PTOTSystematic ReviewEuropean journal of physical and rehabilitation medicine2023

Structural and pathophysiological muscle changes up to one year after post-stroke hemiplegia: a systematic review.

Oscar D Aze, Etienne Ojardias, Barnabé Akplogan and 2 others

PMID 37695037

WHAT IT FOUND

Muscle loss and electrical changes start within hours of stroke on the affected side, but also occur on the unaffected side.

Early rehab should target both limbs to prevent atrophy and maintain strength.

Key findings

01Structural muscle changes, including fiber atrophy and fatty infiltration, begin within the first few months post-stroke on the paretic side.

02Neuromuscular deficits, such as reduced motor unit activity, are detected on the paretic side as early as 4-30 hours after stroke onset.

03The non-paretic side also experiences significant muscle weakness and loss of lean mass, particularly in patients who do not regain ambulation.

STILL TO COME

How it was doneWhat they foundWhat it means for PTsWhat it means for OTs

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What it does not show

High heterogeneity in study designs (cross-sectional vs. longitudinal) and measurement techniques (DEXA, CT, ultrasound, biopsy) makes direct comparison of effect sizes difficult. Most studies lacked control groups or had small sample sizes, limiting the ability to separate stroke effects from general immobility or aging. The review covers changes up to one year, but long-term reversibility beyond this period is not fully characterized.

Declared interests

The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

The easy way to misread this

Do not assume that muscle loss is isolated to the affected side. The review confirms significant atrophy and weakness on the non-paretic side, particularly in patients who do not regain ambulation. Ignoring the unaffected limb in early rehab may accelerate overall functional decline.

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