title: Relationship between ultrasonographic, electromyographic, and clinical parameters in adult stroke patients with spastic equinus: an observational study.
abstract: OBJECTIVE
  To find more accurate indices that could affect decisions in spasticity treatment by investigating the relation between ultrasonographic, electromyographic, and clinical parameters of the gastrocnemius muscle in adults with spastic equinus after stroke.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  University hospitals.
  
  
  METHODS
  Chronic patients with stroke with spastic equinus (N=43).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Ultrasonographic features were spastic gastrocnemius muscle echo intensity, muscle thickness, and posterior pennation angle of the gastrocnemius medialis (GM) and gastrocnemius lateralis (GL) in both legs. Electromyographic evaluation included compound muscle action potentials (CMAPs) recorded from the GM and GL of both legs. Clinical assessment of the spastic gastrocnemius muscle was performed with the Modified Ashworth Scale (MAS) and by measuring ankle dorsiflexion passive range of motion (PROM).
  
  
  RESULTS
  Spastic muscle echo intensity was inversely associated with proximal (GM and GL: P=.002) and distal (GM and GL: P=.001) muscle thickness, pennation angle (GM: P< .001; GL: P=.01), CMAP (GM: P=.014; GL: P=.026), and ankle PROM (GM: P=.038; GL: P=.024). The pennation angle was directly associated with the proximal (GM and GL: P< .001) and distal (GM: P=.001; GL: P< .001) muscle thickness of the spastic gastrocnemius muscle. The MAS score was directly associated with muscle echo intensity (GM: P=.039; GL: P=.027) and inversely related to the pennation angle (GM and GL: P=.001) and proximal (GM: P=.016; GL: P=.009) and distal (GL: P=.006) muscle thickness of the spastic gastrocnemius.
  
  
  CONCLUSIONS
  Increased spastic muscle echo intensity was associated with reduced muscle thickness, posterior pennation angle, and CMAP amplitude in the gastrocnemius muscle. Building on previous evidence that these instrumental features are related to botulinum toxin response, these new findings may usefully inform spasticity treatment decisions.
authors.affiliation: Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Picelli
authors.affiliation: Neurology Section, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Tamburin
authors.affiliation: Rehabilitation Unit, University Hospital, Modena, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cavazza
authors.affiliation: Rehabilitation Unit, University Hospital, Modena, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Scampoli
authors.affiliation: Motion Analysis Laboratory, San Giorgio Hospital, Ferrara, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Manca
authors.affiliation: Motion Analysis Laboratory, San Giorgio Hospital, Ferrara, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Cosma
authors.affiliation: Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Berto
authors.affiliation: Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Vallies
authors.affiliation: Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Roncari
authors.affiliation: Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.
authors.forename: Camilla
authors.initials: C
authors.lastname: Melotti
authors.affiliation: Physical Medicine and Rehabilitation, Department of Orthopedic Science, Sapienza University of Rome, Rome, Italy.
authors.forename: Valter
authors.initials: V
authors.lastname: Santilli
authors.affiliation: Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy; Neurological Rehabilitation Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. Electronic address: nicola.smania@univr.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Smania
mesh_terms: D004576:Electromyography; D004863:Equinus Deformity / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation; D014463:Ultrasonography
keywords: Electromyography; Muscle spasticity; Muscle, skeletal; Rehabilitation; Ultrasonography