Eun Sol Cho

Background: This pilot longitudinal observational study investigated 4-week changes in lower limb muscle quantity and quality in patients with subacute stroke and explored risk factors associated with these changes. Methods: Twenty-six patients with hemiplegia following subacute stroke underwent assessment at baseline and 4-week follow-up. Muscle quantity was evaluated by ultrasound muscle thickness and bioelectrical impedance analysis, while muscle quality was assessed by shear-wave elastography in seven muscles (rectus femoris, vastus intermedius, vastus lateralis [VL], vastus medialis, tibialis anterior, gastrocnemius [GCM], and soleus). Electrophysiological assessments included motor-evoked potential (MEP), somatosensory-evoked potential (SEP), nerve conduction studies (NCSs), and central motor conduction time (CMCT). Results: Muscle thickness and bioimpedance did not significantly change between baseline and follow-up. In contrast, shear modulus increased in the paretic-side VL and GCM muscles (p < 0.001 and p = 0.049), with no differences in the non-paretic side. Greater deterioration in GCM quality was observed in patients with abnormal lower-limb MEP, and increased VL stiffness correlated with prolonged CMCT. Multivariable analyses were performed adjusting for age, sex, National Institutes of Health Stroke Scale, and comorbidity burden; however, due to the small electrophysiology sample (n = 11), these results should be interpreted as exploratory. Conclusions: In subacute stroke, early deterioration in muscle quality can occur despite stable quantity and appears linked to corticospinal integrity. Integrating electrophysiological evaluation with elastography may help identify patients who could benefit from early, targeted neuromuscular rehabilitation. These exploratory findings require validation in larger cohorts.

Vertebral arteriovenous fistula (VAVF) is a rare lesion characterized by an abnormal connection between the extracranial vertebral artery and the surrounding venous plexus. It typically arises due to penetrating injury, although it can occasionally result from blunt trauma. Brachial plexus injury (BPI) is also infrequently associated with VAVF. We present a rare case of VAVF caused by blunt trauma, which resulted in BPI. The patient, who had previously sustained a C2 fracture and C2–3 myelopathy from a bicycle accident, presented with new-onset weakness in the right upper extremity. His previous clinical history led to an initial suspicion of either an exacerbation of a pre-existing lesion or a shoulder injury. However, electromyography indicated that the weakness was due to BPI. Further evaluations later revealed VAVF to be the primary cause of the BPI. VAVF must be recognized as a rare potential reason for BPI, as timely intervention is essential for improving patient recovery and prognosis.

Objective: To analyze the changes in muscle mass and quality with time on the paretic and non-paretic sides in subacute stroke patients and identify correlations between the variation of muscle mass and quality and lower limb functions.Methods: Thirty hemiplegia patients diagnosed with stroke participated in this study. To evaluate poststroke muscle changes, longitudinal measurement of muscle mass and quality was conducted with bilateral lower limbs. The elastic shear modulus was measured using shear wave elastography and muscle thickness (MT) of rectus femoris, vastus intermedius, vastus lateralis (VL), vastus medialis, tibialis anterior, and gastrocnemius (GCM) muscles. Functional evaluation was performed using Berg Balance Scale (BBS), Five Times Sit to Stand Test (FTSST). Follow-up was performed at discharge. The muscle mass and quality were compared according to time. We analyzed whether muscle quantity and quality were related to function.Results: MT demonstrated no significant change with time. The elastic shear modulus increased significantly in the paretic VL and GCM muscles and did not change significantly in the muscles on the non-paretic side. Correlation analysis detected that elastic shear modulus in the VL has a cross-sectional negative relationship between BBS and positive relationship between FTSST. There were significant correlation between variation of FTSST and the variation of the elastic shear modulus in VL.Conclusion: Only paretic VL and GCM muscle quality changed in subacute stroke patients and muscle’s property related to lower limb functions. Therefore, the lower extremity requires an approach to muscle quality rather than quantity for subacute stroke patients.

This study aimed to evaluate the effect of a horse-riding simulator (HRS) with virtual reality (VR) on gross motor function, balance control, and body composition in children with spastic cerebral palsy (CP). Seventeen preschool and school-aged children with spastic CP were included; 10 children in the intervention group (HRS group) received 30 min of HRS with VR training twice a week for a total of 16 sessions in addition to conventional physiotherapy. Seven children in the control group were instructed to perform home-based aerobic exercises twice a week for 8 weeks in addition to conventional physiotherapy. Gross motor function measure (GMFM) and body composition were evaluated before the first session and after the last session. Before and after the 2-month intervention, Pediatric Balance Scale and Timed Up and Go test were evaluated for the HRS group. GMFM scores and body composition changed significantly in the HRS group (p < 0.05). However, no significant differences were observed in the control group. Changes in the GMFM total scores, GMFM dimension D scores, and skeletal muscle mass significantly differed between the HRS and control groups (p < 0.05). HRS with VR may be an effective adjunctive therapeutic approach for the rehabilitation of children with CP.

Background: Deterioration in upper extremity function has been a common problem among children with cerebral palsy (CP). The present study evaluated the effects of virtual reality (VR)-based rehabilitation combined with conventional occupational therapy (COT) on upper extremity function and caregiver assistance among children with CP. Methods: Medical records of 17 children with CP who regularly participated in a rehabilitation program at Samsung Changwon Hospital were retrospectively reviewed. Ten children received VR-based rehabilitation, which utilized RAPAEL Smart Kids and video games combined with COT. Seven children received COT alone, which was provided by a trained occupational therapist and focused on their upper extremities. Clinical outcomes were determined using the Quality of Upper Extremity Skills Test (QUEST) and Pediatric Evaluation of Disability Inventory (PEDI), which were administered before and 8 weeks after the first intervention session. Results: The smart glove (SG) group showed significant improvements in all QUEST domains and five PEDI domains (p < 0.05), whereas the COT group showed a significant change only in total QUEST scores. A comparison between both groups revealed that the SG group had significantly greater improvements in five QUEST domains and two PEDI domains (p < 0.05). Conclusions: Our results suggest that VR-based rehabilitation combined with COT may improve the upper extremity functions and decrease caregiver burden among children with CP.

Song YH, et al. Ann Rehabil Med. 2018 Apr;42(2):296-304. https://doi.org/10.5535/arm.2018.42.2.296