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I. INTRODUCTION The Myotonometer measures force-displacement characteristics of muscle and other tissues located beneath the measuring probe. The force applied by the user with the probe is perpendicular to the muscle. Myotonometric measurements obtained during a muscle contraction are able to quantify strength because muscle stiffness increases proportionally to muscle activation and torque production. “Tone,” “compliance,” “hardness,” and “stiffness” are all terms associated with forcedisplacement or length-tension muscle characteristics. Preferred terminology differs among clinicians, scientists and engineers. measurements. Muscle “compliance” is an intrinsic property of muscle in which tension within the muscle increases during lengthening without a change in the neural drive to the muscle. “Stiffness” is the magnitude of force necessary to cause tissue displacement (the inverse of compliance). “Tone” is defined clinically as a muscle’s resistance to passive stretch. Muscle tone reflects the Following are definitions of terms associated with myotonometric

relative influences of the mechanical-elastic characteristics of muscular and connective tissues, and the reflexive drive to the muscle. “Hypertonia,” an excessive resistance to passive stretch, is one characteristic of spasticity. “Hypotonia” accompanies other medical disorders and diseases. “Spasticity” is a motor disorder characterized by velocity-dependent hypertonia and accentuated tendon reflexes. “Spastic Paresis” typically infers the presence of spasticity and associated positive and negative sensorimotor phenomena. paresis (weakness). Among the negative phenomena associated with spasticity is muscle

For reading ease, the manual will use the term "tone" rather than compliance, stiffness, or hardness.

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The Myotonometer was developed to quantify muscle tone and paresis. Protocols also permit quantification of the level of severity of the spastic paretic condition. Valid and reliable quantifiable measures of muscle tone are obtained easily and quickly. post injury) and quantify muscle imbalances. Clinical trials have shown that myotonometric measurements can distinguish between injured and non-injured muscles (even years The Myotonometer can also quantify differences Intra- and inter-rater reliabilities are between individuals with upper motor neuron involvement from non-disabled individuals as well as distinguishing between ipsi- and contra-lesional extremities. extremely high. Measurements of muscle strength/paresis correlate very well with surface

electromyography (EMG) and joint torque outputs. A summary of these results and a publication list are available on our website, www.neurogenic.com. The Myotonometer assesses the amount of resistance a muscle exerts against a probe as the probe is pushed in a direction perpendicular to the muscle fibers. The amount of resistance is directly proportional to muscle tone. Figure 1 shows the general operation of the probe. The probe is the mechanical part of the Myotonometer and sends information pertaining to force and tissue displacement to the computer. (1) Inner probe (2) Plexiglas collar (3) Inner shaft (4) Handle. The user grasps the handle and applies downward pressure perpendicular to the muscle. As pressure is applied, the inner probe pushes into the muscle whereas the Plexiglas collar remains relatively motionless on the skin surface. Specialized transducers monitor ongoing pressure changes with the accompanying changes in displacement between the inner probe (1) and outer

Рис. Fig.1 1

collar (2).

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Figure 2 shows, schematically, the relationship between tissue displacement and its tension/elasticity. The tissue to be measured consists of the skin layer (s), the muscle (m), and bone (b) (Fig.2A). The User, by applying downward pressure with the Myotonometer, compresses the underlying tissues. The depth of penetration (L) (the difference in displacement between the inner probe and the external Plexiglas collar) is measured at pre-programmed force levels (selected by the User; see section 3.1.7) (Fig. 2B). An activated/contracted muscle, which has higher tone than a relaxed muscle would be characterized by a steep slope when plotted on a length-tension curve (1) because it provides more resistance to the pressure of the probe. In contrast, a relaxed muscle would be characterized by gently sloping curve or a curve that "shifts to the right" (Fig. 2C). Fig. 2 kg

mm A B C

The Myotonometer is programmed to take 8 length-tension measurements per recording. default setting = force levels from 0 to 2.0 kg in steps of .25 kg.

The

...............………………………………………………………….............15 in "off" mode……….....4 II......…………………….…………………………………………………………........6 GB screen 800X600 High Color(16 bit) Windows 95/98 free serial or USB port.........…………............RS232.……….. ± 0.......... combine pre-drug trials from various testing days) export data to other programs such as Excel....001 The precision of measuring mechanical values: pressure (kg)....….............1 Computer Requirements computer processor 80486DX4 or higher RAM 8 MB hard disk 0... General safety requirements).......………………..g...........................………………….... contraction.......... DEVICE SPECIFICATIONS The Myotonometer allows users to: select desired procedure (resting tone....... data format……………………............. .. ± 0. Part 1... Paint and Systat Technical specifications of the device: Electric current (mA): in measuring mode..05 displacement (mm)................……………………………………..0..... Electrical safety: in accordance with ICO-601-1 (Medical electrical equipment.......... fixed force) to measure muscle properties reject measurements when appropriate obtain statistical characteristics of measured values store and analyze information obtain quantifiable measures of resting tone obtain quantifiable measures of muscle paresis obtain quantifiable measures that can indicate relative levels of spasticity group data together (e............

Initiate the program operation from Programs menu. “Programs”. The view of the screen in the process of installation is shown in Figure 3. Connect the cable from the electronic casing to the USB-port of your computer. . MYOTONOMETER OPERATION 1. You may need to manually change to the COM2 port. Do not connect the device until you have installed the software. On initial program starting. Connection of the Device to the Computer. “Myotonometer” (Fig. a screen appears (Fig.5 III. D:\ or E:\) followed by the following: D:\myotonometer\setup. With desktop-computers the mouse often occupies the COM1 port. The program will cue you to insert all necessary program disks. See calibration procedures in section 2. After program installation.1 The probe cable is permanently connected to the electronic casing.5). 2.4. if the computer does not automatically recognize the device. “Myotonometer”. 2. Press "Start" in the left-hand bottom corner of the screen: choose the lower line: "Run" enter the letter of your CD-ROM drive (e.4). The cable from the electronic casing has a 9-pin connection to the serial or USB port of the computer (port COM1 or COM2). 2. Software installation. prompting the user to calibrate the unit to ensure that the Myotonometer has not been damaged during shipping. if the computer recognizes the presence of the Myotonometer on the COM-port. as shown on Figure 4 (Start – Programs – Myotonometer – Myotonometer). 1.2. 2.1.3. Insert CD-ROM into the computer. If the CD does not initiate automatically.exe The installation procedure will start automatically.g. select “Start”.

5 . This procedure must be repeated three times. a blue graph is plotted. After each testing cycle. 5) allows the user to calibrate the Myotonometer.6 Fig. 3.4. Press downward gently until the sound signal is generated. 4 2. Calibration: This screen (Fig. the enclosed mouse-pad is to be used.4. Place one hand on top of the probe so that you can exert downward pressure and hold the Plexiglas collar steady. For this purpose. Fig. as shown on Figure 6 (1). Place the Myotonometer probe on the top of the pad. Fig. If the graph does not Fig.

Fig. (See calibration procedures for further details. If the generated graph exceeds limits (see Fig. You will then need to manually select the desired Comport. Make sure the Plexiglas collar remains in contact with the mouse-pad at all times and the inner probe returns all the way to the collar following each testing session. In rare cases. Click on desired Comport and select "Detect Again.' Opening window will then appear (Fig.7 extend beyond limits.5. Inc . 7).) If errors persist after 3 to 4 testing attempts. 6[2]) this would indicate either testing procedure error or damage to the Myotonometer during shipping. if a computer configuration differs from established standards.8) after a time delay of 15 – 30 seconds. the unit needs to be returned to Neurogenic Technologies®. the program will not be able to recognize the device. If this occurs an error window appears (Fig. If errors are detected (Fig. shown by red dash lines. the test procedure is to be repeated carefully several times. 9). the condition of the sensors has not changed since manufacturer's testing. 7 Fig. 8 2. 10) will appear. Click the left mouse button and the Main Window (Fig. You are now ready to begin taking Myotonometer measurements .6 Fig.

date etc.) can be entered and stored in "Notes". Move the cursor to the red silhouetted figure in the window and click with the left mouse button. Arm right). Selecting Patient and Measurement Conditions Fig. After choosing the part of the body. It is recommended that you avoid long words as it can create later difficulties while working with the database. Fig.3 It is then necessary to select the muscles and conditions you wish to measure. 3.1 Patient Information Data collection begins with the entering of patient/subject information. (e.g.13).8 3.4.2 Any additional information (e.g. This will activate the “Body” window (Fig. The blinking cursor within "Name" makes it possible to enter the patient's name or subject code number from the keyboard. box associated with the muscle (Fig. choose the muscle to be measured by clicking on the appropriate gray .5. 3. 10) select "New Client".12). Select the specific muscle. 3.11) and the window "Body" (Fig. 3. 12). When the Main Window appears (Fig. 10. 12). condition. Selection of muscles and conditions: First. You will then see the window "Client" (Fig. 9 3. a window with a more detailed picture of a particular body part will be shown (Fig.

There are three possible conditions: “Activation" = muscle contraction (a maximal voluntary contraction is recommended) "Relaxation" = resting muscle tone "Fixed Force" is selected if you wish to obtain a measurement at a known and pre-prescribed level of muscle contraction.9 Fig. 14). Fig. For instance. 12 3. 11 Fig. the patient could hold a 5-pound weight or could isometrically contract against a hand-held dynamometer to a certain force level. you must also enter the value in the box to the right. Fig. 14. the window "Muscle Dialog" appears (Fig. If this option is selected. 13. . After choosing the muscle.6.

The "Client" window will appear (Fig. If needed. In some instances (e.7 Selection of Probe Forces: The User can set the amount of maximum pressure exerted by the probe during testing.10 Use the left mouse button to click on the desired conditions. enter values of 1 or 1. children. Upon completing the description of the conditions. debilitated individuals) the 2 kg force is too high and can be uncomfortable.0 kg) cannot be combined or compared in the Analysis portion of the program. In these cases. . The section "Muscles" will then show the list of muscles and conditions (Fig.15).g. 15 Fig. A check mark will appear for each selected condition. The default setting is 2 kg in . 15).0 and 2.g. choose the next muscle for investigation by clicking on the red-silhouetted figure and repeat the procedure described above.25 kg steps. 15) and in the section "Muscles" the name of the muscle and condition will be listed. Fig. This is done within the Force section of the Client window (Fig.5 kg in the Force window. press " OK". It is important to note that measurements obtained during different force values (e. 1. 16 3. In this way you will be able to compile a list of muscles to be measured.

click "Close". 19). Click “Measure” A window with a table and a chart will appear on the screen (Fig. 4 Measurement Procedures 4." The information you have entered (patient name.17). click "Measure" in the window "Client" (Fig. Patient information will be displayed. if you wish just to make a preliminary list of muscles and conditions without immediately performing any measurements. . 3. and test force) will be stored in the database.11 Fig. After that you can exit the program or insert information about another patient. If you want to initiate a measurement session directly after entering patient information.16). The title above the window indicates the name of the muscle.2.1.16). The same Fig. contract…) in which it is to be measured. the patient is asked to contract or relax the muscle (dependent on desired condition).8 After you have completed all your selections within the Client window.3. 4. list of muscles and conditions. Use of the Probe: Before initiating a measurement with the probe. By clicking on it you will progress to the measurement mode. The window "Measure" will open (Fig. notes. But. left mouse click "Save. 17 window will re-appear with the "Measure" button highlighted (Fig. after which the window "Client" will disappear and the “Main Window” will appear. 18. 4. and the condition (relax.

Deleting Measurements: If a measurement differs greatly from previous measurements. After every measurement a new line of the table and an additional curve is displayed.0 kg).g. Several repetitions are needed for each measurement in order for an Fig. perhaps the patient's condition has changed (e. .25 kg to 2.g. results should be deleted. When the pressure reaches 2 kg a sound will occur signaling the end of the measurement.5. For instance. There are several ways to accomplish this: 1) Pressing the button at the top of the probe will delete only the last trial taken. The red curve is the average of all measurements taken during the session. the table and graph will immediately display the results. Measurements that deviate substantially from pervious measurements might indicate a source of error. You must exit out of the program and re-enter to set and save any changes made in this window 4. they contracted the muscle during a relaxed trial) or the probe head slipped off the muscle. A minimum of 5 to 8 repetitions is recommended.10).4. 4. Pressure should be exerted perpendicular to the muscle.12 The probe should be gently pressed against the surface of the skin overlying the desired muscle. 4. After each probe measurement.6. 19 average to be calculated. It is recommended that the user apply the pressure within a 2-3 second time period. The User should look at the graph after each probe measurement. Any number of repetitions can be selected with the “Options” button within the "Main Menu" window (Fig. The graph reflects these numbers. from 0. The table displays the depth of the plunging rod (mm) at 8 different pressures (e. black curves – of each individual measurement.

8. a window will appear (Fig.19) asking if the data are to be saved (“Save”) or deleted ("Remeasure").19) prior to taking measurements. select "Remeasure" and all trials will be deleted and program will automatically put you back in measure mode to repeat your measurements. 4.9. This is done by left clicking on "Exclude" located above the table (Fig. A tone will signal the end of the testing session. Automatic Deletion of Trials: It is possible to have the program automatically delete individual measurements that deviate + 2 standard deviations from the average.11. of intensive work. If there are long time delays between measurements after the initiation of the measuring mode. After completing a cycle of measurements. Batteries should last for one year . another measurement window will appear with the next muscle or condition listed. Measurement procedures are then repeated. This is done to remind the user that the unit is still on and using power. If many errors have occurred.13 2) Left mouse click on "Reset Measure" will also delete last measure.7. 4. 4) At the end of a testing session the window "Save Measure" will appear. 4. the program will produce intermittent sound signals. After data have been saved. 3) Clicking "Reset All Measures" will delete all measurements taken to that point.10. 4. 4. Results are automatically saved and the user can either exit the program or immediately analyze and printout the results by opening the Analysis part of the program. Exiting measurement mode as soon as measurements are completed will ensure long battery life.

window (Fig.2. When this mode is chosen the button “Measure” in Main Window is not activated. The User will be cued to select either "Display Measurements" or "Display Groups of Measurements" "Display Measurements' is used when you have no need to combine data into a different group name. Printout of data as text or graph. The “Analysis” 5. The Analysis program allows: data analysis in numerical and graphical form for a particular muscle or for a group of muscles.g. exporting of data files in formats for import into other software packages (e. 5.14 5 Analysis 5. left click on “ Analysis” in the Main Window. "Display Groups of Measurements allows the User to merge data files and create a new group name for analysis (e. . select “ Work without device" if this is what you wish to do.3. the saving of data as text (table) or graph.g. summation of data from groups of muscles or conditions calculation of percent differences between tonograms of selected measurements. In order to initiate analysis. calculation of “Area Under the Curve” of any length-tension curve. Paint) importing of data for analysis from other Myotonometer™ units and computers It is not necessary to have the Myotonometer™ connected while doing data analysis. 8). Systat. calculation of statistical parameters of a chosen muscle or group.1. Excel.20) will appear. combining pre or post treatment intervention data). At the start of the program (Fig.

Once the icon is located anywhere within the window.20) will bring up another window. muscle. condition). patient name.g.21) will be displayed. release the left mouse button and the file will be rewritten into this window. "Display Measurements" Left mouse clicking on "Display Measurements" (Fig." From here it is necessary to choose the file for analysis and drag it into the right-sided window. while keeping the left mouse button depressed. 20 Fig. To do this.15 5. use your mouse to move the file icon into the right window. Once you have done this. Fig. highlight the desired file. The file to be analyzed can come from any level within the “tree” of file: names (e. "Measurements for Analysis. part of the body. a smaller window "Analysis of Measurements" (Fig.4. then.21 .

This window will also provide a statistical comparison of the % differences. the % difference between relaxed biceps brachii vs.28). 23 Fig. See Figures 24 and 25.4. Fig. "Display Graph of Selected Muscles" Left clicking this button will display your selected data files in graph format (Fig. "Display Table of Selected Muscles" will display data in table format with averages given of each force measurement.22). Area Under the Curve (AUC) calculation is also given for each line.20). When more than 10 tonograms are entered.22 . For instance. the message “Too many graphs" appears. "Calculate % of Difference of Area" will compare each set of data and calculate the % difference between each (e.1 "Analysis of Measurements" (Fig.16 5.g. "Summate Selected Muscles" will combine all selected measurements and display as summated data (a single line on a graph with standard deviations and a table) (Fig. contracted biceps brachii).21) window allows you to select the desired analysis function and display. "Cancel" will bring you back to "Analysis" window (Fig. "Calculate Area Under the Curve" will calculate area under the curve (AUC) for each measurement selected. the data displayed in Figure 27 was summated and then automatically displayed as Figure 28. You are limited to displaying and summating 10 individual trials.

Fig. 26 Fig. You will not be able to pull these data up again from within the Myotonus program. 24 Fig. a window appears (Fig.BMP format and table/text files in .17 Fig.TXT format.5 All of the windows allow switching among the windows by clicking on the buttons located at the bottom of each window. When the button "Save" is pressed. It is recommended that you place your data in a folder designated "Data." The graphic files will be saved in . 25 5.23) that will allow you to save your data. 27 Fig. Buttons to save or printout data are also located at the bottom of each window. 28 .

First. combining pre or post treatment intervention data). Highlighting is not necessary Fig. the "Analysis of Groups of Measurements" window becomes active and all operations necessary for analysis are the same as described above.1 “Remove All Groups” will remove all groups.g.18 5. 5.7 “Remove group" To remove a group from your list in the right window it is necessary to highlight the file to be deleted by left mouse clicking on it. press the button “Remove group”. Then. click and drag all files to be combined into the right window. you might want to combine all muscle activation patient data taken prior to a treatment intervention. An example is shown in Figure 29. Once this is done.6 "Display Groups of Measurement" allows the user to merge data files and create a new group name for analysis (e. 29 . Once all files are listed in the right window. For instance.7. 5. click "Add Group" located on the far right of the window.

Then. This allows the user to change certain settings within the program." The "Saving" window will appear and you can designate the location where you would like the file to be saved. highlight the desired file to be exported. 6. The program will import the data from the floppy and assign the new name "test1.19 6.1.1 Options: Located within the Main Menu is the "Options" button. For instance. 30 Main Window (Fig. 31 Fig. the program will automatically assign the same name but a different number to the data file.2 Importing Files: To import Myotonometer™ data from another source. Clicking on "Save" completes the procedure.3 If a duplicate file name exists.2 "Switch X-Y Axis in Analysis" By selecting this option the user determines whether "Force" or "Displacement" measures will be displayed on the X or Y axes (see Figures 33 and 34). left mouse click on "Export. click "Import" and then highlight and "Open" desired. 31 6. The file will automatically be listed on the Main Menu. 7. First. you might try to import a file named "test" from a floppy disk but you already have a file named "test" listed on your Main Menu.1.30)." 7. The .1 Exporting Files: It is possible to export data to another user or another computer by using the "Export" button located on the Fig. Fig.

20 program typically defaults to having "Force. If subsequent changes are made to the computer configuration it might be necessary to manually change the ComPort. But.1. Corel Draw. PhotoShop. will switch the axes.3 "Number of Measures" Typically it is recommended that the user obtain the average of 3 to 5 measurements for each condition (i. 7. 7. this number can be changed by the user.5 "Port" The Communication Port to be used is typically detected automatically during setup." the independent variable. There is an arrow box located on the top right of the graph which.1.4 "Units" Clicking the right arrow key allows the user to select the unit of measurement to be used during Force measurements. MS Word or any other using . Imaging.e.1.6 "Use external printing program" This option is selected if the user wants data sent to a graphics editor installed on their computer (MS Paint.1.BMP file structures). Click "external printing program" box and use "Browse" to select appropriate path to your graphics editor.7 Please note that you must exit out of the program and re-enter before any of your "Options" selected will become effective. you press the probe onto the muscle 5 times to get the measurement of muscle tone during relaxation and 5 times during contraction). .1. 7. when activated. 7. 7. located on the X-axis. The option to switch X and Y axes is also available within the Analysis program.

33 . 8. or just a change for this particular measurement session (Fig. Fig.1 If you are taking measurements from a patient for which the muscle list has already been established and saved all you need to do is highlight the patient's name in the Main Window and click "Measure. Again the "Measure" button will be activated—click on it and the "Measure" window will appear (Fig.18).21 8.17).1." The window will cue the user regarding whether your intention is to make a permanent file change. After completing the editing process. Fig." The "Client" window will appear with the information about the patient and with the list of previously listed muscles and conditions. You can also delete muscles to be measured from your list by clicking on the small square window with the sign to the left of the name of the muscle.1.32 8.2 The "Edit" button allows the user to change the list of muscles by using "Add" or "Delete.1 Main Window Options/Procedures:. select "OK".

Myotonometric measurements will provide information about individual muscle contribution to torque output. The probe is then lifted off the muscle and re-positioned to take the next measurement. Muscle Strength: Muscle strength is assessed using a maximal voluntary isometric contraction. Muscle stiffness during muscle contraction should show a significant difference from resting tone. Myotonometric measurements are then taken of the desired muscles for each leg (legs must be positioned similarly). The athlete tested normal during computerized isokinetic testing. In addition. they can be used to assess the rehabilitation and progress of specific muscles. muscle stiffness during contraction should be symmetrical between both legs. For knee extensors the rectus femoris. The examiner asks the athlete to maximally contract the muscle to be tested. A hand-held or computerized dynamometer can be used to ensure consistency of effort between trials if this is an issue. This requires less than one minute for data acquisition. Resting muscle tone of the various muscles can be compared between the right and left legs. Analysis: Several types of analyses are possible following the above outlined testing protocol.g. examiner’s resistance etc. the examiner presses the Myotonometer probe perpendicularly onto the muscle. Dynamometry will measure total joint torque production but not provide information about individual muscles. Stiffness of different muscles of the same leg should not be expected to be identical. . The resting tone should be the same.22 Sample Protocol for Testing of Muscle Injury or Muscle Imbalance The following protocol describes a procedure for assessing the muscle health of the knee extensors during or following anterior cruciate ligament (ACL) surgery rehabilitation. the athlete can be sitting at the edge of the treatment table with knees flexed or they can be positioned in isokinetic dynamometer equipment. The graph on the following page was generated by Myotonometer computational software and depicts data collected from the vastus medialis of an athlete three years following ACL surgery. The athlete is asked to maximally contract against an immovable force (e. If myotonometric measurements were taken pre-injury or pre-surgery. While the athlete contracts the muscle. The Myotonometer probe is pressed onto the muscle perpendicularly until an audible tone is heard. Five probe measurements are suggested. For instance. The athlete can then be asked to move into a prone position with legs extended and the biceps femoris tested if desired. vastus lateralis and vastus medialis can be measured separately. The athlete does not have to be in the same position during assessment of muscle strength as they were for resting muscle tone. Resting Muscle Tone: The athlete is positioned in a supine position with legs extended or flexed over the edge of the treatment table. cable attached to treatment table.).

Red line shows resting muscle tone. The blue line shows the stiffness of the surgical leg during a maximal voluntary contraction. This assessment of weakness is further verified by the inability of the surgical VMO to generate as much stiffness during contraction as the nonsurgical VMO (green line). (Note that the legend [generated from the computer’s clock] indicates that all data were acquired in less than two minutes).23 VMO Weakness s/p ACL Surgery Myotonometer measurements of vastus medialis (VMO) of an athlete who had ACL surgery three years prior. The green line shows the stiffness obtained from the non-surgical leg during a maximal voluntary contraction. . The small difference between stiffness of the surgical VMO during contraction (blue line) from resting stiffness indicates weakness of this muscle (despite the fact that computerized isokinetic dynamometry indicated equal strength of both legs).

subjects are instructed to perform a maximal isometric contraction (MVC) of the elbow flexors. Measurements are then be taken with the muscle relaxed. Paresis and Level of Severity of Spastic Paresis Biceps Brachii Testing Tone measurements are taken while the subjects’ muscles are relaxed and during a maximal voluntary contraction (MVC). For this protocol. placed at the distal aspect of the forearm. For the contraction phase. It is recommended that at least 3 trials of 5 measurements each be taken (required testing time is less than 1 minute). This point is marked with an ink pen. subjects should reproduce similar force output for each trial during MVC testing. a strap can be placed at the wrist for resistance.g. The area of application of the Myotonometer probe for the biceps is located (e.24 Sample Protocol for Testing Muscle Tone. should be used to gauge the force of the isometric contraction of the upper extremity. The area over the flexor surface of the arm is tested with the subject in a sitting or supine position. The elbow is extended with the forearm supinated (putting muscle at end range). A hand-held force dynamometer. Myotonometer Measurement Procedures The Myotonometer contains a linear array of transducers that measure: 1) the amount of displacement of a probe as it is pushed onto the skin overlying the tested muscle and 2) the amount of force required per millimeter of tissue displacement. To ensure limited movement of the extremity. equidistant between the lateral aspect of the acromion process and the most inferior part of the olecranon). Measurements are taken .

75 2 .25 kg of force up to 2. Fig.75 1 Force (kg) 1. 1 GROUP 1: CONTROLS BICEPS BRACHII 12 Displacement (mm) 10 8 6 4 2 Contracted Rest 0 0 0. The percent difference at each . contracted). The smaller the difference in measurements between the two conditions.25 1. this protocol will enable the clinician and researcher to determine the extent to which changes in muscle tone or paretic changes within a muscle contribute to a disability.25 0.0 kg. In addition.25 kg of force between the relaxed and contracted conditions can be computed. Percent difference scores correlate with the modified Ashworth scale but Myotonometer measurements are more sensitive to smaller changes.25 every . the more severe the spastic condition (figs 1-3). Computational software generates force/displacement curves for each condition (relaxed.5 1.5 0.

25 Force (kg) 1.75 1 1. 3 12 10 Displacement (mm) GROUP 3: UNINVOLVED EXTREMITY BICEPS BRACHII 8 6 4 Rest Contracted 2 0 0 0. 2 GROUP 2: INVOLVED EXTREMITY BICEPS BRACHII 12 10 Displacement (mm) 8 Rest 6 4 Contracted 2 0 0 0.75 2 Force (kg) .25 1.5 0.26 Fig.75 1 1.25 0.5 0.25 0.5 1.5 1.75 2 Fig.

J.. M. S.. Brown. Kitzman. Electronic publication: ptjournal.. Mikhailenok E. C. Romo. Bizzini M. Ditto. J. 459-461. S.. Horikawa. Med Biol Eng Comput... hand-held device for assessing skeletal muscle stiffness. Pancholi C. T. Leonard CT (2003). ...org/abstracts/pt2003.. Leonard. J. A33. S. M. Ikeda. D. Intra. (2002). Fehrer S. Williams MD. Muscle hardness in patients with chronic tension-type headache: relation to actual headache state. Journal of Orthopedic and Sports Physical Therapy. Coon. Mikhailenok E. E. Journal of Mechanics in Medicine and Biology. Horikawa M. Bendtsen L. Mikhailenok EL. 623-627. Myotonometer assessment of changes in the triceps surae musculotendinous unit following a stretch intervention. E. Fehrer. Comparison of surface electromyography and myotonometric measurements during isometric contractions. T. J. C. Ashina M.. Holland K. (2001) Myotonometer: A reliability study.. (2003) Reliability of a new. Fischer. 84. Kato G. Queen S. (2002). Fehrer. Suoja. Andrew PD. Effect of visual display terminal height on the trapezius muscle hardness: quantitative evaluation by a newly developed muscle hardness meter. C.. C. & Sebastian. Jensen R. Comparison of surface electromyography and myotonometric measurements during isometric contractions. Leonard. Pain 1999. T. Applied Ergonomics. (2004) The effect of position on muscle tone in post stroke patients. APTA-New Jersey State Conference Poster Presentation. 79:201-205. 31. & Mikhailenok. Olesen J (1999). Sakai F. K. (2002).. In press: Electronic publication: ptjournal.and inter-rater reliabilities of the Myotonometer for assessing the spastic condition of children with cerebral palsy. 32:473-478. (2001).. Brown. Arch Phys Med Rehabil. 32(1). Fehrer S. Child Neurology (In press). S.. W. Deshner. Leonard. E. Williams MD. Ebihara. (2004). A29. 4(2): 213-225. Clinical Biomechanics. Leonard CT (2004). Journal of Electromyography and Kinesiology. & Akiyama. Queen SA. Aarrestad DD. Lamb.and inter-rater reliabilities of the Myotonometer for assessing the spastic condition of children with cerebral palsy. Smith T.org/abstracts/pt2004. 928-932. Journal of Orthopedic and Sports Physical Therapy. M. (1993). F. & Warley N. & Price. Day M.. Intra.. Kaplan. Spafford N. and Mannion AF. Sato H.. & Price.. (2004) Reliability and validity of a device to measure muscle hardness. 83:1683. Non-invasive measurement method for hardness in muscular tissues. Myotonometer intra and inter-rater reliabilities. & Leonard. Chernyavasky G. 32(1). Sakai. (2003). 14(6):709-714.27 Myotonometer Reference List Aarrestad DD. Palgi K. Archives Phys Med and Rehabil. P. The effects of strain-counterstrain on muscle hardness and tenderness in subjects with neck pain.

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(2004). 459-461. & Leonard.30 Sport-related Myotonometer References Bizzini M. C.. hand-held device for assessing skeletal muscle stiffness. Fehrer. Nosaka. J.. (2003) Reliability of a new. C.. & Price. Clinical Biomechanics. and Mannion AF. 84. Leonard.. Murayama. C. The effects of strain-counterstrain on muscle hardness and tenderness in subjects with neck pain. Journal of Orthopedic and Sports Physical Therapy. (2002). Comparison of surface electromyography and myotonometric measurements during isometric contractions. Leonard. Brown. Arch Phys Med Rehabil. Queen SA. K. & Minamitani.. S. 30(2): 209-215. (2000). & Price.. Leonard. Changes in hardness of the human elbow flexor muscles after eccentric exercise. Sato H. Ditto. T. Myotonometer intra and inter-rater reliabilities. Mikhailenok EL. Deshner. Comparison of surface electromyography and myotonometric measurements during isometric contractions. Lamb. Age-related changes in contractile capacity of lower extremity muscles caused by inadequate blood supply. T. Shchurova EN. 14(6):709-714. Brown. Coon. Romo. S. K. C. 32(1).... Yoneda. 82. E. Human Physiology. 4(2): 213-225. Kato G. M. European Journal of Applied Physiology and Occupational Physiology. Andrew PD... Ikeda. & Mikhailenok.. EMG and Kinesiology. (In press). (2004). (2003). Grebenyuk LA. Journal of Electromyography and Kinesiology. Journal of Orthopedic and Sports Physical Therapy. (2004) Reliability and validity of a device to measure muscle hardness. (2002). J. A33. 361-367. & Sebastian. (2004).. Fehrer. T. J. T. Fischer.. E.. Suoja. . Shchurov VA. J. D.. 32(1). K.. Myotonometer assessment of changes in the triceps surae musculotendinous unit following a stretch intervention. Journal of Mechanics in Medicine and Biology. E. W. 928-932. A29... M.

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