Sarcopenia in stroke-facts and numbers on muscle loss accounting for disability after stroke

The effect of sarcopenia on prognosis in patients with mild acute ischemic stroke: a prospective cohort study

BACKGROUND

Ischemic stroke is a common chronic disease worldwide and is correlated with a high disability rate. Sarcopenia is considered a key factor in the disablement process. Limited evidence of sarcopenia in acute ischemic stroke is available. The aim of this study was to investigate the effect of sarcopenia on the prognosis of patients with acute ischemic stroke.

METHODS

A prospective cohort study was conducted and included patients who were diagnosed with acute ischemic stroke between August 2020 and May 2021. A modified Poisson regression was applied to determine the relative risk (RR) for the change in modified Rankin Scale (mRS) score and allow adjustment for confounders. The modified Poisson regression was used to identify associations between sarcopenia, and multiple linear regression analyses were used to assess the effect of sarcopenia on the Barthel Index (BI) and stroke-specific quality of life (SSQOL). The generalized linear mixed model was used to investigate the effect of sarcopenia on prognosis at 1, 3 and 6 months. Cox regression proportional risk model was used to analyze the effect of sarcopenia on readmission in patients with acute ischemic stroke.

RESULTS

The prevalence of sarcopenia was 39.83% among the 118 enrolled acute ischemic stroke patients (aged 64.98 ± 11.053 years; 72.88% males). Modified Poisson regression showed that a poor prognostic outcome occurred in sarcopenia patients (relative risk [RR] = 3.021, 95% CI: 1.621-5.633; P = 0.001). Even after adjusting for confounders, sarcopenia still was a risk predictor of the increase of mRS (RR = 2.149, 95% CI: 1.045-4.420; P = 0.038). And sarcopenia was positively correlated with BI and SSQOL with or without adjustment for confounding factors (P < 0.01). Patients with sarcopenia in mild acute ischemic stroke exhibit worse prognoses compared to those without sarcopenia. (t = 3.128, P = 0.002). Cox regression risk ratio model showed that sarcopenia was a predictor of readmission within 6 months after mild ischemic stroke (hazard ratio [HR] = 3.361, 95% CI: 1.277-8.848; P = 0.014). Sarcopenia remained an independent risk factor for mild acute ischemic stroke readmission after adjusting for confounders.

CONCLUSIONS

Sarcopenia has a high prevalence in mild acute ischemic stroke patients. Sarcopenia is an independent risk factor for poor outcomes following mild acute ischemic stroke and contributes to high rates of readmission. These findings may be useful for selecting therapeutic strategies for mild acute ischemic stroke patients with sarcopenia.

Relationship between characteristics of segmental phase angles and walking ability in patients with hemiplegia after stroke and traumatic brain injury in a convalescent rehabilitation ward

This study determined the characteristics of the phase angles (PhAs) of the trunk, affected limb, and unaffected limb at admission and their relationship with walking ability at discharge in patients with stroke and traumatic brain injury in a convalescent rehabilitation ward. Stroke and traumatic brain injury survivors with hemiplegia admitted to a convalescent rehabilitation ward were divided into independent- and dependent-walking groups. The trunk, affected limb, and unaffected limb PhAs were evaluated using bioelectrical impedance analysis and compared between the independent- and dependent-walking groups. Friedman's test was performed to analyze differences in the trunk, affected limb, and unaffected limb PhAs within each group. Multiple regression was performed to examine the association between walking ability and segmental PhAs. We enrolled 47 patients (independent-walking group: n  = 12; dependent-walking group: n  = 35). The dependent-walking group had a significantly lower trunk, affected limb, and unaffected limb PhAs. The segmental PhA was higher in the trunk than in the affected and unaffected limbs in the independent-walking group and lower in the affected limb than in the trunk and unaffected limb in the dependent-walking group. Only the trunk PhA at admission was significantly associated with walking ability at discharge ( β = 0.367; P  = 0.002). The trunk PhA at admission may be related to walking ability at discharge in patients undergoing stroke and traumatic brain injury rehabilitation.

Investigating the effects of ankle foot orthoses on electromyography in impaired populations: a systematic review

PURPOSE

Despite ample evidence supporting ankle foot orthoses (AFOs) for enhancing ambulation in those with neuromuscular impairment, a prevalent belief among rehabilitation professionals is that AFO use may lead to disuse and reduced muscle activity of the lower leg. To determine the effects of AFO intervention on electromyography (EMG) activity during walking in individuals with neuromuscular impairment.

MATERIALS AND METHODS

Five databases were searched for studies that met the predefined inclusion criteria and were published any time through April 2024. AFO design characteristics, muscle groups measured, study design, experimental comparisons, and EMG parameters were extracted from each study. Methodological quality of the included studies was assessed using the modified PEDro scale.

RESULTS

Twenty studies met the inclusion criteria. AFO interventions utilized, EMG outcomes utilized, and result interpretations varied widely. In situations of hypertonicity, reduced EMG activity was deemed a positive outcome, while other studies viewed it negatively. Seven longitudinal studies found no adverse long-term impact on EMG activity.

CONCLUSION

The results of this review challenge the clinical belief that AFOs cause muscle disuse over time; however, the heterogeneity of AFO designs prevents broad statements related to which orthoses optimize muscle activity.

Prevalence and Clinical Implications of Osteosarcopenia in Patients With Acute Stroke: A Cross-sectional Study

OBJECTIVE

The aim of the study is to investigate the prevalence and risk factors of osteosarcopenia in patients with acute stroke.

DESIGN

Overall, 224 patients within 2 wks of having a stroke were enrolled. Demographic characteristics, National Institutes of Health Stroke Scale, modified Rankin Scale, modified Barthel Index, Functional Ambulation Category, Berg Balance Scale, and handgrip strength were recorded. Body composition was evaluated using dual-energy x-ray absorptiometry. Patients who met the diagnostic criteria for osteoporosis and sarcopenia were defined as having osteosarcopenia.

RESULTS

The overall prevalence of osteoporosis and sarcopenia was 46.9% and 50.9%, respectively. The prevalence of osteoporosis without sarcopenia, sarcopenia without osteoporosis, and osteosarcopenia was 18.3%, 22.3%, and 28.6%, respectively. The proportion of female sex (71.9%), median age, and National Institutes of Health Stroke Scale score were significantly higher, and modified Rankin Scale, Berg Balance Scale, modified Barthel Index, Functional Ambulation Category, and grip strength were significantly lower in patients with osteosarcopenia. Older age (≥65 yrs) (odds ratio, 15.4), female sex (odds ratio, 6.23), and lower body mass index (<25 kg/m 2 ) (odds ratio, 43.13) were independently associated with the likelihood of osteosarcopenia.

CONCLUSIONS

Osteosarcopenia may occur in acute stroke survivors. Patients with osteosarcopenia have a significantly higher stroke severity and disability. A comprehensive diagnostic approach is imperative for osteosarcopenia, thereby facilitating implementation of optimal rehabilitative strategies.

Sex difference, proteostasis and mitochondrial function impact stroke-related sarcopenia-A systematic review and meta-analysis

BACKGROUND

The prevalence of stroke-related sarcopenia has been noted; however, epidemiological data and interventions that increase or reduce the incidence of stroke-related sarcopenia remain lacking.

METHODS

Studies on stroke-related sarcopenia were included in association or interventional analyses. All analyses were performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two evaluators independently extracted the data.

RESULTS

Female stroke patients had a higher preference for sarcopenia than male patients (pooled odds ratio [OR] = 0.670, 95 % CI 0.533-0.842, p = 0.001). Although stroke patients without drug use have improved skeletal muscle mass index (SMI) (MD = 0.272, 95 % CI 0.087-0.457, p = 0.004), handgrip strength (HGS) was not significantly altered (MD = -0.068, 95 % CI -0.221-0.076, p = 0.354). Stroke patients with nutrient interventions have improved SMI (MD = -0.354, 95 % CI -0.635- -0.073, p = 0.014) and HGS (MD = -0.394, 95 % CI -0.678- -0.111, p = 0.006); the synergistic effect of rehabilitation exercise has not been ruled out. Whether a sex difference exists in these interventions remains to be investigated. The underlying pathological mechanisms and potential therapeutic strategies for this disease are discussed.

CONCLUSION

Sex difference, proteostasis, and mitochondrial function may impact the incidence of stroke-related sarcopenia. Understanding the underlying pathological mechanisms and potential therapeutic targets for this disease will provide new insights into disease treatment, prevention, and drug development.

Prevalence and Impact of Malnutrition Risk on Outcomes in Critically Ill Patients with Traumatic Brain Injury and Stroke: A Retrospective Cohort Study Using Electronic Health Records

BACKGROUND

Malnutrition is a critical concern in ICU settings. It is associated with increased morbidity and mortality, yet its prevalence and impact on clinical outcomes in patients with stroke and traumatic brain injury (TBI) remain underexplored.

OBJECTIVE

To evaluate the prevalence and impact of malnutrition risk on clinical outcomes in ICU patients with TBI, ischemic stroke, and hemorrhagic stroke, and to identify key risk factors associated with malnutrition risk.

METHODS

This retrospective cohort study utilized electronic health records encompassing ICU admissions from 2017 to 2023. Patients with either stroke or TBI were included, with malnutrition risk assessed using the prognostic nutritional index. Data were extracted and analyzed to determine patient characteristics, clinical and laboratory parameters, and outcomes.

RESULTS

This study included 1352 patients (267 TBI, 825 ischemic stroke, and 260 hemorrhagic stroke patients, >30% with pneumonia at admission). Severe malnutrition risk at admission was observed in over 60% of patients. Stroke patients, particularly those with hemorrhagic stroke, exhibited a higher risk of malnutrition compared to TBI patients. Malnutrition risk was associated with significantly higher hospital mortality and increased need for mechanical ventilation. Predictive factors for malnutrition risk included advanced age, higher SOFA scores, lower FOUR and GCS scores, and the presence of pneumonia at admission.

CONCLUSIONS

Risk of malnutrition is highly prevalent among ICU patients with TBI, ischemic, and hemorrhagic stroke, significantly impacting mortality and other clinical outcomes. Identifying and managing malnutrition early in the ICU setting is crucial for improving patient outcomes. Further prospective, multicenter studies are needed to validate these findings and develop effective interventions.

Top-Down and Bottom-Up Mechanisms of Motor Recovery Poststroke

Stroke remains a leading cause of disability. Motor recovery requires the interaction of top-down and bottom-up mechanisms, which reinforce each other. Injury to the brain initiates a biphasic neuroimmune process, which opens a window for spontaneous recovery during which the brain is particularly sensitive to activity. Physical activity during this sensitive period can lead to rapid recovery by potentiating anti-inflammatory and neuroplastic processes. On the other hand, lack of physical activity can lead to early closure of the sensitive period and downstream changes in muscles, such as sarcopenia, muscle stiffness, and reduced cardiovascular capacity, and blood flow that impede recovery.

The Influence of Body Mass Index on Outcomes in Patients Undergoing Mechanical Thrombectomy for Anterior Circulation Large Vessel Occlusion: Institutional Experience and Meta-analysis

BACKGROUND

An obesity paradox, whereby patients with higher body mass index (BMI) experience improved outcomes, has been described for ischemic stroke. It is unclear whether this applies to patients undergoing mechanical thrombectomy (MT) for large vessel occlusion (LVO).

METHODS

Mechanical thrombectomies for anterior circulation LVO between 2015 and 2021 at a single institution were reviewed. Multivariable logistic regressions were used to determine the association between BMI and favorable functional outcome (90-day modified Rankin Scale 0-2), intracranial hemorrhage, and malignant middle cerebral infarction. A systematic review was performed to identify studies reporting the effect of BMI on outcomes among patients receiving MT for LVO. The data from the systematic review were combined with the institutional data by using a random effects model.

RESULTS

The institutional cohort comprised 390 patients with a median BMI of 27 kg/m2. Most patients were obese [36.7% (BMI ≥ 30 kg/m2)], followed by overweight [30.5% (BMI ≥ 25 and < 30 kg/m2)], normal [27.9% (BMI ≥ 18.5 and < 25 kg/m2)], and underweight [4.9% (BMI < 18.5 kg/m2)]. As a continuous variable, BMI was not associated with any of the outcomes. When analyzing BMI ordinally, obesity was associated with lower odds of favorable 90-day modified Rankin Scale (odds ratio 0.42, 95% confidence interval 0.20-0.86). The systematic review identified three eligible studies comprising 1,348 patients for a total of 1,738 patients. In the random effects model, there was no association between obesity and favorable outcome (odds ratio 0.89, 95% confidence interval 0.63-1.24).

CONCLUSIONS

Obesity is not associated with favorable outcomes in patients undergoing MT for LVO.

Factors influencing the reduction in quadriceps muscle thickness in the paretic limbs of patients with acute stroke

BACKGROUND & AIMS

Muscle atrophy is an early event that occurs after stroke, but there are few reports on the changes in skeletal muscle thickness in acute stroke. This study investigated the factors contributing to reduced muscle thickness in patients with acute stroke.

METHODS

In total, 51 patients with stroke and the National Institute of the Health Stroke Scale (NIHSS) > 3 were included in our study. They were admitted to our hospital between July 2017 and May 2020. The quadriceps muscle thickness was measured with an ultrasound device within 2 days after admission and 14 days later. The collected data included age, sex, body mass index, stroke type, neuromuscular electrical stimulation, NIHSS, serum albumin at admission, start of enteral nutrition, Functional Oral Intake Scale (FOIS), start of mobilization and ambulation, number of physical and occupational therapy units, C-reactive protein at admission and whether surgery had been performed. These data were retrospectively retrieved from medical documents. A dietician calculated energy intake, protein intake, and energy adequacy. Multiple regression analysis was used to identify the factors associated with reduced quadriceps muscle thickness. The independent variables were NIHSS, date of start of enteral feeding, protein intake, FOIS, date of mobilization, and date of start of ambulation training.

RESULTS

The rate of change in quadriceps muscle thickness of the paretic limb was -15.3 % (interquartile range, -46.1-14.8 %). Multiple regression analysis showed that the factors responsible for the decrease in muscle thickness on the paretic side were FOIS (β: 0.376; 95 % Cl, 0.999 to 4.541) and the start date of ambulation (β: -0.378; 95 % Cl, -2.575 to -0.543), with a multiple correlation coefficient of 0.456.

CONCLUSION

The FOIS and the start date of ambulation after acute stroke were related to the rate of reduction in muscle thickness on the paretic side.

Biochemical, biomechanical and imaging biomarkers of ischemic stroke: Time for integrative thinking

Stroke is one of the leading causes of adult disability affecting millions of people worldwide. Post-stroke cognitive and motor impairments diminish quality of life and functional independence. There is an increased risk of having a second stroke and developing secondary conditions with long-term social and economic impacts. With increasing number of stroke incidents, shortage of medical professionals and limited budgets, health services are struggling to provide a care that can break the vicious cycle of stroke. Effective post-stroke recovery hinges on holistic, integrative and personalized care starting from improved diagnosis and treatment in clinics to continuous rehabilitation and support in the community. To improve stroke care pathways, there have been growing efforts in discovering biomarkers that can provide valuable insights into the neural, physiological and biomechanical consequences of stroke and how patients respond to new interventions. In this review paper, we aim to summarize recent biomarker discovery research focusing on three modalities (brain imaging, blood sampling and gait assessments), look at some established and forthcoming biomarkers, and discuss their usefulness and complementarity within the context of comprehensive stroke care. We also emphasize the importance of biomarker guided personalized interventions to enhance stroke treatment and post-stroke recovery.

Differences in Skeletal Muscle Fiber Characteristics Between Affected and Nonaffected Limbs in Individuals With Stroke: A Scoping Review

OBJECTIVE

The objective of this scoping review was to characterize and identify knowledge gaps about the changes in skeletal muscle fiber type proportion and cross-sectional area (CSA) after stroke.

METHODS

This scoping review followed previously proposed frameworks. A systematic search was conducted for articles examining muscle fiber type proportion and CSA in individuals with stroke in EMBASE, MEDLINE, PsycINFO, CINAHL, SPORTDiscus, and Web of Science databases from inception to December 20, 2022. Two independent authors screened and extracted the data. Results were discussed using theories proposed by the authors of the included studies.

RESULTS

Of 13 studies (115 participants), 6 (46%) were case studies or case series, 6 (46%) were cross-sectional studies, and 1 (8%) was an experimental study. Studies had small sample sizes (1-23 participants) and various muscle sampling sites (6 different muscles). All 13 studies examined muscle fiber type distributions, and 6 (46%) examined CSA. Ten (77%) studies examined differences between paretic and nonparetic muscles, and 5 (38%) compared people with stroke to people without stroke. Results from 9 of 13 studies (69%) supported a greater proportion of type II muscle fibers in the paretic limb. Of those, 4 studies (42 participants), 3 studies (17 participants), and 1 study (1 participant) saw no differences, preferential type II and type I CSA loss between limbs, respectively.

CONCLUSION

Of the limited available evidence, stroke appears to result in a shift to a higher proportion of type II muscle fibers in the paretic muscles. There are mixed results for effects on muscle fiber CSA, but there is some evidence of specific atrophy of type II muscle fibers.

IMPACT

Changes in paretic skeletal muscle fibers of individuals with stroke may explain, in part, the substantial losses in strength and power in this population. Interventions to restore type II muscle fiber size may benefit people with stroke.

Torque Onset Angle of the Knee Extensor as a Predictor of Walking Related Balance in Stroke Patients

OBJECTIVE

To investigate the relationship between the torque onset angle (TOA) of the isokinetic test for knee extensors in the paretic side and walking related balance in subacute stroke patients.

METHODS

We retrospectively reviewed patients with first-ever strokes who have had at least two isokinetic tests within 6 months of onset. 102 patients satisfied the inclusion criteria. The characteristics of walking related balance were measured with the Berg Balance Scale sub-score (sBBS), Timed Up and Go test (TUG), 10-m Walk Test (10MWT) and Functional Independence Measure sub-score (sFIM). The second isokinetic test values of the knee extensor such as peak torque, peak torque to weight ratio, hamstring/quadriceps ratio, TOA, torque stop angle, torque at 30 degrees, and peak torque asymmetry ratio between paretic and non-paretic limb were also taken into account. Pearson's correlation, simple regression and multiple regression analysis were used to analyze the correlation between TOA and walking related balance.

RESULTS

TOA of the knee extensor of the paretic limb showed significant correlations with BBS, sBBS, TUG, 10MWT, and sFIM according to Pearson's correlation analysis. TOA also had moderate to good correlations with walking related balance parameters in partial correlation analysis. In multiple regression analysis, TOA of the paretic knee extensor was significantly associated with walking related balance parameters.

CONCLUSION

This study demonstrated that TOA of the paretic knee extensor is a predictable parameter of walking related balance. Moreover, we suggest that the ability to recruit muscle quickly is important in walking related balance.

Risk factors for stroke among anthropometric indices and lipid profiles in the Korean population: a large-scale cross-sectional study

Stroke is strongly associated with death and disability. However, the associations between stroke and lipid profiles such as total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), and red blood cells (RBCs) and anthropometric indices such as waist circumference and waist-to-height ratio (WHtR) remain unclear. The objective of this study was to investigate these relationships in a Korean population. This large-scale cross-sectional study included data from 38,190 subjects collected from 2010 to 2018 by the Korea National Health and Nutrition Examination Survey (KNHANES). Simple logistic regression models and multiple logistic regression models were used to evaluate the association of stroke with lipid profiles and anthropometric indices in the crude model, adjusted Model 1, and fully adjusted Model 2. In men, stroke was negatively associated with height, weight, and hematocrit level. Total cholesterol and triglycerides were strongly negatively associated with stroke in Model 2. Creatinine level and stroke were weakly associated. Additionally, height, weight, total cholesterol, triglycerides, and hematocrit and creatinine levels were associated with stroke both before and after adjustment. In women, in Model 2, stroke was positively associated with height, weight, and creatinine level. A strong negative association was found between total cholesterol and stroke. Stroke was negatively associated with hemoglobin level, hematocrit level, and RBCs. Additionally, total cholesterol, hemoglobin level, hematocrit level, creatinine level, and RBCs were associated with stroke both before and after adjustment. Weight and height were more closely associated with stroke than waist circumference and WHtR in Korean men. Our results suggested that the association of stroke with triglycerides, height, and weight differed according to sex and that HDL-C was not associated with stroke in people of either sex.

Stroke-Related Sarcopenia among Two Different Developing Countries with Diverse Ethnic Backgrounds (Cross-National Study in Egypt and China)

The prevalence of stroke-related sarcopenia differs according to the diagnostic criteria, the cut-off point for assessment, and ethnicity. Egypt and China are developing countries with different races where no research concerning stroke-related sarcopenia has been performed yet. We aimed to evaluate the prevalence of possible sarcopenia and confirmed sarcopenia among Egyptian and Chinese stroke survivors using the Asian Working Group of Sarcopenia (AWGS-2019) criteria and to assess the variables associated with the prevalence rate. A prospective cross-sectional study was carried out among 200 Egyptian and 195 Chinese stroke survivors from 2019 to 2021 using a structural health questionnaire. A hand-held dynamometer was used to measure grip strength. Anthropometric measures were used to estimate muscle mass. Data were analyzed using SPSS statistics version 20. p-values < 0.05 were considered statistically significant. The prevalence of possible sarcopenia ranged from 20.0% to 34.4% among Egyptian and Chinese groups, except for the Egyptian females where it was 52.0%. The prevalence of sarcopenia in both populations ranged from 13.6% to 18.6%. Pre-stroke independent variables that accelerated possible sarcopenia were age, history of dyslipidemia, diabetes mellitus, and ischemic heart disease, but stroke severity was a post-stroke risk factor. Age was the only pre-stroke variable for sarcopenia, while quitting smoking and having good nutritional status were variables for the reduction of possible sarcopenia. Quitting smoking, having a good nutritional status, and early rehabilitation reduced sarcopenia development. Controlling vascular risk factors, enhancing rehabilitation, and nutritional therapy are protective measures against sarcopenia. Longitudinal studies are required to identify further risk factors.

Sarcopenia and Chronic Complications of Type 2 Diabetes Mellitus

Sarcopenia, defined as the loss of skeletal muscle mass and strength and/or a decrease in physical performance, is classically related to aging. However, chronic disease, including type 2 diabetes mellitus (T2DM), may accelerate the development of sarcopenia. Previous studies found strong association between T2DM and sarcopenia. Insulin resistance that exists in T2DM is thought to be the key mediator for impaired physical function and mobility which may lead to sarcopenia. T2DM may cause sarcopenia through the mediation of insulin resistance, inflammation, accumulation of advanced glycation end-products, and oxidative stress that may affect muscle mass and strength, protein metabolism, and vascular and mitochondrial dysfunction. On the other hand, loss of muscle in sarcopenia may play a role in the development of T2DM through the decreased production of myokines that play a role in glucose and fat metabolism. This review highlights the findings of existing literature on the relationship between T2DM and sarcopenia which emphasize the pathophysiology, chronic vascular complications, and the course of macrovascular and microvascular complications in T2DM.

The effects of nutrition supplement on rehabilitation for patients with stroke: Analysis based on 16 randomized controlled trials

BACKGROUND

Malnutrition is a relatively common and often unrecognized condition in stroke survivors, which may negatively affect functional recovery and survival. Though previous studies have indicated significant role of nutrition supplement for rehabilitation of patients with stroke, the results still remain controversy.

OBJECTIVE

The present analysis was designed to systematically review effective evidence of nutrition supplement on rehabilitation for patients with stroke.

METHODS

A systematic search of PubMed, EMBASE, the Cochrane Library, and Web of Science up to August 1, 2021 was performed to find relevant studies that analyzed the effect of nutrition supplement on rehabilitation of patients with stroke. The primary outcome was functional outcomes and activities of daily living (ADL). The secondary outcomes included disability, all-cause mortality, infections, pneumonia, walking ability, stroke recurrence, and laboratory results indicating nutrition status of patients. All statistical analyses were performed using standard statistical procedures with Review Manager 5.2.

RESULTS

Ultimately, 16 studies including 7547 patients were identified. Our pooled results found no significant difference in total, cognitive and motor FIM score between nutrition supplement and placebo groups, with pooled MDs of 7.64 (95% CI - 1.67 to 16.94; P = .11), 0.74 (95% CI - 1.33 to 2.81; P = .48), 1.11 (95% CI - 1.68 to 3.90; P = .44), respectively. However, our result showed that nutritional interventions had significant effect on ADL for patients with stroke (MD 3.26; 95% CI 0.59 to 5.93; P = .02). In addition, nutrition supplement reduced the incidence of infections for patients with stroke, with a pooled RR of 0.65 (95% CI 0.51 to 0.84; P = .0008). No significant results were found in disabilities, complication and laboratory outcomes.

CONCLUSIONS

The present meta-analysis indicated no statistically significant effect of nutrition supplement on functional outcomes as well as disabilities, complication and laboratory outcomes for patients with stroke. However, it increased ADL and reduced the incidence of infections.

Sex Differences in Functional Capacity in Older Adults With Stroke: An Analysis of Data From the National Health and Aging Trends Study

OBJECTIVE

Women experience greater disability following stroke, but biological sex differences in both overall and specific domains of functional capacity are not well understood. The primary objective of this study was to examine sex differences in overall functional capacity (Short Physical Performance Battery [SPPB] score) cross-sectionally and longitudinally over a 3-year follow-up period. The secondary objective was to determine whether sex differences exist in specific domains of functional capacity of walking speed and lower extremity functional strength.

METHODS

This study was a secondary analysis of data of individuals with stroke from the National Health and Aging Trends Study. For the cross-sectional analyses, general linear models were used to examine differences between 293 men and 427 women in SPPB, walking speed, and the 5-Times Sit-to-Stand Test (5XSST). For the longitudinal analysis, survey-weighted, multivariable-adjusted generalized linear mixed models were used to compare 3-year trajectories in SPPB scores between the sexes (87 men, 153 women).

RESULTS

Women had lower SPPB scores at baseline (difference = 0.9, linearized SE = 0.3) and over 3 years. SPPB scores declined similarly between men and women. Women had lower walking speed (difference = 0.08 m/s, SE = 0.02) as compared with men, but men and women had similar 5XSST scores (difference = 0.6 seconds, SE = 0.5).

CONCLUSION

Older women with stroke have clinically meaningfully lower overall functional capacity as compared with older men but decline at a similar rate over time. Walking speed was lower in older women with stroke, but similar between sexes in 5XSST.

IMPACT

Women with stroke have poorer functional capacity compared with men, which reinforces the importance of targeted stroke rehabilitation strategies to address these sex-specific disparities.

LAY SUMMARY

Women with stroke have poorer outcomes in terms of their ability to move around the community when compared with men. However, both men and women with stroke have similar physical functioning over time.

Association between food texture levels consumed and the prevalence of malnutrition and sarcopenia in older patients after stroke

BACKGROUND/OBJECTIVES

Texture-modified diets (TMDs) may affect nutritional status and sarcopenia in patients after stroke. This study aimed to investigate the association of food texture levels consumed by patients after stroke with the prevalence of malnutrition and sarcopenia.

SUBJECTS/METHODS

This was a two-center cross-sectional study. A total of 443 patients aged ≥65 years undergoing post-stroke rehabilitation and with oral intake in rehabilitation wards in Shizuoka prefecture and Okinawa prefecture, Japan, were included in the analysis. Food textures were categorized according to the International Dysphagia Diet Standardization Initiative (IDDSI) framework. Malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition and sarcopenia was assess by the European Working Group on Sarcopenia in Older People 2 criteria. The Cochran-Armitage trend test was used to examine the prevalence of malnutrition and sarcopenia by consumption of lower food texture levels.

RESULTS

Malnutrition and sarcopenia were diagnosed in 245 (55.3%) and 275 (62.1%) participants, respectively. Consumption of lower food texture levels was associated with a higher prevalence of malnutrition and severe malnutrition (P < 0.001 for both). In addition, consumption of lower food texture levels was associated with a higher prevalence of probable sarcopenia and sarcopenia (P < 0.001 for both). On multivariate analysis, significant associations were observed between IDDSI levels 5 (P < 0.001) and 4 (P = 0.009) and malnutrition, and between IDDSI levels 6 (P = 0.015), 5 (P = 0.033), and 4 (P = 0.015) and sarcopenia.

CONCLUSIONS

In patients with stroke, consumption of lower food texture levels categorized by the IDDSI framework was associated with a higher prevalence of malnutrition and sarcopenia.

High-Intensity Interval Training Improves Physical Function, Prevents Muscle Loss, and Modulates Macrophage-Mediated Inflammation in Skeletal Muscle of Cerebral Ischemic Mice

Although skeletal muscle is the main effector organ largely accounting for disability after stroke, considerably less attention is paid to the secondary abnormalities of stroke-related skeletal muscle loss. It is necessary to explore the mechanism of muscle atrophy after stroke and further develop effective rehabilitation strategy. Here, we evaluated the effects of high-intensity interval (HIIT) versus moderate-intensity aerobic training (MOD) on physical function, muscle mass, and stroke-related gene expression profile of skeletal muscle. After the model of middle cerebral artery occlusion (MCAO) was successfully made, the blood lactate threshold corresponding speed (S_LT) and maximum speed (S_max) were measured. Different intensity training protocols (MOD < S_LT; S_LT < HIIT < S_max) were carried out for 3 weeks beginning at 7 days after MCAO in the MOD and HIIT groups, respectively. We found that both HIIT and MOD prevented stroke-related gastrocnemius muscle mass loss in MCAO mice. HIIT was more beneficial than MOD for improvements in muscle strength, motor coordination, walking competency, and cardiorespiratory fitness. Furthermore, HIIT was superior to MOD in terms of reducing lipid accumulation, levels of IL-1β and IL-6 in paretic gastrocnemius, and improving peripheral blood CD4+/CD8+ T cell ratio, level of IL-10. Additionally, RNA-seq analysis revealed that the differentially expressed genes among HIIT, MOD, and MCAO groups were highly associated with signaling pathways involved in inflammatory response, more specifically the I-kappaB kinase/NF-kappaB signaling. Following the outcome, we further investigated the infiltrating immune cells abundant in paretic muscles. The results showed that HIIT modulated macrophage activation by downregulating CD86+ (M1 type) macrophages and upregulating CD163+ (M2 type) macrophages via inhibiting the TLR4/MyD88/NFκB signaling pathway and exerting an anti-inflammatory effect in paretic skeletal muscle. It is expected that these data will provide novel insights into the mechanisms and potential targets underlying muscle wasting in stroke.

Frailty in Stroke-A Narrated Review

This narrative review provides a summary introduction to the relationship between stroke and physical and cognitive frailty syndromes and the neuro-inflammatory similarities (including inflammaging) between the two. The review argues the potential effects of Post COVID-19 Neurological Syndrome (PCNS, also known as Long COVID) with similar pathophysiology. Many patients who have suffered from acute stroke experience long-lasting symptoms affecting several organs including fatigue, brain fog, reduced physical activity, loss of energy, and loss of cognitive reserve, culminating in the loss of independence and poor quality of life. This is very similar to the emerging reports of PCNS from different parts of the world. Stroke, particularly in older adults with comorbidities appears to impact the health and welfare of patients by reducing central neuronal input and neuromuscular function, with muscular atrophy and neuropsychiatric complications. The cumulative effects can potentially lead to a range of physical and cognitive frailty syndromes, which, in many cases may be attributed to persistent, maladapted, low grade, chronic inflammation. Meanwhile, post-COVID-19 Neurological Syndrome (also known as Long COVID Syndrome) appears to share a similar trajectory, adding further urgency for investigations into the mechanisms underlying this constellation of symptoms.

Delayed Dysphagia May Be Sarcopenic Dysphagia in Patients After Stroke

OBJECTIVE

In many cases, swallowing function is impaired after the onset of stroke and gradually improves. However, delayed dysphagia has been reported in some post-stroke patients. Recently, several studies have reported that low muscle strength and decreased muscle mass cause dysphagia. This study aimed to investigate whether these conditions are associated with delayed dysphagia after stroke.

DESIGN

A multicenter prospective observational cohort study.

SETTING AND PARTICIPANTS

Participants included 165 patients with post-stroke dysphagia (mean age 79.1 ± 8.0 years, 53.3% women) admitted to rehabilitation wards for post-stroke rehabilitation.

METHODS

Swallowing function was assessed using the Functional Oral Intake Scale. Delayed dysphagia was defined as dysphagia that occurred more than 7 days after stroke onset. We used logistic regression to examine the independent association between low muscle strength and decreased muscle mass and delayed dysphagia development. Furthermore, we examined the relationship between improvement in dysphagia and delayed dysphagia.

RESULTS

Delayed dysphagia was observed in 18 (10.9%) patients. The combination of severely low muscle strength and decreased muscle mass was independently associated with the development of delayed dysphagia (adjusted odds ratio: 4.423, 95% confidence interval: 1.400-13.974, P = .011). Delayed dysphagia had an adverse effect on the improvement of dysphagia during in-hospital rehabilitation (adjusted odds ratio: 0.278, 95% confidence interval: 0.078-0.986, P = .047).

CONCLUSIONS AND IMPLICATIONS

The development of delayed dysphagia was influenced by a combination of severely low muscle strength and decreased muscle mass. Furthermore, delayed dysphagia adversely affects the improvement of dysphagia in patients with stroke and needs to be identified early. Identifying delayed dysphagia using the methods proposed in this study and incorporating early intervention may prevent or delay dependency conditions in this population.

Ultrasound Evaluation of the Rectus Femoris for Sarcopenia in Patients with Early Subacute Stroke

We investigated the ultrasound characteristics of the rectus femoris for sarcopenia detected by dual-energy X-ray absorptiometry (DEXA) in the early subacute stroke phase. Physical features (age, sex, body mass index, and circumference of thigh) and performances (modified Barthel index in Korean, functional ambulation categories, and mini-mental state examination in Korean) were measured. The thickness of the fat layer, the thickness of the rectus femoris (TRF), echo intensity (EI), EI to TRF ratio, and strain ratio of elastography (SRE) were measured by ultrasound in 30 patients with first-ever stroke (male: n = 20). Appendicular lean body mass was measured by DEXA. Sarcopenia was defined according to the Foundation for the National Institutes of Health Sarcopenia Project. In total, 14 patients were in the sarcopenia group, and 16 were in the non-sarcopenia group. Clinical characteristics were similar between the two groups. In the sarcopenia group, TRF was significantly decreased in the paretic (p < 0.026) and non-paretic sides (p < 0.01), and the EI to TRF ratio on the paretic side was significantly increased (p < 0.049). Multivariate binary logistic regression showed that TRF on the non-paretic side was independently and significantly associated with sarcopenia (OR = 0.616, 95% CI: 0.381-0.996). The EI and SRE were not significant between the two groups. In the early subacute stroke phase, TRF on the non-paretic side is a key factor for quantitative evaluation of sarcopenia, and the EI to TRF ratio on the paretic side is also a meaningful qualitative evaluation of sarcopenia.

Irisin-Associated Neuroprotective and Rehabilitative Strategies for Stroke

Irisin, a newly discovered protein hormone that is secreted in response to low frequency whole body vibration (LFV), could be a promising post-stroke rehabilitation therapy for patients who are frail and cannot comply with regular rehabilitation therapy. Irisin is generated from a membrane-bound precursor protein fibronectin type III domain-containing protein 5 (FNDC5). Aside from being highly expressed in muscle, FNDC5 is highly expressed in the brain. The cleaved form of FNDC5 was found in the cerebrospinal fluid as well as in various regions of the brain. Numerous studies suggest that irisin plays a key role in brain metabolism and inflammation regulation. Both the metabolism and inflammation govern stroke outcome, and in a published study, we demonstrated that LFV therapy following middle cerebral artery occlusion significantly reduced innate immune response, improved motor function and infarct volume in reproductively senescent female rats. The observed effect of LFV therapy could be working via irisin, therefore, the current review focuses to understand various aspects of irisin including its mechanism of action on the brain.

Ischemic stroke-induced polyaxonal innervation at the neuromuscular junction is attenuated by robot-assisted mechanical therapy

Ischemic stroke is a leading cause of disability world-wide. Mounting evidence supports neuromuscular pathology following stroke, yet mechanisms of dysfunction and therapeutic action remain undefined. The objectives of our study were to investigate neuromuscular pathophysiology following ischemic stroke and to evaluate the therapeutic effect of Robot-Assisted Mechanical massage Therapy (RAMT) on neuromuscular junction (NMJ) morphology. Using an ischemic stroke model in male rats, we demonstrated longitudinal losses of muscle contractility and electrophysiological estimates of motor unit number in paretic hindlimb muscles within 21 days of stroke. Histological characterization demonstrated striking pre- and postsynaptic alterations at the NMJ. Stroke prompted enlargement of motor axon terminals, acetylcholine receptor (AChR) area, and motor endplate size. Paretic muscle AChRs were also more homogenously distributed across motor endplates, exhibiting fewer clusters and less fragmentation. Most interestingly, NMJs in paretic muscle exhibited increased frequency of polyaxonal innervation. This finding of increased polyaxonal innervation in stroke-affected skeletal muscle suggests that reduction of motor unit number following stroke may be a spurious artifact due to overlapping of motor units rather than losses. Furthermore, we tested the effects of RAMT - which we recently showed to improve motor function and protect against subacute myokine disturbance - and found significant attenuation of stroke-induced NMJ alterations. RAMT not only normalized the post-stroke presentation of polyaxonal innervation but also mitigated postsynaptic expansion. These findings confirm complex neuromuscular pathophysiology after stroke, provide mechanistic direction for ongoing research, and inform development of future therapeutic strategies. SIGNIFICANCE: Ischemic stroke is a leading contributor to chronic disability, and there is growing evidence that neuromuscular pathology may contribute to the impact of stroke on physical function. Following ischemic stroke in a rat model, there are progressive declines of motor unit number estimates and muscle contractility. These changes are paralleled by striking pre- and postsynaptic maladaptive changes at the neuromuscular junction, including polyaxonal innervation. When administered to paretic hindlimb muscle, Robot-Assisted Mechanical massage Therapy - previously shown to improve motor function and protect against subacute myokine disturbance - prevents stroke-induced neuromuscular junction alterations. These novel observations provide insight into the neuromuscular response to cerebral ischemia, identify peripheral mechanisms of functional disability, and present a therapeutic rehabilitation strategy with clinical relevance.

Elevated Urinary Titin and its Associated Clinical Outcomes after Acute Stroke

INTRODUCTION

Urinary titin is a biomarker of muscle atrophy, which is a serious complication after stroke. However, there are currently no clinical data regarding urinary titin in stroke patients.

METHODS

Consecutive stroke patients admitted to the stroke care unit were included. Spot urine samples were collected immediately after admission, and on days 3, 5, and 7. The primary outcome was the trend of urinary titin in patients after acute stroke. The secondary outcomes included the association between the peak urinary titin level and the modified Rankin Scale (mRS) score, the National Institutes of Health Stroke Scale (NIHSS) score, and the Barthel index (BI) upon hospital discharge. Multivariate analysis was adjusted for age, sex, NIHSS at admission, and the peak urinary titin to predict poor outcome (mRS 3-6).

RESULTS

Forty-one patients were included (29 male; age, 68 ± 15 years), 29 had ischemic stroke, 8 had intracerebral hemorrhage, and 4 had subarachnoid hemorrhage. The levels of urinary titin on days 1, 3, 5, and 7 were 9.9 (4.7-21.1), 16.2 (8.6-22.0), 8.9 (4.8-15.2), and 8.7 (3.6-16.2) pmol/mg Cr, respectively. The peak urinary titin level was associated with the mRS score (r = 0.55, p < 0.01), the NIHSS score (r = 0.72, p < 0.01), and the BI (r = -0.59, p < 0.01) upon hospital discharge. In multivariate analysis, the peak urinary titin was associated with poor outcome (p = 0.03).

CONCLUSIONS

Urinary titin rapidly increased after stroke and was associated with impaired functional outcomes at hospital discharge.

Prediction of muscle loss after stroke by analysis of corticospinal tract

INTRODUCTION

Skeletal muscle loss induces a poor rehabilitation outcome after stroke. Little is known about the usefulness of diffusion tensor tractography (DTT) findings of the corticospinal tract (CST) in terms of predicting muscle loss in affected limbs after stroke.

METHODS

This research was designed as a preliminary study. Forty-four patients, with stroke onset more than one year earlier, were recruited. DTT was performed within 7-30 days after stroke onset. The patients were classified into two groups based on the DTT findings: a DTT+ group, in which the CST was preserved, and a DTT- group, in which the CST was interrupted by the stroke lesion. Additionally, the patients' functions were evaluated based on the modified Brunnstrom classification and functional ambulation category.

RESULTS

In the DTT- group, the values of the lean tissue mass of the affected upper and lower limbs were smaller than those of the unaffected side. On the other hand, in the DTT+ group, the values of the lean tissue mass between the affected and unaffected limbs were not significantly different.

CONCLUSION

The DTT evaluation of CST at the early stage of stroke may be useful for predicting muscle loss of the affected limb at the chronic stage in stroke patients.

Preventive Effects of Repetitive Peripheral Magnetic Stimulation on Muscle Atrophy in the Paretic Lower Limb of Acute Stroke Patients: A Pilot Study

Objective:

The aim of this study was to investigate the effect of repetitive peripheral magnetic stimulation (rPMS) on muscle atrophy prevention in the rectus femoris muscle (RF) of the paretic limb in acute stroke patients.

Methods:

Twelve acute stroke patients with a National Institute of Health Stroke Scale score >5 and a motor score of the paretic lower limb >2 at admission were divided into an intervention group (rPMS: mean age, 75±6.4 years) and a conventional care group (non-rPMS: mean age, 62±11.8 years). Baseline measurements were performed within 4 days of stroke onset. In the rPMS group, treatment was applied to the paretic thigh only for 2 weeks, 5 days a week, in addition to conventional care. The cross-sectional area (CSA) of the RF was assessed in both limbs using ultrasound at baseline and 2 weeks later. Data on patient characteristics were collected from the clinical records to assess correlations with the CSA rate of change.

Results:

Patients in the rPMS group were significantly older. Although the CSA of the RF did not change significantly on either side in the rPMS group, there was a significant decrease in the CSA on the paretic side in the non-rPMS group. However, no significant difference was observed in the CSA rate of change in the rPMS and non-rPMS groups. The CSA rate of change on the paretic side correlated negatively with age in the rPMS group.

Conclusions:

Our results suggest that rPMS prevents muscle atrophy more effectively in patients in their 60s than in patients more than 70 years old.

Muscle changes after stroke and their impact on recovery: time for a paradigm shift? Review and commentary

In stroke rehabilitation there is a growing body of evidence that not all patients have the same potential to recover. Understanding the processes that give rise to the heterogeneous treatment responses in stroke survivors will lay foundations for any conceivable advance in future rehabilitation interventions. This review was set out to shine new light on the debate of biomarkers in stroke rehabilitation by linking fundamental insights from biogerontological sciences to neurorehabilitation sciences. In particular, skeletal muscle changes and inflammation are addressed as two potential constructs from which biomarkers for stroke rehabilitation can be derived. Understanding the interplay between these constructs as well as their relation to recovery could enhance stroke rehabilitation in the future. The rationale for the selection of these constructs is three-fold: first, recent stroke literature emphasizes the importance of identifying muscle wasting (also called stroke-induced muscle wasting) in stroke patients, a concept that is widely investigated in geriatrics but less in the stroke population. Second, insights from transdisciplinary research domains such as gerontology have shown that inflammation has severe catabolic effects on muscles, which may impede rehabilitation outcomes such as gait recovery. Last, it has been proven that (high-intensity) muscle strengthening exercises have strong anti-inflammatory effects in a non-stroke population. Therefore, an evidence-based rationale is presented for developing research on individual changes of muscle and inflammation after a stroke.

Sarcopenia in Hemiplegia

Sarcopenia is a disease characterized by quantitative and qualitative degeneration of the skeletal muscles and it primarily presents with a decline in the muscle strength. It frequently occurs in patients after a cerebrovascular accident due to a combination of various factors, such as the brain injury, structural adaptations, limited physical activity as long as malnutrition. Most of the articles and reviews concerning stroke-related sarcopenia are limited and usually are discussing about the factors and causes that may lead to the muscle wasting and the particular characteristics that distinguish it from age-related sarcopenia. As a result, even though sarcopenia is described as a medical entity, it appears to lack the attention that requires, limiting the maximum therapeutic effect a patient can obtain. Suggestions have been made concerning general treatment and management of sarcopenia, associated with exercise, diet and the use of medical preparations, lacking though disease-specific guidelines for management, treatment and possibly prevention of stroke-related sarcopenia. Nowadays, it is considered of major importance that the medical community should be properly informed and to raise awareness on this particular issue aiming to a better and holistic management of the patients after a cerebrovascular accident, in order to reduce morbidity and disability that both are sequelae that reduce quality of life.

Compensatory neuromuscular junction adaptations of forelimb muscles in focal cortical ischemia in rats

INTRODUCTION

Upper limb movements are affected frequently by brain ischemia (BI). Mechanisms involved in recovery and compensatory movements have developed several studies. However, less attention is given to skeletal muscles, where neuromuscular junction (NMJ) has an important role on muscle tropism and functional performance.

METHODS

Animals were divided into two groups: control (C) and BI. Then, animals were skilled to perform single-pellet retrieval task, following these procedures: habituation, shaping, and single-pellet retrieval task. BI was induced using stereotaxic surgery in order to apply endothelin-1 in motor cortex, representative of movements of dominant paw. Reaching task performance was evaluated by single-pellet retrieval task 1 day before BI induction, 4 and 15 days after BI induction. After that, biceps, triceps, fingers flexor, and extensor muscles were extracted. NMJ was assessed in morphometric characteristics (total area, total perimeter, and feret). Muscle fiber cross-sectional area and connective tissue percentage were also evaluated for characterization. Student's t test was used for comparisons between C and BI groups. Tau Kendall's correlation was applied among variables from BI group.

RESULTS

An increase in all NMJ morphometric parameters, as well as increase of atrophy and fibrosis in BI group compared with C. There was a high level of direct correlation between mean values of NMJ morphometry with percentage of success in reaching task in BI group.

CONCLUSION

Brain ischemia-induced NMJ compensatory expansion, muscle atrophy, and fibrosis in forelimb muscles that are related to reaching performance.

Prevalence and Risk Factors Governing the Loss of Muscle Function in Elderly Sarcopenia Patients: A longitudinal Study in China with 4 Years of Follow-Up

OBJECTIVES

Data regarding the occurrence of risk factors that promote the loss of muscle mass, strength and function in sarcopenia patients in elderly Chinese patients are sparse. Here, we investigated the alterations in muscle mass, function and strength in those with sarcopenia over a 4-year period. We further evaluated the risk factors leading to a loss of grip strength, gait speed and skeletal muscle mass index in sarcopenia patients.

DESIGN

A face-to-face cross-sectional survey.

SETTING AND PARTICIPANTS

The study population consisted of 560 Chinese aged over 59 years.

MEASUREMENTS

Study recordings took places over a four-year period from 2014. Muscle mass was assessed through bioelectrical impedance analysis (BIA) performed on an Inbody720, Biospace. Hand-grip strength and 6 m walking speed were used as measurements of muscle strength and function. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia criteria (AWGS).

RESULTS

In total, 474 of the elderly residents completed the follow-up. The rates of decreased ASMI, grip strength, and gait speed in the sarcopenia patients increased over the 4-year period. Following multivariate analysis, age was identified as the main risk factor for all the observed decrease, gender was specifically related to the loss of ASMI, stroke was a risk factor for gait speed and sarcopenia. A high BMI was a risk factor for a low gait speed but was protective for a loss of skeletal muscle mass and sarcopenia.

CONCLUSIONS

Age leads to a decline in muscle strength and function. In elderly Chinese patients with sarcopenia, the rates of reduced grip strength, gait-speed and sarcopenia increased. A high BMI was protective against the decline in muscle mass and sarcopenia, but represented a risk factor for low gait speed. Stoke was identified to cause a loss of gait speed in sarcopenia patients.

Effects of physical exercise on skeletal muscles of rats with cerebral ischemia

Physical exercise is a known preventive and therapeutic alternative for several cerebrovascular diseases. Therefore, the objective of the present study was to evaluate the motor performance and histomorphometry of the biceps brachii, soleus, and tibialis anterior muscles of rats submitted to a treadmill training program prior to the induction of cerebral ischemia via occlusion of the middle cerebral artery (OMCA). A total of 24 Wistar rats were distributed into four groups: Sham-Sed: sedentary control animals (n=6), who underwent sham surgery (in which OMCA did not occur); Sham+Ex: control animals exercised before the sham surgery (n=6); I-Sed: sedentary animals with cerebral ischemia (n=6); and I+Ex: animals exercised before the induction of ischemia (n=6). The physical exercise consisted of treadmill training for five weeks, 30 min/day (5 days/week), at a speed of 14 m/min. The results showed that the type-I fibers presented greater fiber area in the exercised ischemic group (I+Ex: 2347.96±202.77 µm2) compared to the other groups (Sham-Sed: 1676.46±132.21 µm2; Sham+Ex: 1647.63±191.09 µm2; I+Ex: 1566.93±185.09 µm2; P=0.0002). Our findings suggested that the angiogenesis process may have influenced muscle recovery and reduced muscle atrophy of type-I fibers in the animals that exercised before cerebral ischemia.

Sarcopenia as a predictor of activities of daily living capability in stroke patients undergoing rehabilitation

AIM

The aim of the present study was to clarify the relationship between sarcopenia, as defined by the European Working Group on Sarcopenia in Older People, and the recovery of the capability to carry out activities of daily living in convalescent stroke patients who completed a rehabilitation program.

METHODS

This retrospective study included consecutive stroke patients admitted to convalescent rehabilitation wards. To determine which patients had sarcopenia, we used the European Working Group on Sarcopenia in Older People criteria. At admission, participants were classified by either the presence or absence of sarcopenia. Baseline characteristics, including the Functional Independence Measure-motor domain score (FIM-M), were retrospectively analyzed. The primary outcome to be explained was the FIM-M at discharge. A multiple linear regression analysis was used to examine how well a sarcopenia diagnosis and various baseline characteristics could predict the FIM-M score at discharge.

RESULTS

In total, 267 participants (117 women) were included in this study. Of these, 129 (48.3%) were classified as definitely having sarcopenia. Participants with sarcopenia showed lower FIM-M at discharge than those without this condition (median 72 vs 89, P < 0.001). Multiple linear regression analyses exploring determinants of the FIM-M scores showed that a diagnosis of sarcopenia independently predicted them at discharge for men (B -4.957, 95% confidence interval -9.902--0.012), but not for women.

CONCLUSIONS

Stroke-related sarcopenia appears to be a predictor of how well male patients can engage in activities of daily living after rehabilitation. Geriatr Gerontol Int 2019; 19: 1124-1128.

The Sparthan Three-Dimensional Printed Exo-Glove: A Preliminary Evaluation of Performance Via Case Study

This paper describes the development and testing of a low-cost three-dimensional (3D) printed wearable hand exoskeleton to assist people with limited finger mobility and grip strength. The function of the presented orthosis is to support and enable light intensity activities of daily living and improve the ability to grasp and hold objects. The Sparthan Exoskeleton prototype utilizes a cable-driven design applied to individual digits with motors. The initial prototype is presented in this paper along with a preliminary evaluation of durability and performance efficacy.

Burden of Care and Quality of Life in Home Caregivers of Patients With Stroke in Iran

The purpose of this study was to investigate the relationship between Burden of Care and Quality of Life in informal home caregivers of stroke patients in Iran. Also we were trying to explore the factors that affect the burden of care. In this cross-sectional study, we have selected 62 informal home caregivers of the patients admitted to “the stroke outpatient unit of the neurology clinic” of the central hospital in Semnan province, Iran, to take part in the investigation. We interviewed them using the Caregiver Burden Inventory and SF-36 Questionnaire for assessing their quality of life. There was a negative and significant correlation between different aspects of quality of life and burden of care. In the bivariate regression model, being married and having lower levels of education (minimum years of schooling) were associated with higher levels of the burden. Our study shows that increasing burden of care in informal home caregivers reduces the quality of life in all domains. Thus, the results of this study indicate that an increase in the burden of caregiving on caregivers lowers their quality of life in all aspects; especially, caregivers who provide care to their spouses encountered more burden. Therefore, these caregivers must be in the center of interest while planning to reduce the burden of care.

Effects of Nutrition Therapy in Older Stroke Patients Undergoing Rehabilitation: A Systematic Review and Meta-Analysis

OBJECTIVE

To systematically review evidence on the effects of nutrition therapy in older stroke patients undergoing rehabilitation and identify its effectiveness using meta-analysis.

METHODS

PubMed (MEDLINE), EMBASE (via Dialog), Cochrane Central Register of Controlled Trial, World Health Organization International Clinical Trials Registry Platform and Ichu-shi Web were searched for relevant articles. Randomized controlled trials investigating the effects of nutrition therapy compared to control interventions in older stroke patients undergoing rehabilitation were considered eligible. The primary outcome was activities of daily living (ADL), and secondary outcomes were all-cause mortality, infections, pneumonia incidence, disability level, walking ability, fall, stroke recurrence, and quality of life. The risk of bias of each trial was assessed using the Cochrane Collaboration Tool, and the quality of the body of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS

Eight randomized controlled trials with a total of 5484 participants were included in the meta-analysis. The meta-analysis for ADL showed no significant effects (mean difference, 4.16; 95% confidence interval [CI], -0.88 to 9.20; I2=53%, low-quality evidence). The meta-analyses for secondary outcomes revealed a significant effect of reduced infections (risk ratio, 0.65; 95% CI, 0.51 to 0.84; I2=0%; low-quality evidence), with no significant effects on the other outcomes.

CONCLUSION

Nutrition therapy had no statistically significant effect on ADL. However, it reduced the incidence of infections. More high-quality trials are warranted to clarify the effects of nutrition therapy in older stroke patients undergoing rehabilitation.

Effects of a leucine-enriched amino acid supplement on muscle mass, muscle strength, and physical function in post-stroke patients with sarcopenia: A randomized controlled trial

OBJECTIVES

The aim of this study was to investigate the effects of a leucine-enriched amino acid supplement on muscle mass, muscle strength, and physical function in post-stroke patients with sarcopenia.

METHODS

We conducted an eight-wk, two-parallel group intervention, randomized controlled, blinded outcome assessment among 44 post-stroke older patients with sarcopenia. Sarcopenia was defined as a loss of skeletal muscle mass and decreased muscle strength according to the Asian Working Group for Sarcopenia criteria. The intervention group (n = 21) received a leucine-enriched amino acid supplement; the control group (n = 23) did not. Both groups performed low-intensity resistance training in addition to a post-stroke rehabilitation program. A primary outcome of physical function by using the motor domain of Functional Independence Measure (FIM), and secondary outcomes of appendicular muscle mass (skeletal muscle mass index [SMI]) measured via bioelectrical impedance analysis and muscle strength as handgrip strength were measured at baseline and at the end of the intervention.

RESULTS

The FIM score increased significantly in both groups over time (P < 0.01), with significantly greater improvement in the intervention group than in the control group (P < 0.045). Handgrip strength also increased significantly over time (P <0.05), with significantly greater improvement in the intervention group (P < 0.01). The SMI increased significantly in the intervention group but not in the control group over time, with significantly greater improvement in the intervention group (median estimated difference, 0.50 kg/m²; 95% confidence interval, 0.01-2.11).

CONCLUSIONS

We demonstrated that an eight-wk intervention consisting of a leucine-enriched amino acid supplementation and low-intensity resistance training increased muscle mass, strength, and physical function in post-stroke patients with sarcopenia.

Efficacy of neuromuscular electrical stimulation for preventing quadriceps muscle wasting in patients with moderate or severe acute stroke: A pilot study

BACKGROUND

Stroke-related muscle wasting is one of the factors leading to long-term disability and functional dependency. No study has reported an effective therapeutic intervention for such muscle wasting.

OBJECTIVE

The purpose of this study was to investigate the effects of neuromuscular electrical stimulation (NMES) on quadriceps muscle mass preservation in patients with acute moderate or severe stroke by using ultrasonography (US).

METHODS

Twenty patients with acute, moderate, or severe stroke (age: 68±11 years) were divided into usual care group (control group) and intervention groups (NMES group), respectively. Patients in the NMES group underwent NMES treatment for bilateral quadriceps muscles for 2 weeks in addition to the usual care. Quadriceps muscle thickness was measured on admission and 2 weeks after the first measurement.

RESULTS

The quadriceps muscle thickness on the paretic and non-paretic sides in the NMES group (-12.4% ±12.7%, -5.5% ±15.3%, respectively) significantly decreased to a lesser degree than that in the control group (-29.5% ±12.1%, P = 0.004; and -22.0% ±16.8%, P = 0.04, respectively).

CONCLUSIONS

NEMS seemed to have preserved the quadriceps muscle mass in patients with moderate or severe acute stroke.

Relationships between muscle mass, intramuscular adipose and fibrous tissues of the quadriceps, and gait independence in chronic stroke survivors: a cross-sectional study

OBJECTIVE

To examine the relationships between muscle mass, intramuscular adipose and fibrous tissues of the quadriceps, and gait independence in chronic stroke survivors.

DESIGN

Cross-sectional study.

SETTING

Hospital-based research.

PARTICIPANTS

Seventeen chronic stroke survivors who were unable to walk independently (non-independent walker group) and 11 chronic stroke survivors who were able to walk independently (independent walker group) participated in this study. In addition, 25 healthy older adults (healthy group) were enrolled.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

The muscle mass and intramuscular adipose and fibrous tissues of the rectus femoris and vastus intermedius were assessed based on muscle thickness and echo intensity of ultrasound images, respectively.

RESULTS

The thicknesses of the rectus femoris and vastus intermedius on the paretic and non-paretic sides in the non-independent walker group were significantly lower than those in the healthy group (mean difference -0.5 to -0.2cm; P<0.001-0.037). The paretic side in the non-independent walker group had significantly higher rectus femoris and vastus intermedius echo intensity compared with the healthy group (mean difference 15.8-17.4; P=0.007-0.025). The thickness of the rectus femoris on the non-paretic side was significantly lower in the independent walker group than in the healthy group (mean difference -0.3cm; P=0.001).

CONCLUSIONS

These results suggest that chronic stroke survivors who are unable to walk independently are likely to experience secondary changes in skeletal muscle on both the paretic and non-paretic sides.