A Comparative Study on the Neural and Mechanical Properties of Spastic Medial Gastrocnemius Muscle before and after Twelve Months of Illness in Patients with Stroke

Document Type : Original Articles


1 PhD Candidate, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran AND Assistant Professor, Department of Physiotherapy, School of Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran

2 Professor, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Associate Professor, Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran



Introduction: Stroke is the most important cause of disability in adult people. Spasticity is a common motor disorder that develops secondary to upper motor neuron lesions such as stroke. Spasticity can cause changes in skeletal muscle, and affects both the neural and mechanical properties of skeletal muscles. The aim of this study was to compare neural and mechanical properties of spastic muscle between two groups of patients with stroke based on the duration of disease.Materials and Methods: In this study, 45 patients with stroke were divided into two groups of less and more than twelve months of stroke onset. Clinical assessment including muscle tone, achilles deep tendon reflex, and range of motion of ankle joint were measured using Modified Ashworth Scale, hammer, and goniometer, respectively. Neural properties, including H-reflex latency and Hmax/Mmax ratio, were acquired with electromyography (EMG) machine, and mechanical properties, including fascicle length, pennation angle, and muscle thickness in the spastic medial gastrocnemius muscle, were evaluated using ultrasonography instrument. To compare between two groups, we used t-test.Results: Except for the duration of the disease (P < 0.001), there were not any significant differences in others parameters between the two groups.Conclusion: The results of this study showed that there was no significant difference in neural and mechanical parameters between the patients with stroke before and after 12 months of onset.


  1. Kandel E, Kandel ER, Jessell JH, Schwartz J, Jessell T. Principles of neural science. 4th ed. New York, NY: McGraw-Hill; 2000.
  2. Foran JR, Steinman S, Barash I, Chambers HG, Lieber RL. Structural and mechanical alterations in spastic skeletal muscle. Dev Med Child Neurol 2005; 47(10): 713-7.
  3. Wissel J, Manack A, Brainin M. Toward an epidemiology of poststroke spasticity. Neurology 2013; 80(3 Suppl 2): S13-S19.
  4. Sommerfeld DK, Eek EU, Svensson AK, Holmqvist LW, von Arbin MH. Spasticity after stroke: its occurrence and association with motor impairments and activity limitations. Stroke 2004; 35(1): 134-9.
  5. Malhotra S, Pandyan AD, Rosewilliam S, Roffe C, Hermens H. Spasticity and contractures at the wrist after stroke: time course of development and their association with functional recovery of the upper limb. Clin Rehabil 2011; 25(2): 184-91.
  6. Ward AB. A literature review of the pathophysiology and onset of post-stroke spasticity. Eur J Neurol 2012; 19(1): 21-7.
  7. Mayer NH. Clinicophysiologic concepts of spasticity and motor dysfunction in adults with an upper motoneuron lesion. Muscle Nerve Suppl 1997; 6: S1-13.
  8. Lance JW. The control of muscle tone, reflexes, and movement: Robert Wartenberg Lecture. Neurology 1980; 30(12): 1303-13.
  9. Lorentzen J, Grey MJ, Geertsen SS, Biering-Sorensen F, Brunton K, Gorassini M, et al. Assessment of a portable device for the quantitative measurement of ankle joint stiffness in spastic individuals. Clin Neurophysiol 2012; 123(7): 1371-82.
  10. Galiana L, Fung J, Kearney R. Identification of intrinsic and reflex ankle stiffness components in stroke patients. Exp Brain Res 2005; 165(4): 422-34.
  11. Mirbagheri MM, Barbeau H, Ladouceur M, Kearney RE. Intrinsic and reflex stiffness in normal and spastic, spinal cord injured subjects. Exp Brain Res 2001; 141(4): 446-59.
  12. Sinkjaer T, Magnussen I. Passive, intrinsic and reflex-mediated stiffness in the ankle extensors of hemiparetic patients. Brain 1994; 117 (Pt 2): 355-63.
  13. Schieppati M. The Hoffmann reflex: a means of assessing spinal reflex excitability and its descending control in man. Prog Neurobiol 1987; 28(4): 345-76.
  14. Angel RW, Hofmann WW. The H reflex in normal, spastic, and rigid subjects. Arch Neurol 1963; 9: 591-6.
  15. Pizzi A, Carlucci G, Falsini C, Verdesca S, Grippo A. Evaluation of upper-limb spasticity after stroke: A clinical and neurophysiologic study. Arch Phys Med Rehabil 2005; 86(3): 410-5.
  16. Narici M. Human skeletal muscle architecture studied in vivo by non-invasive imaging techniques: functional significance and applications. J Electromyogr Kinesiol 1999; 9(2): 97-103.
  17. Chleboun GS, France AR, Crill MT, Braddock HK, Howell JN. In vivo measurement of fascicle length and pennation angle of the human biceps femoris muscle. Cells Tissues Organs 2001; 169(4): 401-9.
  18. Gao F, Grant TH, Roth EJ, Zhang LQ. Changes in passive mechanical properties of the gastrocnemius muscle at the muscle fascicle and joint levels in stroke survivors. Arch Phys Med Rehabil 2009; 90(5): 819-26.
  19. Chung SG, Van RE, Bai Z, Roth EJ, Zhang LQ. Biomechanic changes in passive properties of hemiplegic ankles with spastic hypertonia. Arch Phys Med Rehabil 2004; 85(10): 1638-46.
  20. Ghotbi N, Nakhostin AN, Naghdi S, Hasson S. Measurement of lower-limb muscle spasticity: intrarater reliability of Modified Modified Ashworth Scale. J Rehabil Res Dev 2011; 48(1): 83-8.
  21. Ansari NN, Naghdi S, Hasson S, Valizadeh L, Jalaie S. Validation of a Mini-Mental State Examination (MMSE) for the Persian population: a pilot study. Appl Neuropsychol 2010; 17(3): 190-5.
  22. Bakheit AM, Maynard V, Shaw S. The effects of isotonic and isokinetic muscle stretch on the excitability of the spinal alpha motor neurones in patients with muscle spasticity. Eur J Neurol 2005; 12(9): 719-24.
  23. Rezasoltani A, Namavarian N, Khalkhali Zavieh M, Tabatabaee S, Nadimi B. Gastrocnemius Muscle Variance in Women with Different Knee Alignments. Journal of Clinical Physiotherapy Research. 2016.
  24. Abe T, Fukashiro S, Harada Y, Kawamoto K. Relationship between sprint performance and muscle fascicle length in female sprinters. J Physiol Anthropol Appl Human Sci 2001; 20(2): 141-7.