[ARTICLE] Assessing Hand Muscle Structural Modifications in Chronic Stroke – Full Text

The purpose of the study is to assess poststroke muscle structural alterations by examining muscular electrical conductivity and inherent electrophysiological properties. In particular, muscle impedance and compound muscle action potentials (CMAP) were measured from the hypothenar muscle bilaterally using the electrical impedance myography and the electrophysiological techniques, respectively. Significant changes of muscle impedance were observed in the paretic muscle compared with the contralateral side (resistance: paretic: 27.54 ± 0.97 Ω, contralateral: 25.46 ± 0.91 Ω, p < 0.05; phase angle: paretic: 8.81 ± 0.61°, contralateral: 10.79 ± 0.69°, p< 0.05). In addition, impedance changes correlated moderately with the CMAP amplitude in the paretic hand (phase angle: r = 0.66, p < 0.05; reactance: r = 0.58, p < 0.05). The study discloses significant muscle rearrangements as a result of fiber loss or atrophy, fat infiltration or impaired membrane integrity in chronic stroke.


Muscle weakness is a remarkable symptom in stroke and contributes significantly to impaired motor functions. To understand mechanisms underlying weakness, studies can focus on assessing changes in neural control and muscular properties. In particular, intramuscular electromyography (EMG) and morphological techniques have been applied to examine muscle structural rearrangements poststroke. Increased motor unit fiber density, larger and complex motor unit action potentials (13), small angular fibers, as well as fiber type grouping (45) have been observed in the acute and chronic stages of stroke suggesting the process of muscle denervation and reinnervation. While these studies characterize structural alterations in the paretic muscles, most approaches involve invasive recording and are limited by sampling only small selective areas of the muscle.

Electrical impedance myography (EIM) is an emerging technique for noninvasive evaluation of muscle electrical conductive properties. It applies weak, high-frequency alternating current to the muscles and produces raw bio-impedance data without causing neuronal and muscular depolarization (67). EIM measures three impedance parameters in terms of resistance (R), reactance (X), and phase angle [θ = arctan (X/R)] (78), which represent the inherent resistivity of skeletal muscle relative to extracellular and intracellular fluid, the integrity of cell membranes, tissue interfaces and non-ionic substances, and membrane oscillation properties of the muscle respectively (912).

Electrical impedance myography has been used to examine muscle structural alterations in a number of neuromuscular diseases including amyotrophic lateral sclerosis (ALS), muscular dystrophy, and spinal muscular atrophy (671319). It is sensitive to muscle structural modifications in terms of atrophy, increased fat infiltration or connective tissue growth (2022). In addition, the technique demonstrates strong correlations with standard measures of ALS including ALS functional rating scale-revised, handheld dynamometry, and motor unit number estimation in tracking the progression of the disease (131723).

Applications of EIM to assess poststroke muscle conditions are relatively limited in the literature. In a previous study, we examined muscle impedance properties in the biceps brachii and found significant changes of muscle structural properties in the paretic side (24). Since proximal muscles demonstrate different extents of impairment from distal muscles (25), it remains unknown whether findings from biceps brachii are applicable to hand muscles. In this study, we applied EIM technique to examine impedance changes in the hypothenar muscle poststroke. In addition, we measured the compound muscle action potentials (CMAP) of the muscle, to assess inherent electrical properties. CMAP is evoked by electrical activation of all functioning motor units and represents summation of all action potentials in spatial distribution. Application of the two different techniques to the same muscle may disclose different features of the muscle and improve current knowledge on structural changes in the paretic hand muscle.[…]


Continue —> Frontiers | Assessing Hand Muscle Structural Modifications in Chronic Stroke | Neurology

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