muscle of both the respiratory muscles were measured. [Results] The comparison of respiratory muscles on the affected and non-affected sides in stroke patients showed statistically significant declines in the muscle tone and stiffness of all measured muscles but not in the stiffness of the external oblique abdominal muscle and rectus abdominis muscles. After intervention, the diaphragm taping with breathing exercise group exhibited statistically significant increases in the muscle tone of all measured muscles and in the stiffness of the upper trapezius and scalene muscles, and statistically significant declines in the saturation of peripheral oxygen. However, the breathing exercise group showed statistically significant increases only in the muscle tone of the upper trapezius and external oblique abdominal muscles. [Conclusion] This study demonstrated that diaphragm taping with breathing exercise had positive effects of immediately increasing the muscles tone and stiffness in the respiratory muscles.

Effect of Direction to be Used for the Timed Up and Go Test on Walking Time in Stroke Patients

Background: In the stroke patients with the characteristics of hemiplegic gait, turning direction of the affected and unaffected side influences turning time. Therefore, it is important to investigate the walking response to turning directions in stroke patients. Objects: This study aimed to measure the walking time while turning direction in hemiplegic patients depending on balance ability measured by Berg Balance Scale. Methods: A group of forty-five subjects with stroke (Berg Balance Scale score were twenty-eight, Berg Balance Scale score were seventeen) were enrolled in this study. Subjects were asked to perform the Timed Up and Go test. Testing indications included two directions for turning in each subject. These indications were for turning toward the affected and unaffected side in stroke patients. The duration of total analysis duration, sit to stand phase, stand to sit phase, mid-turning phase, and end turning phase were recorded. The obtained data were analyzed by using paired t-test and Wilcoxon signed rank test in the group that are below and above 45 points of Berg Balance Scale score. The significance level was set at . Results: There were significant increase time in the analysis duration and end turning phase duration while subjects were turned the unaffected side in stroke patients that presented a Berg Balance Scale score (p, revealed no significant differences of the measured parameters. Conclusion: This finding should be suggested in the specific definition of turning direction for evaluation with Timed Up and Go test in the Berg Balance Scale score, and other intervention for hemiplegic patients need to be suggested the direction of turning during walking training program.

Descending neural drives to ankle muscles during gait and their relationships with clinical functions in patients after stroke

ObjectiveThe objective of this study was to investigate the descending neural drive to ankle muscles during gait in stroke patients using a coherence analysis of surface electromyographic (EMG) recordings and the relationships of the drive with clinical functions. MethodsEMG recordings of the paired tibialis anterior (TA), medial and lateral gastrocnemius (MG and LG), and TA–LG muscles were used to calculate intramuscular, synergistic, and agonist–antagonist muscle coherence, respectively, in 11 stroke patients and 9 healthy controls. Paretic motor function, sensory function, spasticity, ankle muscle strength, and gait performance were evaluated. ResultsParetic TA–TA and MG–LG beta band (15–30Hz) coherences were significantly lower compared with the non-paretic side and controls. TA–LG beta band coherence was significantly higher on both sides compared with controls. Paretic TA–TA beta band coherence positively correlated with gait speed, and paretic TA–LG beta band coherence negatively correlated with paretic ankle plantar flexor muscle strength. ConclusionsThe intramuscular and synergistic muscle neural drives were reduced during gait on the paretic side in stroke patients. The agonist–antagonist muscle neural drive was increased to compensate for paretic ankle muscle weakness. SignificanceDescending neural drive reorganization to agonist–antagonist muscles is important for patients with paretic ankle muscle weakness.

The evaluation tool to predict decreased exercise tolerance in elderly patients with chronic heart failure

Purpose: The purpose of this study is to clarify the effect of CHKB on the walking speed and knee function of stroke patients. Methods: Eleven stroke patients who could walk at least 50m without assistance participated. We used 2-D motion analysis tomeasurewalking speed andminimumkneeflexion angle at mid-stance on the hemiplegic side. The participants walked 10m under two conditions, with a hinged knee brace (KB) andwithCHKB.Themeasurement sequencewas determined randomly. We examined each condition twice, and investigated the average walking speed and minimum knee flexion angle at mid-stance on the hemiplegic side. Results: The average walking speed in the two condition was 0.78m/swithKBand 0.82m/swithCHKB.A significant difference was observed between KB and CHKB. Five of eleven participants hadwalking speed improvements of more than 10%with CHKB compared with KB. Seven participants had abnormal knee-patterns with KB; one had a stiff-knee pattern, two had a buckling-knee pattern and four had an extension-thrust pattern. In five of these seven participants, twowith a buckling-knee pattern and threewith an extensionthrust pattern, the abnormal knee motion was improved with CHKB. Conclusion(s): This study suggests that CHKB can improve walking speed and reduce abnormal knee patterns at mid-stance on the hemiplegic side in stroke patients. Implications: To improve walking speed and abnormal knee pattern,CHKBmight useful in cases ofmild hemiplegia. CHKB may promote acute stroke rehabilitation.

Development of the Implicit Method that directs weight shifting to the affected side in stroke patients

Hemiplegic patients cannot sufficiently weight shift to the affected side because of fear of falling. We aimed to invent and evaluate the Implicit Method that directs weight shifting to the affected side without it being noticed by the patient and reduces the fear of falling down. This method uses vibratory biofeedback to provide center of foot pressure displacement. A clinical study was conducted with 5 hemiplegic patients and the results showed that during walking, the stance phase of the affected leg increased after training in moderate paralytics. The results suggest that the Implicit Method can make hemiplegic patients stay on the affected leg while walking.

Neuromuscular and biomechanical strategies of turning in ambulatory individuals post-stroke.

Given that the inter-limb asymmetry and additional balance control are required for turning, stroke subjects spend more time to turn than healthy subjects. Few studies have investigated specific turning-related neuromuscular and biomechanical strategies post-stroke to clarify factors favoring or hindering turning speed toward different directions. The purpose of this study was to compare the speed and lower-limb muscular and kinematic strategies of turning between individuals with stroke and matched controls. Fifteen ambulatory individuals with chronic stroke and 15 matched healthy controls participated in this study. Turning speed during turning along a 0.8-meter radius curved path toward both sides for 5 meters was recorded. Simultaneously, kinematics and muscle activation patterns of lower extremity were measured by the joint angle and electromyography during turning. The slower speed was noted for the turning task in stroke patients when compared to controls. Individuals with stroke have insufficient muscle activation in tibialis anterior and biceps femoris of the affected inner leg, accompanied by reduced standing knee flexion, which disturb turning toward the affected side. The augmented standing knee flexion of unaffected side in stroke patients hindered the function of the outer leg while turning toward the affected side, but assisted the role of the inner leg while turning toward the unaffected side. However, the absence of difference in turning speeds toward the affected and unaffected sides may attribute to the diminished swing phase knee flexion of the affected outer leg. Our findings suggest that there are direction-related strategies in turning for stroke subjects since the inner and outer legs, respectively, have specific roles for standing support and leg swing during turning. Therefore, in addition to turning speed, kinematics and muscular components during turning toward either direction should be considered to improve turning performance as well as to prevent falls in stroke rehabilitation.

Immediate effects of single-leg stance exercise on dynamic balance, weight bearing and gait cycle in stroke patients

Methods: Eighteen patients with hemiplegia participated in this study. There were twelve males and six females. This study investigated the effects of the single-leg stance exercise on dynamic balance, weight bearing, and gait ability compared with four conditions. Dynamic balance and weight bearing were measured using the step test (ST) of the affected side in stroke patients. In addition, gait parameters were measured using the optogait system for analysis of the spatial and temporal parameters of walking in stroke patients. Results: This study investigated the effect of the single leg stance exercise on the paralysis side. The ST showed significant findings for all conditions (p<0.05). Therefore, knee extension and flexion exercise on the affected side single-leg stance (condition 4) significantly improved dynamic balance and weight bearing on the affected side (p<0.05). In the condition of moving the knee joint in a single-leg stance was discovered that the stance phase time significantly increased more than in the condition of supporting the maximal voluntary weight on the affected side (p<0.05). Conclusions: Single-leg stance on the paralysis side with knee flexion and extension increased symmetry in weight bearing during stance phase time. This study suggests that single-leg stance exercises augments improved gait function through sufficient weight bearing in the stance phase of the affected side.

Activity of Thigh Muscles During Static and Dynamic Stances in Stroke Patients: A Pilot Case-Control Study

Purpose: Impaired postural control is a key characteristic of mobility problems in stroke patients and has great impact on the incidence of falls and on the level of independence in activities of daily living. The role played by the thigh muscles in balance impairment in stroke patients has not been sufficiently investigated. This study investigated the activities of the thigh muscles in stroke patients during standing balance manipulations. Method: Ten stroke patients and 15 healthy subjects performed 5 upright standing tasks on a force platform: normal standing with eyes open, normal standing with eyes closed, feet together, semi-tandem standing, and a dynamic measurement along a predefined route. The posturography parameters, normalized muscle activity by maximal voluntary isometric contraction of the thigh muscles, were measured. The Berg Balance Scale was administered to evaluate functional balance. Results: The stroke patients showed excessive postural sway compared with healthy control subjects in all conditions of the static balance tests (P < .05). Muscle activity measured by surface electromyography (sEMG) showed higher normalized average EMG (aEMG) in the vastus medialis, rectus femoris, and biceps femoris on the affected side than that in control subjects during all static balance tests (P < .05). The rectus femoris on the unaffected side showed higher aEMG than that in control subjects in the 4 static standing tasks (P < .05). In dynamic tests, the performance time and excursion of the center of pressure were longer in the stroke patients than in the control subjects (P < .05). The activity of the biceps femoris muscle on the affected side was significantly different from that of the control subjects (P < .01). Conclusions: The vastus medialis, rectus femoris, and biceps femoris muscles on the affected side and the rectus femoris muscle on the unaffected side of stroke patients are involved in the static balance deficits, while the biceps femoris on the affected side influences dynamic balance control.

Ultrasonographic measurement of the femoral cartilage thickness in hemiparetic patients after stroke

The aim of the study was to evaluate the femoral cartilage thicknesses of hemiparetic patients after stroke using musculoskeletal ultrasonography and to determine whether there is any correlation between cartilage thicknesses and the clinical characteristics of the patients. Femoral cartilage thicknesses of both knees were measured in 87 (33 women, 54 men) hemiparetic patients. The mean age of the patients was 61.8 years (SD 11.1 years, range 32-87 years) and the mean duration of stroke was 12.3 months (SD 10.5 months, range 1-36 months). The outcome was measured in terms of motor recovery (Brunnstrom stages), spasticity (Modified Ashworth Scale), walking ability (Functional Ambulation Categories), and motor functioning (Functional Independence Measurement instrument). Ultrasonographic measurements were made axially from the suprapatellar window using linear probes while the patients' knees were held in maximum flexion. Three (midpoint) measurements were taken from both knees [lateral condyle (LFC), intercondylar area, and medial condyle (MFC)]. The mean cartilage thicknesses were found to be less on the paretic side (statistically significant only for LFC) when compared with the nonparetic side. Cartilage thickness values were found to be negatively correlated with the duration of immobilization (with paretic side LFC) and BMI (with both sides' MFC) and positively correlated with the Functional Independence Measurement motor score (with paretic side LFC) and the Functional Ambulation Categories scores (with both sides' LFC and MFC). Femoral cartilage is thinner on the paretic side in stroke patients. As the thickness values correlate with the duration of the disease and the ambulatory status of the patients, we suggest that early mobilization would be important in maintaining their cartilage integrity.