The investigators will use 3D freehand ultrasound to investigate changes in muscle morphology of the paretic m. rectus femoris and m. gastrocnemius medialis during the first 3 months after stroke. Additionally, 2D ultrasound and surface EMG will be synchronized to examine muscle activation and morphological changes resulting from this activation. Clinical tests will be conducted on the same test occasions to objectify lower limb impairment and gait recovery. As such, the investigators will explore the relationship between the muscle specific changes and functional recovery.
During this longitudinal study, patients who suffer their first-ever stroke will be included within the first week after their stroke (if the inclusion criteria are met). Thereafter, each participant will be assessed at four pre-determined time-points: week 1, 5, 8 and 12 after stroke. On each of the four time-points, the investigators will assess muscle specific parameters of the affected m. rectus femoris (RF) and m. gastrocnemius medialis (GM), together with clinical tests to assess lower limb impairment (Fugl-Meyer Assessment for the lower limb and the Tardieu scale) and gait parameters (10-meter walk test). Specifically, muscle specific parameters will be investigated using 3D freehand ultrasound (3DfUS) and combined dynamic 2D US and surface electromyography (sEMG). Such assessments will help us characterize the electromechanical properties of these muscles, their time-related trajectories and the relationship with the recovery of gait and lower limb function after stroke. At the end of the investigation period, after 3 months, patients who can walk independently will perform a 3D gait analysis. As such, the relationship between changes in muscle specific parameters and the eventual gait quality at the end of the investigation period will be investigated.
Study Type
OBSERVATIONAL
Enrollment
100
Patients after stroke who meet the in- and exclusion criteria will be examined 4 times during the first 3 months after their stroke.
Functional Ambulation Categories (FAC)-score
Scores ranging from 0 (not able to walk) to 5 (independent ambulator who can walk freely on any surface)
Time frame: Frequency: week 1, 5, 8 and 12 after stroke
Muscle volume
Through 3D freehand ultrasound (3DfUS)
Time frame: Frequency: week 1, 5, 8 and 12 after stroke
Cross-sectional area (CSA)
Through 3D freehand ultrasound (3DfUS)
Time frame: Frequency: week 1, 5, 8 and 12 after stroke
Physiological cross-sectional area (pCSA)
Through 3D freehand ultrasound (3DfUS)
Time frame: Frequency: week 1, 5, 8 and 12 after stroke
Muscle tickness
Through 3D freehand ultrasound (3DfUS)
Time frame: Frequency: week 1, 5, 8 and 12 after stroke
Fascicle length
Through 3D freehand ultrasound (3DfUS)
Time frame: Frequency: week 1, 5, 8 and 12 after stroke
Muscle length
Through 3D freehand ultrasound (3DfUS)
Time frame: Frequency: week 1, 5, 8 and 12 after stroke
Tendon length
Through 3D freehand ultrasound (3DfUS)
Time frame: Frequency: week 1, 5, 8 and 12 after stroke
Pennation angle
Through 2D ultrasound
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Time frame: Frequency: week 1, 5, 8 and 12 after stroke
Echo Intensity
Through 2D ultrasound
Time frame: Frequency: week 1, 5, 8 and 12 after stroke
Dynamic muscle morphology
Dynamic 2D ultrasound used to investigate the changes in cross-sectional area (CSA) en fascicle length
Time frame: Frequency: week 1, 5, 8 and 12 after stroke
Change in cross-sectional area
Through dynamic 2D ultrasound
Time frame: Frequency: week 1, 5, 8 and 12 after stroke
Change in fascicle length
Through dynamic 2D ultrasound
Time frame: Frequency: week 1, 5, 8 and 12 after stroke
Average root mean square (RMS)
Through surface electromyography (sEMG)
Time frame: Frequency: week 1, 5, 8 and 12 after stroke
Peak root mean square (RMS)
Through surface electromyography (sEMG)
Time frame: Frequency: week 1, 5, 8 and 12 after stroke
Muscle strength
Assessed with a handheld dynamometer (Nm)
Time frame: Frequency: week 1, 5, 8 and 12 after stroke
Spasticity
Assessed with the Tardieu Scale. Scores ranging from 0 (no resistance throughout passive movement) to 5 (immobile joint).
Time frame: Frequency: week 1, 5, 8 and 12 after stroke.
Lower limb motor impairment
Fugl-Meyer Assessment of the lower limb (FMA LL). Scores ranging from 0 to 34 (no impairment present).
Time frame: Frequency: week 1, 5, 8 and 12 after stroke.
Spatiotemporal gait parameters
Patients will perform the 10-meter walk test while wearing the GaitUp sensors.
Time frame: Frequency: week 1, 5, 8 and 12 after stroke.
Gait quality
Gait profile score (index number in degrees (°)), calculated from the lower limbs' kinematics (3D gait analysis). A higher score means more deviation of the expected (normal) gait pattern.
Time frame: Frequency: only at week 12.
TWIST-score
TWIST gait prediction model scores will be calculated to externally validate this model.
Time frame: Within first week after stroke
Knee extension strength
Medical Research Council knee extension. Scores ranging from 0 (no muscular activity) to 5 (normal strength).
Time frame: Frequency: only during the first assessment (week 1).
Balance
Berg Balance Scale. Scores ranging from 0 (Severe balance deficits) to 56 (normal balance).
Time frame: Frequency: only during the first assessment (week 1)