Structural Remodeling of Tibialis Anterior Muscle in Stroke

Istanbul Physical Medicine Rehabilitation Training and Research Hospital36 enrolled

Overview

This study aims to investigate the structural architectural changes of the Tibialis Anterior muscle in patients with subacute and chronic stroke using ultrasonography. The study will compare the morphological parameters (pennation angle, fascicle length, and muscle thickness) of the paretic side with the non-paretic side and analyze the relationship between these structural changes and the patients' clinical and demographic data.

Stroke is a serious neurological disease characterized by high mortality, morbidity, and disability rates. Post-stroke motor and sensory impairments significantly limit patients' independence. A common impairment is hemiparesis, specifically weakness in the paretic leg leading to reduced dorsiflexion range of motion (foot drop). It remains unclear whether this weakness stems solely from neurological impairment or also involves changes in muscle architecture. Muscle fascicle length and pennation angle are critical architectural parameters influencing force production capacity.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Stroke Tibialis Anterior Architecture

Eligibility

Sex: ALLMin age: 40 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Male and female patients aged 40-80 years. * History of ischemic or hemorrhagic Cerebrovascular Accident (CVA). * Being in the subacute or chronic phase post-stroke. * Absence of communication deficits; ability to follow verbal commands. * Voluntary agreement to participate and provision of written informed consent. * Ability to ambulate without physical assistance from another person (use of assistive devices such as leg orthoses or tripods is permitted). Exclusion Criteria: * Presence of other comorbidities affecting gait (e.g., Parkinson's disease, hip surgery, etc.). * History of dyspnea (shortness of breath) during activities of daily living within the last 6 months. * Presence of bone or joint-related pain or pathology in the spine or hips. * Presence of psychiatric or cognitive disorders (e.g., learning disabilities, mental disorders, autism, etc.). * Decompensated cardiac, renal, or hepatic failure. * Presence of malignancy.

Locations (1)

Istanbul Physical Medicine Rehabilitation Training and Research Hospital

Istanbul, Turkey (Türkiye)

Outcomes

Primary Outcomes

Pennation Angle

The Pennation Angle is the angle formed between muscle fascicles and the deep aponeurosis, serving as a critical determinant of muscle force-generating capacity. Measured via longitudinal ultrasonography on the Tibialis Anterior, this parameter quantifies structural remodeling. In stroke survivors, alterations in this angle reflect muscle atrophy and directly impact functional recovery and gait potential.

Time frame: at baseline assessment

Muscle Thickness

Muscle Thickness is defined as the perpendicular distance between the superficial and deep aponeuroses at the widest point of the muscle belly. Measured via ultrasonography on the Tibialis Anterior, it serves as a direct indicator of muscle volume. In stroke survivors, reduced thickness quantifies the extent of muscle atrophy, providing insight into the loss of contractile mass and associated weakness.

Time frame: at baseline assessment

Muscle Fascicle Length

Muscle Fascicle Length is defined as the linear distance between the superficial and deep aponeuroses along the muscle fiber path. Assessed via ultrasonography in the Tibialis Anterior, this parameter is a key determinant of muscle shortening velocity and excursion range. In post-stroke patients, shortened fascicles often indicate structural adaptations related to spasticity and reduced functional mobility.

Time frame: at baseline assessment

Secondary Outcomes

The Brunnstrom Recovery Stage

The Brunnstrom Recovery Stage is a standardized clinical tool used to evaluate motor recovery in stroke survivors. It classifies the progression of motor function into six sequential stages, ranging from flaccidity (Stage 1) to isolated, near-normal movement (Stage 6). In this study, it quantifies lower extremity motor impairment to correlate functional recovery status with the structural architectural changes observed in the Tibialis Anterior muscle.

Time frame: at baseline assessment

Data from ClinicalTrials.gov

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