introduction:The aim of this study was to show the relationship of distal femoral cartilage and quadriceps thicknesses with functional status and presence of sarcopenia in ambulatory stroke patients with voluntary movement. Materials and Method: Forty-eight patients who were diagnosed with stroke due to cerebrovascular disease, had started voluntary movement, and had a motor recovery of 3 or above according to Brunnstrom's Staging were included in this cross-sectional study.
Forty-eight patients who were diagnosed with stroke due to cerebrovascular disease, had started voluntary movement, and had a motor recovery of 3 or above according to Brunnstrom's Staging were included in this cross-sectional study. Bilateral distal femoral cartilage thickness and quadriceps femoris (rectus femoris+vastus intermedius) thickness were measured by ultrasonography. In addition, A Simple Questionnaire to Rapidly Diagnose Sarcopenia (SARC-F questionnaire), hand grip strength, muscle mass measurement with Dual energy X-ray absorptiometry (DXA), short physical performance battery (KFPB) tests were performed and the presence of sarcopenia The European Working Group on Sarcopenia in Older People-2 (EWGSOP- 2) were evaluated according to the criteria. Patients' Functional Independence Scale (FIM), Functional Ambulation Scale (FAS), Barthel Index and modified ashworth scale (MAS) were evaluated.
Study Type
OBSERVATIONAL
Enrollment
48
Health Sciences University, Kayseri Medicine Faculty
Talas, Kayseri, Turkey (Türkiye)
Health Sciences University, Kayseri Medicine Faculty
Kayseri, Kocasinan, Turkey (Türkiye)
Distal Femoral Cartilage Measurement
Horizontal imaging was performed from the suprapatellar region using the patient in the supine position with the knees at maximum flexion, and the femoral cartilage thickness was measured three times separately from 3 different locations: medial, intercondylar and lateral, and the averages were be recorded.
Time frame: once at the beginning
Quadriceps Femoris Muscle Thickness Measurement
Each participant was scanned in a relaxed supine position. The examiner placed the probe on the anterior aspect of the thigh, perpendicular to its long axis at a point midway between the anterior superior iliac spine and the proximal end of the patella according to a previous study.The examiner identified the subcutaneous adipose tissue, rectus femoris, vastus intermedius, and the femur. Excess gel was applied to the skin to minimize distortion.
Time frame: once at the baseline
Functional Independence Scale
Functional Independence Scale: Functional Independence Scale is a scale consisting of motor and cognitive subheadings and scoring functions. The Functional Independence Scale is scored under 3 main headings: The total score consists of the sum of the scores of 13 motor items and the scores of 5 cognitive items. A high score indicates high functioning status.
Time frame: once at the beginning
Brunnstrom Stages of Stroke Recovery
It is used to evaluate the improvement in motor functions. The lowest stage (flaccid stage and no voluntary movement) is stage 1, and the highest stage (period with isolated joint movements) is stage 6. Its validity and reliability have been previously proven.
Time frame: once at the baseline
Modified Ashworth Scale
It is a method used to determine the severity of spasticity. It is based on the principle that the physician subjectively rates the resistance he feels during the examination. It is divided into six grades: 0 = normal muscle tone, 1 = slight increase in muscle tone, minimal muscle resistance at the end of the range of motion, 1 + = minimal resistance at less than half of the joint range of motion, 2 = significant muscle resistance at more than half of the joint range of motion. Increased tone, but affected parts can be moved easily, 3=Passive movement is difficult, there is a significant increase in muscle tone, 4=Affected parts are rigid in flexion and extension, there is a severe increase in tone.
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Time frame: once at the baseline
Barthel Index for Activities of Daily Living
It is used to measure the level of disability experienced by the patient during daily living activities. Barthel index consists of a total of 10 main items. Nutrition, wheelchair-bed transfer, self-care, sitting and standing on the toilet, washing, walking on smooth surfaces, going up and down stairs, dressing and undressing, bowel and bladder care are questioned. The total score is evaluated between 0 and 100. 0-20 points: fully dependent, 21-61 points: severely dependent, 62-90 points: moderately dependent, 91-99: slightly dependent, 100 points: fully independent.
Time frame: once at the baseline
Functional Ambulation Scale
It classifies patients according to the motor skills required for functional ambulation. It was developed in 1984. Six different functional ambulation stages have been determined: Stage 0 for patients who cannot walk or who need physical support or supervision from more than one person to walk other than the parallel bar, and Stage 5 for patients who ambulate independently at any speed on flat and uneven surfaces, slopes and stairs.
Time frame: once at the baseline
Evaluation of Muscle Mass
The most common method used to evaluate muscle mass and body composition in stroke patients is Dual-energy X-ray absorptiometry (DXA). Total muscle mass is related to body size. Therefore, appendicular skeletal muscle mass measured on DXA; Appendicular Skeletal Muscle Index (ASM)/height²), that is, appendicular muscle mass (ASMI), was calculated by correcting for height to adapt it to body size, and muscle mass was evaluated. The recommended cut-off point for ASMI was \<7.26 kg/m2 for men and \<5.5 kg/m2 for women. Patients with low ASMI were evaluated as sarcopenia.
Time frame: once at the baseline
Evaluation of Muscle Performance
The short physical performance battery is used in both medical research and clinical practice to evaluate lower extremity physical performance. It evaluates balance, walking speed and endurance. The total score is 12 points, with ≤ 8 points indicating poor physical performance. In our study, if the physical performance of the person diagnosed with sarcopenia was low, it was considered as severe sarcopenia.
Time frame: once at the beginning
Evaluation of Muscle Strength
In general, hand grip strength is one of two methods used to measure muscle strength in patients with suspected sarcopenia. Hand grip strength is related to strength in other muscles and can therefore be used as a tool to demonstrate muscle weakness. The hydraulic hand dynamometer was used in all patients included in our study, and measurements were recorded in kilogram. Measurements were made with the patient in a sitting position on a chair, with the elbow close to the body and 90 degrees of flexion, and the wrist in neutral. Patients were asked to grasp the dynamometer as firmly as possible. Three measurements were taken for the patients and the average was taken. The recommended cut-off point for the hand grip test was considered to be \<27 kg for men and \<16 kg for women. Patients with low hand grip strength were evaluated as having possible sarcopenia.
Time frame: once at the baseline