Ann Rehabil Med.  2020 Feb;44(1):20-37. 10.5535/arm.2020.44.1.20.

Suggested Assessments for Sarcopenia in Patients With Stroke Who Can Walk Independently

• Jung HJ
• Lee YM
• Kim M
• Uhm KE
• Lee J

• KMID: 2501043
• DOI: http://doi.org/10.5535/arm.2020.44.1.20

Abstract

Objective
To investigate variables for assessment of stroke-related sarcopenia that are alternative options to the current assessment for sarcopenia, which focuses on age-related sarcopenia and also has limitations in addressing sarcopenia due to weakness resulting from stroke.
Methods
Forty patients (17 men, 23 women; mean age, 66.9±15.4 years) with first-ever stroke who can walk independently were included. Muscle mass was determined by measuring ultrasonographic muscle thickness of vastus intermedius, rectus femoris, tibialis anterior, medial gastrocnemius, and biceps brachii muscles in addition to using the skeletal muscle index (SMI) with bioelectrical impedance analysis. Muscle strength was assessed with the Medical Research Council (MRC) sum score as well as handgrip (HG) strength. Physical performance was measured by the Berg Balance Scale (BBS) along with 4-meter gait speed (4MGS). Correlations between each assessment in the three categories were analyzed and adjusted by stroke severity, comorbidity, and nutritional status.
Results
For muscle mass, SMI showed the highest correlation with the tibialis anterior muscle (r=0.783, p<0.001) among the other muscles. Regarding muscle strength, the MRC sum score correlated with the HG (r=0.660, p<0.001). For physical performance, the BBS correlated with the 4MGS (r=0.834, p<0.001). The same result was obtained after adjusting for factors of stroke severity, comorbidity, and nutritional status.
Conclusion
These results suggest that ultrasonographic muscle thickness of the tibialis anterior, the MRC sum score, and BBS might be alternatives to SMI, HG, and usual gait speed for sarcopenia in stroke patients.

Keyword

Sarcopenia; Stroke; Balance; Skeletal muscle; Ultrasonography

Figure

• 

  Fig. 1. Flowchart of patient enrollment and diagnostic flow of sarcopenia in stroke patient using Asian Working Group Sarcopenia (AWGS) cut-off value. 4MGS, 4-meter gait speed; SMI, skeletal muscle index.

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  Fig. 2. Examples of measurement sites, ultrasonography scan, and schematic structure of ultrasonography of (A) biceps brachii, (B) tibialis anterior, (C) rectus femoris and vastus intermedius, and (D) medial gastrocnemius were depicted. The dotted black lasso represents the region of target muscle. Muscle thickness is symbolized by the black arrow.

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  Fig. 3. Example of Berg Balance Scale. (A) Sit to stand, standing without support; (B) stand to sit, sitting without support; (C) transport; (D) standing with eyes closed, the Romberg test with eyes open; (E) functional reach in standing; (F) picking up something off the floor; (G) turning and looking behind; (H) a 360º turn to the right and left; (I) toe touches to a stool; (J) the sharpened Romberg; and (K) single leg stance.

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  Fig. 4. Receiver operation characteristic curves of (A) men and (B) women for ultrasonographic muscle thickness (VI, RF, TA, GCM, BB) and SMI by BIA; (C) men and (D) women for MRC sum score and maximum HG; and (E) BBS and 4MGS. The p-value represents the difference in the AUC between (A) men and women for ultrasonographic muscle thickness (VI, RF, TA, GCM, BB) and SMI by BIA; (C) men and (D) women for MRC sum score and maximum HG; and (E) BBS and 4MGS. VI, vastus intermedius; RF, rectus femoris; TA, tibialis anterior; GCM, medial gastrocnemius; BB, biceps barchii; SMI, skeletal muscle index; BIA, bioimpedance analysis; MRC, Medical Research Council; HG, handgrip strength; BBS, Berg Balance Scale; 4MGS, 4-meter gait speed; AUC, area under the curve; CI, confidence interval. *p<0.05, **p<0.01.

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