Relationship Between Gastrocnemius and Soleus Muscle Thickness Assessed by Ultrasound and Balance and Fear of Falling in Hemiplegic Patients

Relationship Between Gastrocnemius and Soleus Muscle Thickness Assessed by Ultrasound and Balance and Fear of Falling in Hemiplegic Patients

Structural and functional changes occurring in the lower extremity muscles of hemiplegic stroke patients play a decisive role in gait ability, balance impairment, and fall risk. In this context, the relationship between muscle architecture parameters such as the thickness of the gastrocnemius and soleus muscles and functional performance is being investigated. Ultrasonography is a reliable and accessible method for the non-invasive assessment of muscle thickness.

Yakut et al. (2024) reported that in acute stroke patients, particularly the thickness and cross-sectional area of the soleus muscle were significantly associated with the Berg Balance Scale, Single-Leg Stance Test, and Timed Up and Go Test. In the same study, it was also shown that the thickness of the gastrocnemius muscle on the non-paretic side was related to balance.

Onat et al. (2022) demonstrated correlations between lower extremity muscle architecture and measures such as the Timed Up and Go Test, Fugl-Meyer Lower Extremity Assessment, and Functional Independence Measure, emphasizing that the gastrocnemius and soleus muscles play a determining role in motor and functional level.

Suh et al. (2022) reported that trunk muscle thickness was significantly associated with the Berg Balance Scale, Functional Ambulation Scale, and Functional Reach Test.

In this study, gastrocnemius and soleus muscle thickness will be evaluated using ultrasonography in subacute and chronic stroke patients, and their relationship with balance (Berg Balance Scale), mobility (Timed Up and Go Test and Functional Ambulation Scale), and fear of falling (Falls Efficacy Scale International) will be investigated. The study aims to provide original contributions to the literature by revealing the interaction between muscle architecture and both physical and psychosocial outcomes, and to support the development of targeted rehabilitation strategies for individuals at high risk of falling.

Inclusion Criteria:

Individuals diagnosed with hemiplegia confirmed by clinical and imaging methods Patients in the subacute-chronic phase, at least 1 month post-stroke Adults aged 18 years and older Individuals able to stand and/or walk a few steps (at least FAS ≥ 2) Individuals scoring 24 or higher on the Mini-Mental State Examination Individuals who agree to participate in the study

Exclusion Criteria:

Individuals with gait or balance limitations due to other neurological disorders Individuals unable to tolerate physical testing due to severe cardiac disease, active infection, malignancy, or other systemic diseases Patients with skin lesions or amputations preventing ultrasound assessment Individuals with a history of prior lower extremity orthopedic surgery, prosthesis use, or musculoskeletal abnormalities Individuals with cognitive or communication impairments that prevent understanding of instructions or participation Receipt of botulinum toxin injection within the last 3 months Presence of spasticity ≥ 3 on the Modified Ashworth Scale (MAS) in the muscles to be assessed