Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
An Investigation of the Stiffness and Thickness of Abdominal Muscles in Early/Mild Stage Multiple Sclerosis Patients: A Primary Study
Erken/Hafif Evre Multipl Skleroz Hastalarında Karın Kasları Sertliğinin ve Kalınlığının Araştırılması: Birincil Çalışma
Nezehat Özgül ÜNLÜERa, Seval YILMAZb, Serkan TAŞc, Alp ÇETİNd
aDepartment of Physiotherapy and Rehabilitation, Ankara Yıldırım Beyazıt University Faculty of Health Sciences, Ankara, TURKEY
bDepartment of Physiotherapy and Rehabilitation, Yalova University Faculty of Health Sciences, Yalova, TURKEY
cDepartment of Physiotherapy and Rehabilitation, Toros University Faculty of Health Sciences, Mersin, TURKEY
dDepartment of Physical Medicine and Rehabilitation, Hacettepe University Faculty of Medicine, Ankara, TURKEY
Turkiye Klinikleri J Health Sci. 2021;6(1):88-93
doi: 10.5336/healthsci.2020-75198
Article Language: EN
Full Text
ABSTRACT
Objective: Loss of strength in abdominal muscles causes functional problems. Morphological features such as thickness and stiffness of the muscle give an idea about muscle strength. The morphological features of the abdominal muscles of early/mild multiple sclerosis (MS) patients are unknown. The study aimed to compare the thickness and stiffness of the abdominal muscles of early/mild MS patients with healthy individuals. Material and Methods: Seventeen patients with MS between the ages of 19-56 years and 17 healthy individuals between the ages of 22-50 years participated in this study. The disability level was determined by the Expanded Disability Status Scale. Thickness and stiffness of lateral abdominal muscles consisting of external oblique (EO), internal oblique (IO) and transversus abdominis (TrA) muscles were evaluated with ACUSON S3000 (Siemens Medical Solution, Mountain Wiew, CA, USA) ultrasonography device using linear ultrasonography probe (9L4, 4-9 MHz). The stiffness measurements of the muscles were evaluated by shear wave elastography (SWE) method. Results: The thickness of the IO (p=0.892), EO (p=0.260), and TrA (p=0.865) muscles were similar in both groups. In addition, IO (p=0.317), EO (p=0.357), TrA (p=0.573) muscle stiffness were found to be similar in both groups. Conclusion: In early / mild MS patients, the thickness and stiffness of the IO, EO and TrA muscles were similar to healthy individuals. There was no change in the morphological features of the lateral abdominal muscles of early/mild MS patients.

Keywords: Multiple sclerosis; abdominal muscles; thickness; stiffness; ultrasound; shear wave elastography
ÖZET
Amaç: Abdominal kaslarda görülen kuvvet kaybı fonksiyonel problemlere neden olmaktadır. Kasın kalınlığı ve sertliği gibi morfolojik özellikleri kas kuvveti ile ilgili fikir vermektedir. Erken/hafif evre multiple skleroz (MS) hastalarının abdominal kaslarının morfolojik özellikleri bilinmemektedir. Bu çalışmanın amacı, erken/hafif evre MS hastalarının karın kaslarının kalınlık ve sertliğini sağlıklı bireylerle karşılaştırmaktır. Gereç ve Yöntemler: Bu çalışmaya, 19-56 yaş aralığında 17 MS hastası ve 22-50 yaş aralığında 17 sağlıklı birey katıldı. MS hastalarının özür düzeyi Genişletilmiş Engellilik Durum Ölçeği ile belirlendi. Eksternal oblik (EO), internal oblik (IO) ve transversus abdominis (TrA) kaslarından oluşan lateral abdominal kasların kalınlığı ve sertliği ACUSON S3000 (Siemens Medical Solution, Mountain Wiew, CA, USA) ultrasonografi cihazı ile lineer ultrasonografi probu (9L4, 4-9 MHz) kullanılarak değerlendirildi. Lateral abdominal kasların sertlik ölçümleri shear wave elastografi yöntemi ile değerlendirildi. Bulgular: Her iki grupta IO (p=0.892), EO (p=0.260), and TrA (p=0.865) kaslarının kalınlığı benzerdi. Ayrıca, her iki grupta IO (p=0.317), EO (p=0.357), TrA (p=0.573) kas sertliğinin de benzer olduğu bulundu. Sonuç: Erken/hafif evre MS hastalarında, IO, EO ve TrA kaslarının kalınlığı ve sertliği sağlıklı bireylerle benzerdi. Erken/hafif evre MS hastalarının lateral abdominal kaslarının morfolojik özelliklerinde değişim olmadığı tespit edildi.

Anahtar Kelimeler: Multiple skleroz; abdominal kaslar; kalınlık; sertlik; ultrason; shear wave elastografi
REFERENCES:
  1. O'Connor P; Canadian Multiple Sclerosis Working Group. Key issues in the diagnosis and treatment of multiple sclerosis. An overview. Neurology. 2002;59(6 Suppl 3):S1-33.[Crossref] [PubMed] 
  2. Akuthota V, Nadler SF. Core strengthening. Arch Phys Med Rehabil. 2004;85(3 Suppl 1):S86-92.[Crossref] [PubMed] 
  3. Verheyden G, Nieuwboer A, Mertin J, Preger R, Kiekens C, De Weerdt W, et al. The Trunk Impairment Scale: a new tool to measure motor impairment of the trunk after stroke. Clin Rehabil. 2004;18(3):326-34.[Crossref] [PubMed] 
  4. Lanzetta D, Cattaneo D, Pellegatta D, Cardini R. Trunk control in unstable sitting posture during functional activities in healthy subjects and patients with multiple sclerosis. Arch Phys Med Rehabil. 2004;85(2):279-83.[Crossref] [PubMed] 
  5. Cholewicki J, Panjabi MM, Khachatryan A. Stabilizing function of trunk flexor-extensor muscles around a neutral spine posture. Spine (Phila Pa 1976). 1997;22(19):2207-12.[Crossref] [PubMed] 
  6. Ebenbichler GR, Oddsson LI, Kollmitzer J, Erim Z. Sensory-motor control of the lower back: implications for rehabilitation. Med Sci Sports Exerc. 2001;33(11):1889-98.[Crossref] [PubMed] 
  7. Taş S, Onur MR, Yılmaz S, Soylu AR, Korkusuz F. Shear Wave Elastography Is a Reliable and Repeatable Method for Measuring the Elastic Modulus of the Rectus Femoris Muscle and Patellar Tendon. J Ultrasound Med. 2017;36(3):565-70.[Crossref] [PubMed] 
  8. Miyamoto N, Hirata K, Kanehisa H, Yoshitake Y. Validity of measurement of shear modulus by ultrasound shear wave elastography in human pennate muscle. PLoS One. 2015;10(4):e0124311.[Crossref] [PubMed] [PMC] 
  9. Stetts DM, Freund JE, Allison SC, Carpenter G. A rehabilitative ultrasound imaging investigation of lateral abdominal muscle thickness in healthy aging adults. J Geriatr Phys Ther. 2009;32(2):60-6. Erratum in: J Geriatr Phys Ther. 2009;32(3):110.[Crossref] [PubMed] 
  10. Sions JM, Teyhen DS, Hicks GE. Criterion Validity of Ultrasound Imaging: Assessment of Multifidi Cross-Sectional Area in Older Adults With and Without Chronic Low Back Pain. J Geriatr Phys Ther. 2017;40(2):74-9.[Crossref] [PubMed] [PMC] 
  11. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983;33(11):1444-52.[Crossref] [PubMed] 
  12. Hirayama K, Akagi R, Moniwa Y, Okada J, Takahashi H. TRANSVERSUS ABDOMINIS ELASTICITY DURING VARIOUS EXERCISES: A SHEAR WAVE ULTRASOUND ELASTOGRAPHY STUDY. Int J Sports Phys Ther. 2017;12(4):601-6.[PubMed] [PMC] 
  13. Pinto RZ, Ferreira PH, Franco MR, Ferreira MC, Ferreira ML, Teixeira-Salmela LF, et al. The effect of lumbar posture on abdominal muscle thickness during an isometric leg task in people with and without non-specific low back pain. Man Ther. 2011;16(6):578-84.[Crossref] [PubMed] 
  14. Linek P, Saulicz E, Wolny T, Myśliwiec A. Reliability of B-mode sonography of the abdominal muscles in healthy adolescents in different body positions. J Ultrasound Med. 2014;33(6):1049-56.[Crossref] [PubMed] 
  15. Wilson A, Hides JA, Blizzard L, Callisaya M, Cooper A, Srikanth VK, et al. Measuring ultrasound images of abdominal and lumbar multifidus muscles in older adults: A reliability study. Man Ther. 2016;23:114-9.[Crossref] [PubMed] 
  16. Rankin G, Stokes M, Newham DJ. Abdominal muscle size and symmetry in normal subjects. Muscle Nerve. 2006;34(3):320-6.[Crossref] [PubMed] 
  17. Freund JE, Stetts DM, Vallabhajosula S. Relationships between trunk performance, gait and postural control in persons with multiple sclerosis. NeuroRehabilitation. 2016;39(2):305-17.[Crossref] [PubMed] 
  18. Ikezoe T, Mori N, Nakamura M, Ichihashi N. Effects of age and inactivity due to prolonged bed rest on atrophy of trunk muscles. Eur J Appl Physiol. 2012;112(1):43-8.[Crossref] [PubMed] 
  19. Yoosefinejad AK, Motealleh A, Khademi S, Hosseini SF. Lower Endurance and Strength of Core Muscles in Patients with Multiple Sclerosis. Int J MS Care. 2017;19(2):100-4.[Crossref] [PubMed] [PMC] 
  20. David P, Mora I, Pérot C. Neuromuscular efficiency of the rectus abdominis differs with gender and sport practice. J Strength Cond Res. 2008;22(6):1855-61.[Crossref] [PubMed] 
  21. Hodges PW, Richardson CA. Transversus abdominis and the superficial abdominal muscles are controlled independently in a postural task. Neurosci Lett. 1999;265(2):91-4.[Crossref] [PubMed] 
  22. Linek P, Wolny T, Sikora D, Klepek A. Supersonic Shear Imaging for Quantification of Lateral Abdominal Muscle Shear Modulus in Pediatric Population with Scoliosis: A Reliability and Agreement Study. Ultrasound Med Biol. 2019;45(7):1551-61.[Crossref] [PubMed] 
  23. Linek P, Wolny T, Myśliwiec A, Klepek A. Shear wave elastography for assessing lateral abdominal muscles in thoracolumbar scoliosis: A preliminary study. Biomed Mater Eng. 2020;31(2):131-42.[Crossref] [PubMed] 
  24. Tran D, Podwojewski F, Beillas P, Ottenio M, Voirin D, Turquier F, et al. Abdominal wall muscle elasticity and abdomen local stiffness on healthy volunteers during various physiological activities. J Mech Behav Biomed Mater. 2016;60:451-9.[Crossref] [PubMed] 
  25. Lieber RL, Ward SR. Cellular mechanisms of tissue fibrosis. 4. Structural and functional consequences of skeletal muscle fibrosis. Am J Physiol Cell Physiol. 2013;305(3):C241-52.[Crossref] [PubMed] [PMC] 
  26. Linek P, Saulicz E, Wolny T, Myśliwiec A. Intra-rater reliability of B-mode ultrasound imaging of the abdominal muscles in healthy adolescents during the active straight leg raise test. PM R. 2015;7(1):53-9.[Crossref] [PubMed] 
  27. Linek P. The importance of body mass normalisation for ultrasound measurements of the morphology of oblique abdominis muscles: the effect of age, gender, and sport practice. Folia Morphol (Warsz). 2018;77(1):123-30.[Crossref] [PubMed] 

.: Up To Date

Login



Contact


Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com