F-2-17-06
HOW DO STRENGTH AND CROSS-SECTIONAL AREA OF THE THIGH MUSCLES CHANGE AFTER A REHABILITATION PROGRAM IN STROKE PATIENTS?
Yoichiro Aoyagi, Meigen Liu, Tetsuya Tsuji, Kazuto Tsujiuchi, Naoichi Chino (Saitama Prefecture General Rehabilitation Center and Keio University, Saitama and Tokyo, Japan)
[Objective] To investigate the changes of isometric muscle torques (ISO) and cross-sectional areas (CSA) of the thigh muscles in stroke patients after a comprehensive rehabilitation program (CRP).
[Methods] The subjects were 22 hemiplegic inpatients, 13 females and 9 males, mean age 52.4±10.3 years. 13 had right brain and 9 left brain lesion. At the start (median; 99.5 days from onset) and the end (median; 206 days) of the CRP (1.5 to 3 hours/day, 5 days/week), we measured ISO of the knee extensors and flexors at 60 degrees of knee flexion with a KinCom125AP-TR, and CSA of the mid-portion of the thigh with a Signa-TR CT scanner. We analyzed the differences of ISO and CSA between the affected and unaffected side and between the initial and final examination. We also analyzed how ISO and CSA related to age, days from onset to admission, grip strength, Stroke Impairment Assessment Set (SIAS) motor scores and Functional Independence Measure (FIM) motor scores.
[Results] 1) On both examinations, the CSA of the affected side (A) were smaller than those of the unaffected side (U) except gracilis (paired t-test, p<0.01). 2) ISO and CSA were larger on both sides at the end of the CRP (paired t-test, p<0.05). 3) A/U knee extensor torque ratio, A/U CSA ratio of the quadnceps, SIAS knee scores were significantly intercorrelated (r=-0.56〜0.80). 4) The disuse index, defined as U CSA on admission/U CSA at discharge, correlated with FIM motor scores (r=0.70) and SIAS knee scores (r=0.69).
[Conclusion] Disuse atrophy is present in the thigh muscles of both the affected and unaffected sides of the hemiplegics, which is partially reversible through a comprehensive rehabilitation program.
F-2-17-07
METABOLIC CHANGES OF THE HEMIPARETIC LIMB MUSCLE IN STROKE
Mi J Kim, Soo A Lee, In Y Seong, Sang B Ha
(University of Ulsan, College of Medicine/Asan Medical Center, Seoul, Korea)
Purpose: There have been many investigatory studies on energy metabolic changes in neuromusculoskeletai disorders using 31P magnetic resonance spectroscopy (MRS). Since no such research on hemiplegic limb was performed, we present the result of our preliminary study on it.
Method: 16 stroke patients were involved in this study. MR spectrum data were obtained from the flexor digitorum superficialis muscle of both affected and sound limbs and analyzed with Aspect 3000 computer system.
Result: Intracellular Phosphate-inormanic/Phosphate-creatimine ratio in hemiparetic limb was 0.18±0.01 whereas its ratio in sound limb was 0.14±0.01. The difference between two ratios was statistically of signifcance (P<0.05). Intracellular pH of hemiparetic and sound limbs were 7.00±0.01 and 6.98±0.01 respectively. Phosphodiester signal was appeared in 8 of 16 affected limbs.
Conclusion: The metabolic changes of muscle after stroke were similar to those of myopathy or peripheral nerve injury. The muscle wasting not of usual fashion in upper motor neuron disorders can occur in stroke patients as evidenced by the result of our study. Further study is necessary to clarify our suggestion.
