Quadriceps Thickness and Echo Intensity Predict Gait Independence in Individuals with Severe and Mild Hemiparetic Stroke

Eur Neurol. 2020;83(2):167-173. doi: 10.1159/000507548. Epub 2020 May 25.


Introduction: Smaller muscle size and higher adipose tissue ratio of the quadriceps femoris are often observed after stroke. However, it is unclear whether muscle size and the intramuscular fat ratio of the quadriceps measured with ultrasonography (US) reflect gait independence in individuals with mild or severe hemiparetic stroke.

Objective: The present study was performed to examine the relationships of gait independence with muscle thickness (MT) and echo intensity (EI) of the quadriceps femoris in individuals with hemiparesis after stroke.

Methods: We examined 43 individuals with hemiparetic stroke. We assessed functional independence measure (FIM) gait scores and measured thickness and EI of the quadriceps using US. The relationships of FIM gait scores with MT and EI were examined using Spearman's correlation coefficients in mild (n = 21) and severe (n = 22) hemiparetic stroke groups.

Results: In the mild hemiparetic group, FIM gait scores were correlated with paretic limb MT (rho = 0.60, p < 0.01) and EI (rho = -0.57, p < 0.01). In the severe hemiparetic group, FIM gait scores were correlated with paretic limb MT (rho = 0.67, p < 0.01) and EI (rho = -0.43, p < 0.05), as well as non-paretic limb MT (rho = 0.86, p < 0.01) and EI (rho = -0.56, p < 0.01).

Conclusions: Quadriceps thickness and EI were associated with the degree of gait independence. Atrophy and increased intramuscular fat of the quadriceps may be limiting factors for achieving gait independence.

Keywords: Gait; Hemiparesis; Muscle morphology; Stroke.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adipose Tissue / diagnostic imaging
  • Aged
  • Female
  • Gait*
  • Humans
  • Male
  • Middle Aged
  • Muscular Atrophy / diagnostic imaging
  • Muscular Atrophy / etiology
  • Paresis / etiology
  • Paresis / rehabilitation
  • Quadriceps Muscle / diagnostic imaging
  • Quadriceps Muscle / pathology*
  • Recovery of Function / physiology*
  • Stroke / complications*
  • Stroke Rehabilitation
  • Ultrasonography