200 Section - Balneotherapy-Based Multimodal Rehabilitation and Muscle Ultrasound Changes in Patients With Probable Sarcopenia: A Case Series​

Case Diagnosis: Probable sarcopenia in older adults undergoing inpatient rehabilitation, characterized by reduced anterior thigh muscle thickness and impaired muscle quality assessed by ultrasound-derived parameters.

Case Description: This case series includes 32 patients with probable sarcopenia admitted to an inpatient rehabilitation program. Sarcopenia was assessed using ultrasound measurements of anterior thigh muscle thickness (ATMT) and the STAR ratio (ATMT/BMI), applying sex-specific thresholds. Rectus femoris and vastus intermedius muscles were measured separately, with bilateral assessment performed before and after a 3-week rehabilitation program. The intervention consisted of balneotherapy-based multimodal rehabilitation, including radon baths, fango therapy, electrotherapy to the quadriceps, medical training therapy, chair-based exercises, and structured daily mobility. Ultrasound measurements were obtained using standardized musculoskeletal imaging protocols.

Discussions: This case series demonstrates that a short-term balneotherapy-based multimodal rehabilitation program was associated with improvements in ultrasound-derived muscle parameters in patients with probable sarcopenia. Increases in ATMT and STAR ratio suggest enhanced muscle mass and muscle quality following rehabilitation. Notably, rectus femoris hypertrophy was more pronounced than vastus intermedius thickening, indicating differential adaptation between superficial and deep muscle layers. This finding may reflect greater activation of superficial muscles during electrotherapy and functional exercise. Ultrasound proved to be a feasible and sensitive tool for monitoring muscle morphology changes in a rehabilitation setting. These observations support the potential role of multimodal rehabilitation in addressing sarcopenia-related muscle changes.

Conclusions: Balneotherapy-based multimodal rehabilitation was associated with measurable improvements in anterior thigh muscle thickness and muscle quality in patients with probable sarcopenia. Ultrasound assessment revealed greater hypertrophy of the rectus femoris compared with the vastus intermedius, suggesting preferential superficial muscle adaptation. Muscle ultrasound may serve as a practical method for monitoring rehabilitation-induced changes in sarcopenia. Further controlled studies are needed to confirm these findings and clarify the contribution of individual rehabilitation components.