Muscle-tendon Interaction in the Spastic Sural Triceps During Gait (GEcho)

This project aims to study the mechanical behavior of the muscle-tendon unit (MTU) of the gastrocnemius medialis (GM) and the Achilles tendon (AT) in post-stroke and spinal cord injured (SCI) patients compared to a healthy population, focusing on the variations in muscle and tendon length during the stance phase of the gait cycle. The primary objective is to assess the respective contributions of the GM and AT lengthening in the MTU during walking. Inclusion criteria include adult post-stroke and post-SCI patients with voluntary motor function and some walking capacity. Methods include ultrasound measurements and 3D gait analysis.

Study Overview

• Status: Completed
• Conditions: Stroke; Spinal Cord Injuries
• Intervention / Treatment: Other: Gait analysis coupled with ultrasound; Other: Isokinetic dynamometer with simultaneous ultrasound

Detailed Description

Primary Objective: Evaluate the respective contributions of the gastrocnemius medialis (GM) muscle and the Achilles tendon (AT) within the muscle-tendon unit (MTU) during the single support phase of walking in post-stroke patients compared to healthy subjects.

Study Description: Strokes often lead to spastic paresis, degrading patients' walking performance. Instrumented gait analysis allows for the evaluation of these performances to propose adapted therapeutic strategies. This project will compare muscle and tendon behavior during walking between healthy individuals and post-stroke patients.

Methodology:

• Participants: Adult post-stroke patients or incomplete SCI patients with voluntary motor function on the triceps surae and walking capacity. Control group composed of healthy adults.

• Procedures:

  • Measure the force/length profile of the GM on an isokinetic dynamometer with simultaneous ultrasound.
  • Conduct gait analysis coupled with ultrasound to measure the lengths of the AT and GM.
  • Compare muscle and tendon length data during the stance phase of the gait cycle between the two groups.

• Study Type: Observational
• Enrollment (Actual): 64

Contacts and Locations

Study Locations

• France
  • Loire Atlantique
    • Nantes, Loire Atlantique, France, 44093
      • CHU de Nantes

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Healthy subjects, post-stroke subject, SCI subjects

Description

Inclusion Criteria :

Post-Stroke Population:

• Adult male or female
• Patient who had a stroke more than 7 days ago
• Patient hospitalized (in conventional hospitalization or day hospital) in the university neurological rehabilitation department of CHU de Nantes
• Patient with voluntary motor function graded between 2 and 4 on the MRC (Medical Research Council) scale at the GM level
• Patient classified between 3 and 8 on the New Functional Ambulation Classification

Post-Spinal Cord Injury Population:

• Adult male or female
• Patient with an incomplete spinal cord injury classified as ASIA AIS C or D from level C2 to L5
• Patient hospitalized (in conventional hospitalization or day hospital) in the neurological rehabilitation department of CHU de Nantes
• Patient with voluntary motor function graded between 2 and 4 on the MRC (Medical Research Council) scale at the GM level
• Patient classified between 3 and 8 on the New Functional Ambulation Classification

Healthy Population:

• Adult male or female without any neurological disorders

Exclusion Criteria :

Post-Stroke and Post-Spinal Cord Injury Population:

• Minor patient
• History of calf surgery, surgery to reduce triceps surae spasticity, or intramuscular injection (e.g., botulinum toxin) in the plantar flexors within the last 6 months
• Patient with a progressive condition contraindicating physical exertion (e.g., syrinx, cardiovascular instability)
• Peripheral pathology of the considered lower limb

Healthy Population:

• History of calf surgery
• History of muscle injury, fracture, or sprain of the lower limb within the last 3 months
• History of neurological disorders

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Post-Stroke Patients; Patients will undergo gait analysis coupled with ultrasound to measure the lengths of the Achilles tendon and gastrocnemius medialis muscle. They will also have their force/length profile of the GM measured on an isokinetic dynamometer with simultaneous ultrasound	Other: Gait analysis coupled with ultrasound; Measure the lengths of the Achilles tendon and gastrocnemius medialis muscle; Other: Isokinetic dynamometer with simultaneous ultrasound; Measure the force/length profile of the gastrocnemius medialis muscle
Post-Spinal Cord Injury Patients; Similar to the post-stroke group, these patients will undergo gait analysis coupled with ultrasound to measure the lengths of the Achilles tendon and gastrocnemius medialis muscle. The force/length profile of the GM will also be measured on an isokinetic dynamometer with simultaneous ultrasound.	Other: Gait analysis coupled with ultrasound; Measure the lengths of the Achilles tendon and gastrocnemius medialis muscle; Other: Isokinetic dynamometer with simultaneous ultrasound; Measure the force/length profile of the gastrocnemius medialis muscle
Healthy controls; The healthy control group will undergo the same gait analysis and ultrasound measurements as the patient groups. Their force/length profile of the GM will also be measured on an isokinetic dynamometer with simultaneous ultrasound for comparison with the post-stroke and post-spinal cord injury groups.	Other: Gait analysis coupled with ultrasound; Measure the lengths of the Achilles tendon and gastrocnemius medialis muscle; Other: Isokinetic dynamometer with simultaneous ultrasound; Measure the force/length profile of the gastrocnemius medialis muscle

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Length of the Achilles Tendon (AT), Muscle Fibers of the Gastrocnemius Medialis (GM), and the Muscle GM During the Single Support Phase of Walking	This measure involves the use of ultrasound to assess the lengths of the Achilles tendon, muscle fibers of the gastrocnemius medialis, and the entire muscle GM during the single support phase of the gait cycle in post-stroke and SCI patients compared to healthy controls. The primary goal is to determine the contributions of the muscle and tendon to the overall muscle-tendon unit during walking.	1 Day

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Positioning of the Muscle Fibers on the Force-Length Curve During Different Phases of Walking	This outcome measure evaluates the positioning of the muscle fibers of the gastrocnemius medialis on the force-length curve during various phases of the gait cycle, including the single support phase and the double support phases (reception and propulsion). The measurements will be compared between post-stroke, SCI patients and healthy controls. The assessment will involve ultrasound measurements and isokinetic dynamometry to determine the force-length relationship.	1 Day

Collaborators and Investigators

• Sponsor: Nantes University Hospital
• Collaborators: Société Française de Physiothérapie (SFP).; Laboratoire Motricité, Interactions, Performance (MIP)

Study record dates

Study Major Dates

• Study Start (Actual): November 15, 2024
• Primary Completion (Actual): February 17, 2026
• Study Completion (Actual): February 17, 2026

Study Registration Dates

• First Submitted: June 19, 2024
• First Submitted That Met QC Criteria: June 19, 2024
• First Posted (Actual): June 25, 2024

Study Record Updates

• Last Update Posted (Actual): March 4, 2026
• Last Update Submitted That Met QC Criteria: March 3, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Stroke; Gait; Spinal Cord Injury; Echography
• Additional Relevant MeSH Terms: Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Wounds and Injuries; Trauma, Nervous System; Spinal Cord Diseases; Stroke; Spinal Cord Injuries; Physical Phenomena; Radiation; Radiation, Nonionizing; Ultrasonic Waves; Sound; High-Energy Shock Waves
• Other Study ID Numbers: RC24_0274; 2024-A01157-40 (Other Identifier: ANSM (IDRCB))

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No