Academic literature on the topic 'Heckmatt scale'

Aim: This study aims to investigate reliability of quantitative ultrasound measurement of the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) muscles in stroke. Materials & methods: Patients with a history of stroke were recruited. FDP and FDS muscles on both upper extremities were investigated with ultrasound. Two independent assessors acquired images and analyzed them using a program and Heckmatt scale. Results: Forty-eight patients were included. The inter-rater intraclass correlation coefficient for echo intensities was calculated as 0.91 while intrarater intraclass correlation coefficient as 0.80. For Heckmatt scale, the inter-rater reliability for FDS was Kw = 0.74 (p < 0.0005) and for FDP it was Kw = 0.73 (p < 0.0005). Mean echo intensity values showed significant strong correlations with Heckmatt scores (r = 0.663 and r = 0.633 with both p values <0.001). Conclusion: Quantitative ultrasound imaging of FDS and FDP is a reliable method to demonstrate echo intensity changes of muscles in stroke.

Abstract Objective: Ultrasound studies in inclusion body myositis (IBM) have reported a characteristic pattern of increased echointensity in the flexor digitorum profundus (FDP) with relative sparing of the flexor carpi ulnaris (FCU). We examined the relationship between echointensity of the FDP and FCU muscles and hand strength or patient-reported outcomes (PROs). Methods: A total of 15 patients with IBM were recruited. Ultrasound images of the FDP and FCU muscles were obtained by a point-of-care ultrasound and graded using the modified Heckmatt score. Hand grip and neutral pinch strength were measured by dynamometry. PROs were assessed by the IBM Upper Extremity Function Scale. Results: FDP and/or FCU modified Heckmatt score showed a significant relationship with grip, neutral pinch strength, and PROs. Conclusions: Point-of-care ultrasound examination of the forearm may serve as an extension of the neuromuscular examination. The semi-qualitative echointensity rating based on modified Heckmatt score seems to correlate well with the objective strength measurement and PROs.

Qualitative assessment by the Heckmatt scale (HS) and quantitative greyscale analysis of muscle echogenicity were compared for their value in detecting intensive care unit-acquired weakness (ICU-AW). We performed muscle ultrasound (MUS) of eight skeletal muscles on day 3 and day 10 after ICU admission. We calculated the global mean greyscale score (MGS), the global mean z-score (MZS) and the global mean Heckmatt score (MHS). Longitudinal outcome was defined by the modified Rankin scale (mRS) and Barthel index (BI) after 100 days. In total, 652 ultrasound pictures from 38 critically ill patients (18 with and 20 without ICU-AW) and 10 controls were analyzed. Patients with ICU-AW had a higher MHS on day 10 compared to patients without ICU-AW (2.6 (0.4) vs. 2.2 (0.4), p = 0.006). The MHS was superior to ROC analysis (cut-off: 2.2, AUC: 0.79, p = 0.003, sensitivity 86%, specificity 60%) in detecting ICU-AW compared to MGS and MZS on day 10. The MHS correlated with the Medical Research Council sum score (MRC-SS) (r = −0.45, p = 0.004), the mRS (r = 0.45; p = 0.007) and BI (r = −0.38, p = 0.04) on day 100. Qualitative MUS analysis seems superior to quantitative greyscale analysis of muscle echogenicity for the detection of ICU-AW.

Background/Objectives: Strokes remain a major global health concern, contributing significantly to disability and healthcare costs. Currently, there are no established indicators to accurately assess the degree of muscle tissue impairment in stroke-affected individuals. However, ultrasound imaging with an echotexture analysis shows potential as a quantitative tool to assess muscle tissue quality. This study aimed to identify specific echotexture features in the gastrocnemius medialis that effectively characterize muscle impairment in post-stroke individuals. Methods: An observational study was conducted with 22 post-stroke individuals. A total of 21 echotexture features were extracted and analyzed, including first-order metrics, a grey-level co-occurrence matrix, and a grey-level run length matrix. The modified Heckmatt scale was also applied to correlate with the most informative echotexture features. Results: Among the features analyzed, echovariation (EV), echointensity, and kurtosis emerged as the most informative indicators of muscle tissue quality. The EV was highlighted as the primary feature due to its strong and significant correlation with the modified Heckmatt scale (r = −0.81, p < 0.001) and its clinical and technical robustness. Lower EV values were associated with poorer muscle tissue quality, while higher values indicated better quality. Conclusions: The EV may be used as a quantitative indicator for characterizing the gastrocnemius medialis muscle tissue quality in post-stroke individuals, offering a more nuanced assessment than traditional qualitative scales. Future studies should investigate the correlation between the EV and other clinical outcomes and explore its potential to monitor the treatment efficacy, enhancing its applicability in clinical practice.

Background/Objectives: Ultrasound (US) imaging and echotexture analysis are emerging techniques for assessing muscle tissue quality in the post-stroke population. Clinical studies suggest that echovariation (EV) and echointensity (EI) serve as objective indicators of muscle impairment, although methodological limitations hinder their clinical translation. This secondary analysis aimed to refine the assessment of echotexture by using robust statistical techniques. Methods: A total of 130 regions of interest (ROIs) extracted from the gastrocnemius medialis of 22 post-stroke individuals were analyzed. First, inter-examiner reliability between two physiotherapists was assessed by using Cohen’s kappa for muscle impairment classification (low/high) for each echotexture feature. For each examiner, the correlation between the classification of the degree of impairment and the modified Heckmatt scale for each feature was analyzed. The dataset was then reduced to 44 ROIs (one image per leg per patient) and assessed by three physiotherapists to analyze inter-examiner reliability by using Light´s kappa and correlation between both assessment methods globally. Statistical differences in 21 echotexture features were evaluated according to the degree of muscle impairment. A binary logistic regression model was developed by using features with a Cohen’s kappa value greater than 0.9 as predictors. Results: A strong and significant degree of agreement was observed among the three examiners regarding the degree of muscle impairment (Kappalight = 0.85, p < 0.001), with nine of the 21 features showing excellent inter-examiner reliability. The correlation between muscle impairment classification with the modified Heckmatt scale was very high and significant both globally and for each echotexture feature. Significant differences (<0.05) were found for EV, EI, dissimilarity, energy, contrast, maximum likelihood, skewness, and the modified Heckmatt scale. Logistic regression highlighted dissimilarity, entropy, EV, Gray-Level Uniformity (GLU), and EI as the main predictors of muscle tissue impairment. The EV and EI models showed high explanatory power (Nagelkerke’s pseudo-R2 = 0.74 and 0.76) and robust classification performance (AUC = 94.20% and 95.45%). Conclusions: This secondary analysis confirms echotexture analysis as a reliable tool for post-stroke muscle assessment, validating EV and EI as key indicators while identifying dissimilarity, entropy, and GLU as additional relevant features.

BackgroundImmune-mediated myopathies (IMM) are a heterogeneous group of diseases characterized by inflammation and muscle weakness; among their differential diagnoses are the dysferlinopathies, which are autosomal recessive neuromuscular disorders caused by mutations in the DYSF gene that present muscle weakness and significant increase of CK, just like IMM.ObjectivesDetermine the sonographic differences between dysferlinopathies and immune-mediated myopathies and whether these allow their classification.MethodsObservational, cross-sectional, and analytical study in which we evaluated 20 muscles from 11 patients with dysferlinopathies and 11 with inflammatory myopathies according to current classification criteria. They were matched for age, sex, and time of disease evolution. Clinical and laboratory variables were analyzed. GE LOGIQTMe equipment with a 4-12 MHz linear transducer was used, and the thickness of each muscle was measured. A semiquantitative scale evaluated elementary lesions: atrophy, edema, power Doppler, and the Heckmatt scale (0-4) was calculated. Descriptive statistics were performed using measures of central tendency and dispersion according to the distribution of the variables, followed by bivariate analysis (Student’s t-test and Chi[2]test). Finally, discriminant analysis was performed to determine which ultrasound variables best predicted the diagnoses.ResultsA total of 40 muscles were evaluated, finding a greater degree of atrophy and a higher Heckmatt scale in patients with dysferlinopathies compared to MII. Discriminant analysis showed that the set of 3 muscles, Right biceps/brachialis (BB), Right quadriceps (CD), and Gastrocnemius/right soleus (GC), had a diagnostic accuracy of 100% (sensitivity 100%, specificity 100%, canonical coefficient 0.733 p=.000). We present a set of 2 formulas that allow classifying with the highest score according to the measurement of the muscles in group 1 (dysferlinopathy) or group 2 (MII). Finally, a COR analysis was performed to determine the cut-off points of each muscle to classify as dysferlinopathies.ConclusionThe study of 3 muscle groups (BB, CD, GC) presents high diagnostic accuracy to differentiate dysferlinopathies from MII, especially when there is no genetic study or antibodies available, and there is diagnostic doubt.Reference[1]Izumi R, Takahashi T, Suzuki N, Niihori T, Ono H, et al. The genetic profile of dysferlinopathy in a cohort of 209 cases: Genotype-phenotype relationship and a hotspot on the inner DysF domain. Hum Mutat. 2020; 41(9):1540-1554. doi: 10.1002/humu.24036.Table 1.Characterization of patients with dysferlinopathies and inflammatory myopathiesDysferlinopathies n=11IMM n=11General characteristics*pWomen9 (81.8%)9 (81.8%)Males2 (18.18%)2 (18.18%)Ages (years)39.54±11.2437.36±10.62.971Evolution (years)16±6.4316.55±6.25.852Manual Muscle Testing Scores [MMT8 (mean)]100 (79-112)145 (136-147).007LaboratoriesCK (mcg/L)2785.50 (1052.75-4378.75)162.00 (72.00-311.00).000LDH (U/L)289.00 (192.00-411.75)170.00 (156.00-196.00).001TGO (U/L)52.75 (42.25-71.55)25.30 (16.90-29.70).011TGP (U/L)78.30 (64.90-113.80)20.10 (15.50-28.00).016Muscle sizeBB (cm)1.67±0.632.78±0.49<0.0001CD (cm)2.70±0.843.45±0.87.046GC (cm)1.88±0.423.16±0.42<0.001Discriminant analysisFunctionFunction**CPBB7.43413.928<2.44CD-1.117-4.250<2.72GC13.48925.399<2.29Constant-18.051-52.935• Group 1: -18.051 + 7.434(B/B)-1.117(CD)+13.489(GC)• Group 2: -52.953 + 13.928(B/B)-4.250(CD)+25.399(GC)*p= <0.05; **CP: cut-off pointAcknowledgements:NIL.Disclosure of InterestsNone Declared.

The tibialis posterior muscle is a frequent target for injection of botulinum toxin during the management of spastic equinovarus foot in adults with post-stroke spasticity. Although it is deep-seated, the needle insertion into the tibialis posterior muscle is usually performed using anatomical landmarks and safety information obtained from healthy subjects and cadavers. Our aim was to evaluate the botulinum toxin injection site for the medial approach to the tibialis posterior muscle in chronic stroke patients with spastic equinovarus foot. Forty-six patients were evaluated at the affected middle lower leg medial surface with ultrasonography according to the following parameters: tibialis posterior muscle depth, thickness, and echo intensity. As to the spastic tibialis posterior, we found a mean muscle depth of 26.5 mm and a mean muscle thickness of 10.1 mm. Furthermore we observed a median tibialis posterior muscle echo intensity of 3.00 on the Heckmatt scale. The tibialis posterior muscle thickness was found to be inversely associated with its depth (p < 0.001) and echo intensity (p = 0.006). Furthermore, tibialis posterior muscle depth was found to be directly associated with its echo intensity (p = 0.004). Our findings may usefully inform manual needle placement into the tibialis posterior for the botulinum toxin treatment of spastic equinovarus foot in chronic stroke patients.