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Correlation Between Muscle Structures and Electrical Properties of the Tibialis Anterior in Subacute Stroke Survivors: A Pilot Study

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Correlation Between Muscle Structures and Electrical Properties of the Tibialis Anterior in Subacute Stroke Survivors: A Pilot Study

Chengpeng Hu et al. Front Neurosci.

Abstract

Electrical impedance myography (EIM) is a non-invasive diagnostic tool that assesses the muscle inherent properties, whereas ultrasonography can assess the alteration in muscle architecture. This study aimed to combine EIM with ultrasonography to assess the changes of the tibialis anterior (TA) muscle properties during passive plantar/dorsiflexion in stroke survivors. Fifteen patients with subacute stroke were recruited. The muscle structures were simultaneously assessed by EIM and ultrasonography at five different extension angles (-10°, 0°, 10°, 20°, and 30°) of the ankle joint. The EIM parameters measured were resistance (R), reactance (X), and phase angle (θ). The parameters recorded by ultrasonography were pennation angle (PA), muscle thickness (MT), and fascicle length (FL). Two-way repeated ANOVA was performed to compare the differences between the affected and unaffected sides as well as the parameters that changed with joint angle. Linear correlation analysis was conducted to assess the association between muscle parameters and clinical scores. The results showed that as the ankle was passively plantarflexed, the θ (P = 0.003) and PA (P < 0.001) values decreased, and the X (P < 0.001), R (P < 0.001), and FL (P < 0.001) values increased. Significant correlations were found between the FL and R values (r = 0.615, P = 0.015), MT and R values (r = 0.522, P = 0.046), and FL and θ values (r = 0.561, P = 0.03), as well as between the PA and the Fugl-Meyer Assessment of Lower Extremity score (r = 0.615, P = 0.015), the R and the Modified Ashworth Scale (MAS) score (r = 0.58, P = 0.023), and the PA and the manual muscle testing (MMT) score (r = -0.575, P = 0.025). This study demonstrated a correlation between the EIM and the ultrasonography parameters at different joint angles. Therefore, both methods could jointly be applied in patients with stroke to detect changes in the muscle inherent properties and muscle architecture. This could assist clinicians to quantitatively evaluate the muscle condition in people with subacute stroke. The study was registered on the Chinese Clinical Trial Registry (trial registration number: ChiCTR-IOR-17012299, http://www.chictr.org.cn/showprojen.aspx?proj=19818). Clinical Trial Registration Number: ChiCTR-IOR-17012299.

Keywords: correlation study; electrical impedance; stroke; tibialis anterior; ultrasonography.

Figures

FIGURE 1
FIGURE 1
(A) One male subject was relaxed and in supine position on an instrumented bed with foot fixed on the isokinetic dynamometer pedal. One pair of current electrodes (red and black) and one pair of voltage electrodes (yellow and blue) were linearly arranged along the surface of the TA on the muscle belly. An ultrasound probe was placed between voltage current electrodes. (B) Demonstration of positions of EIM parameters and ultrasound probe. I1 and I2 were a pair of current electrodes of EIM. V1 and V2 were a pair of voltage electrodes of EIM. An ultrasound probe was placed between these two pairs of electrodes. TA, tibialis anterior; EIM, electrical impedance myography.
FIGURE 2
FIGURE 2
A typical ultrasonography image of non-paretic tibialis anterior (TA) from a participant during assessment. MT1 and MT2 are the distance of the visible fiber distal end point to the superficial aponeurosis and the distance of the visible fiber proximal end to the aponeurosis, respectively; and α is the pennation angle (PA). We considered the middle thickness of captured image as the muscle thickness (MT) of the TA, so we measured, respectively, the thickness of both left and right edges of the TA in the image and take the average value of these two measurements as MT for statistical analysis. APO, aponeurosis; EAPO, extension of the visible aponeurosis; SAPO, superficial aponeurosis; Lf, entire estimated muscle fascicle length; Lm, visible part of the muscle fiber in the image; MT, muscle thickness; SF, subcutaneous fat; TA, tibialis anterior.
FIGURE 3
FIGURE 3
Two-way repeated ANOVA with post hoc analysis results of EIM parameters. (A) Phase angle (θ) value comparison among five ankle joint angles. (B) Reactance (X) value comparison among five ankle joint angles. (C) Resistance (R) value comparison among five ankle joint angles, and significant difference was revealed between random two groups of ankle joint angles. The Y axis of A, B, and C did not start from 0 to demonstrate the variation trend of parameters versus joint angle as well as comparison between three parameters. P ≤ 0.05. ANOVA, analysis of variation; θ, phase angle; X, reactance; R, resistance; EIM, electrical impedance myography.
FIGURE 4
FIGURE 4
Two-way repeated ANOVA with post hoc analysis results of ultrasonography parameters. (A) PA values comparisons among five ankle joint angles. (B) Fascicle length (FL) values comparison among five ankle joint angles, and significant difference was revealed between random two groups of ankle joint angles. (C) MT value comparison among five ankle joint angles. Y axis of A, B, and C did not start from 0 to demonstrate the variation trend of parameters versus joint angle as well as comparison between three parameters. P ≤ 0.05.
FIGURE 5
FIGURE 5
(A) Comparison of slope value of EIM and ultrasound parameters; significant difference was indicated in SFL, SR, SX, and Sθ between affected and unaffected sides. (B) Significant correlation between dSMT and dSR values. (C) Significant correlation between dSFL and dSθ. (D) Significant correlation between dSFL and dSR value. P ≤ 0.05. dSFL, difference value of slope-fascicle length; dSR, difference value of slope-resistance; dSMT, difference value of slope-muscle thickness; dSθ, difference value of slope-phase angle; EIM, electrical impedance myography. Correlation between EIM and ultrasonography parameters.
FIGURE 6
FIGURE 6
Correlation between muscle intrinsic properties and clinical scales. (A) Significant correlation between FMA-LE score and dAPA value. (B) Significant correlation between MAS score and dAR value. (C) Significant correlation between MMT score and dAPA value. FMA-LE, Fugl–Meyer assessment of lower extremity; MAS, modified ashworth scale; MMT, manual muscle test; dAPA, difference value of average pennation angle parameter; dAR, difference value of average resistance parameter.

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