Elderly Patients after Stroke Increase Skeletal Muscle Mass by Exercise Therapy in Rehabilitation Wards

Muscle mass at admission and increased muscle mass during hospitalization as predictors for improved walking function in patients with stroke

BACKGROUND & AIMS

The muscle mass at hospital admission that contributes the most to improved walking ability and the muscle mass to focus on during hospitalization have not yet been fully investigated. This study examined the effects of site-specific muscle mass measurements at admission and their increase during hospitalization on walking ability (walking independence and walking speed) of patients with cerebral infarction at discharge from the hospital.

METHODS

This study included patients with cerebral infarction aged ≥65 years. Patients were considered to be walking independently if they had a Functional Independence Measure locomotion walking score ≥6. Walking speed was evaluated using the 10-min walking test. The primary and secondary outcome measures were independent walking and walking speed, respectively.

RESULTS

The average age of the 135 participants was 77.2 years; 78 (57.8 %) were men. The multivariate logistic regression analysis demonstrated no significant association between muscle mass (at admission or its gain during hospitalization) and independent walking at discharge. However, it also revealed that the limb muscle mass index (LMI) at admission and an increase in the LMI on the paralyzed side during hospitalization were independently associated with the comfortable and fastest walking speeds.

CONCLUSION

For patients with cerebral infarction, muscle mass at admission and its increase during hospitalization were associated with walking speed, not with walking independence. These findings suggest that early assessment and targeted interventions to maintain or increase muscle mass, particularly on the paralyzed side, may benefit walking speed and mobility improvements of these patients during rehabilitation.

Redistribution of Intraspinal and Muscular 18F-FDG Uptake after the Epidural Electrical Stimulation Treatment in Spinal Cord Injury Individuals

PURPOSE

This study investigates the redistribution of resting 18F-Fluorodeoxyglucose (18F-FDG) uptake in both spinal cord and lower limb muscles following 6 months of epidural electrical stimulation (EES) treatment in spinal cord injury (SCI) individuals, examining potential implications for metabolic and functional recovery.

MATERIALS AND METHODS

A clinical trial (NCT04969042) was conducted to improve lower limb motor function using EES. Resting 18F-FDG Positron Emission Tomography-Computed Tomography (PET/CT) was performed before EES implantation and after 6 months of EES treatment. Metabolic changes were assessed in both the spinal cord and lower limb muscles.

RESULTS

After 6 months of EES treatment, the motor function of the lower limbs gradually recovers. EES can synergistically activate the muscles to form a rhythmic gait. Increased intraspinal 18F-FDG uptake was observed in the EES-implanted region, while a decrease was noted in nonstimulated segments, indicating a redistribution of spinal cord 18F-FDG uptake. In addition, muscle cross-sectional total glycolysis (TLG) increased in the lower limbs. The TLG increased by 19.84% in the psoas major, by 30.67% in the iliacus muscle, and by 9.78% in the thigh muscles.

CONCLUSIONS

EES promotes localized 18F-FDG uptake at stimulated intraspinal region and lower limb muscles, suggesting potential as a targeted metabolic intervention for motor recovery in SCI and related metabolic dysfunctions.

Relationship between skeletal muscle mass change and swallowing function improvement among stroke patients with dysphagia during rehabilitation

OBJECTIVES

The purpose of this study was to evaluate the relationship between changes in skeletal muscle mass and improvements in swallowing function in stroke patients with dysphagia during rehabilitation.

METHODS

The study included 145 patients with a stroke or dysphagia. The two groups were divided into two groups: those with improved skeletal muscle mass index (SMI) at discharge and those without. Clinical data, including SMI, and Mann Assessment of Swallowing Ability (MASA), were collected from the database.

RESULTS

The increase in MASA was significantly higher in the group with increased SMI than in the group with no increase in SMI. In the multivariate analysis, the duration of rehabilitation and the group with increased SMI were associated with increased MASA.

CONCLUSION

SMI gain and the duration of rehabilitation per day were associated with improved swallowing function in patients with stroke.

Reduced trunk muscle mass in patients with stroke is associated with reduced balance function recovery

BACKGROUND & AIMS

Skeletal muscles are essential for postural retention and balance function. However, the relationship between trunk muscle mass (TMM) and balance function has not yet been clarified. This study aimed to examine the impact of TMM on the change in balance function in patients with stroke from admission to a rehabilitation hospital to discharge.

METHODS

This retrospective observational study included patients aged ≥65 years with cerebral infarction admitted to our rehabilitation hospital from May 2018 to July 2022. The trunk muscle mass index (TMI) was calculated at admission and discharge using bioelectrical impedance analysis. Patients were divided into low and high TMI groups according to the median TMI at admission. The primary outcome was the change in the Berg Balance Scale (BBS) score (BBS score at discharge - BBS score at admission).

RESULTS

A total of 315 patients (mean age, 78.9 ± 8.0 years; 172 men and 143 women) were included. The median TMI was 7.31 kg/m2 in men and 6.30 kg/m2 in women. Among male patients, the high TMI group had higher BBS scores at admission (31.2 ± 18.2 vs. 23.4 ± 17.7, P = 0.005) and discharge (43.0 ± 15.3 vs. 33.4 ± 19.0, P < 0.001) than those in the low TMI group. After adjusting for confounding factors, TMI at admission was independently associated with the change in BBS score (β = 0.587, P = 0.002).

CONCLUSIONS

Reduced TMM negatively influences balance function recovery in patients after stroke. A strategy aimed at increasing TMM could have beneficial effects on balance function.

Low muscle mass in patients with stroke on admission reduces walking ability at discharge

BACKGROUND & AIMS

Reduced skeletal muscle mass may negatively influence postural retention and walking function. This study aimed to examine the influence of the skeletal muscle mass index on walking function in patients with stroke.

METHODS

This study included patients with cerebral infarction aged ≥65 years. The Asian Working Group for Sarcopenia's skeletal muscle mass index criteria were used to classify the participants into the low and high skeletal muscle mass index groups. The patient characteristics of the two groups were compared. The primary and secondary outcome measures were independent walking and walking speed, respectively.

RESULTS

In total, 174 participants were included. There were no significant differences in the length of hospital stay, rehabilitation volume, or functional independence measure score at discharge between the males and females. Multivariate logistic regression analysis revealed that independent walking was independently associated with the skeletal muscle mass index on admission. The SMI, as an explanatory variable, was independently associated with the comfortable and fastest walking speeds. Faster walking was associated with higher skeletal muscle mass indexes on admission for both males and females.

CONCLUSIONS

A low skeletal muscle mass index negatively influences walking function improvement in patients with stroke. A strategy aimed at increasing skeletal muscle mass can have beneficial effects on walking function in patients with stroke.

Impact of increased trunk muscle mass on trunk function and activities of daily living in older individuals with cerebral infarction

BACKGROUND & AIMS

The association between trunk muscle mass or trunk function or trunk muscle strength and activities of daily living (ADLs) has been reported, but no studies have examined the impact of increased trunk muscle mass on trunk function or ADL. This study aimed to determine whether increased trunk muscle mass is associated with trunk function and ADL in older individuals with cerebral infarction during rehabilitation.

METHODS

This retrospective observational study enrolled 158 patients with cerebral infarction aged ≥65 years who were admitted for post-stroke rehabilitation. The trunk muscle mass index (TMI) was calculated at admission and discharge using bioelectrical impedance analysis. Patients were divided into two groups: one with increased TMI (64 participants; 41 %) and the other without TMI increase (94 participants; 59 %). Multiple linear regression analysis was performed with functional assessment for control of trunk (FACT) or functional independence measure (FIM)-motor gain as the objective variable and increased TMI group as the explanatory variable.

RESULTS

We analyzed a total of 158 patients (79.5 ± 7.8 years of age, 51.9 % men). TMI increase was independently associated with FACT gain (coefficient = 1.413, 95 % confidence interval = 0.34-2.49, P = 0.010), but not with FIM-motor gain.

CONCLUSIONS

The results suggest that increased TMI is independently associated with recovery of trunk function. Further prospective studies are needed to elucidate the relationship between increased TMI and ADL.