The aim of this study is to evaluate the morphological and functional characteristics of parasternal intercostal muscles in patients with stroke using ultrasonography. Parasternal intercostal muscle thickness and thickening fraction will be assessed on both the hemiplegic and non-hemiplegic sides. The relationship between ultrasonographic findings and respiratory muscle strength, motor function, balance, functional independence, and quality of life will also be investigated. A healthy control group will be included to establish reference values and enable comparative analyses.
Age between 18 and 75 years.
History of ischemic or hemorrhagic stroke.
Ability to understand and comply with study procedures.
Provision of written informed consent.
Presence of acute or chronic pulmonary disease.
History of thoracic or abdominal surgery.
Presence of another neuromuscular disorder.
Aphasia or cognitive impairment preventing participation in assessments.
Adults with a history of ischemic or hemorrhagic stroke attending the outpatient Physical Medicine and Rehabilitation clinic of Marmara University, and age-eligible healthy volunteers recruited as controls.
Case-control
Cross-sectional
Not listed
Parasternal Intercostal Muscle Thickening Fraction (ICTf)
Ultrasonographic assessment of parasternal intercostal muscle contractility. Thickening fraction will be calculated as: (Inspiratory Thickness - Expiratory Thickness) / Expiratory Thickness × 100. Higher values indicate greater inspiratory muscle contractile activity. Comparison will be performed between the hemiplegic and non-hemiplegic sides.
Parasternal Intercostal Muscle Thickness
Ultrasonography will be used to examine the structure and function of the muscle and to measure muscle thickness at the end of inspiration and expiration.
Intercostal Muscle Asymmetry Index
Intercostal Muscle Asymmetry Index (AI) is a normalized measure of side-to-side differences in parasternal intercostal muscle contractility. The asymmetry index is calculated using the formula \|TF₁ - TF₂\| / \[(TF₁ + TF₂)/2\] × 100, where TF represents the intercostal muscle thickening fraction measured by ultrasonography. Higher values indicate greater asymmetry between the two sides, whereas lower values indicate more symmetrical intercostal muscle function.
Relative Hemiplegic Deficit
Relative Hemiplegic Deficit is a measure of the reduction in parasternal intercostal muscle contractility on the hemiplegic side relative to the non-hemiplegic side in individuals with stroke. It is calculated using the formula \[(TFnon-hemiplegic - TFhemiplegic) / TFnon-hemiplegic\] × 100, where TF represents the intercostal muscle thickening fraction measured by ultrasonography. Higher values indicate a greater functional deficit of the hemiplegic side, while lower values indicate more preserved intercostal muscle function.
Diaphragm Thickening Fraction
Diaphragm contractility assessed by ultrasonography. Thickening fraction is calculated as \[(Thickness at maximal inspiration - Thickness at end-expiration) / Thickness at end-expiration\] × 100. Higher values indicate greater diaphragm contractile function.
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