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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

..........6 GB screen 800X600 High Color(16 bit) Windows 95/98 free serial or USB port....0................05 displacement (mm).…………………….. Part 1...............1 Computer Requirements computer processor 80486DX4 or higher RAM 8 MB hard disk 0............. DEVICE SPECIFICATIONS The Myotonometer allows users to: select desired procedure (resting tone.... Paint and Systat Technical specifications of the device: Electric current (mA): in measuring mode.........................………………….4 II...…………………………………………………………......001 The precision of measuring mechanical values: pressure (kg)......15 in "off" mode………..... . Electrical safety: in accordance with ICO-601-1 (Medical electrical equipment..RS232.. combine pre-drug trials from various testing days) export data to other programs such as Excel.………………………………………………………….……….................... ± 0.............. contraction..………………..... 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...............……………………………………............ ± 0................…………..........g.....…. data format……………………. General safety requirements)..........

5).exe The installation procedure will start automatically. 2. prompting the user to calibrate the unit to ensure that the Myotonometer has not been damaged during shipping. See calibration procedures in section 2. a screen appears (Fig. 1. if the computer does not automatically recognize the device.1 The probe cable is permanently connected to the electronic casing. Initiate the program operation from Programs menu. Do not connect the device until you have installed the software. The program will cue you to insert all necessary program disks. 2. The view of the screen in the process of installation is shown in Figure 3. You may need to manually change to the COM2 port. MYOTONOMETER OPERATION 1.g.4. Software installation. . as shown on Figure 4 (Start – Programs – Myotonometer – Myotonometer). 2. Insert CD-ROM into the computer. Connection of the Device to the Computer.4). 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. With desktop-computers the mouse often occupies the COM1 port. “Programs”.3. “Myotonometer” (Fig. select “Start”.5 III.2.1. D:\ or E:\) followed by the following: D:\myotonometer\setup. On initial program starting. If the CD does not initiate automatically. 2. if the computer recognizes the presence of the Myotonometer on the COM-port. “Myotonometer”. After program installation. The cable from the electronic casing has a 9-pin connection to the serial or USB port of the computer (port COM1 or COM2). Connect the cable from the electronic casing to the USB-port of your computer.

4 2. After each testing cycle.4. Place the Myotonometer probe on the top of the pad. Calibration: This screen (Fig. Fig. For this purpose.4. Place one hand on top of the probe so that you can exert downward pressure and hold the Plexiglas collar steady. 5) allows the user to calibrate the Myotonometer. as shown on Figure 6 (1). a blue graph is plotted. 5 . Fig. This procedure must be repeated three times.6 Fig. Press downward gently until the sound signal is generated. the enclosed mouse-pad is to be used. 3. If the graph does not Fig.

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

1 Patient Information Data collection begins with the entering of patient/subject information. choose the muscle to be measured by clicking on the appropriate gray . 3.8 3.g. 10. Selecting Patient and Measurement Conditions Fig. The blinking cursor within "Name" makes it possible to enter the patient's name or subject code number from the keyboard. 3. (e. Move the cursor to the red silhouetted figure in the window and click with the left mouse button.2 Any additional information (e. Select the specific muscle. After choosing the part of the body. When the Main Window appears (Fig. 10) select "New Client". box associated with the muscle (Fig.5. Selection of muscles and conditions: First. condition.3 It is then necessary to select the muscles and conditions you wish to measure. 12). 9 3. It is recommended that you avoid long words as it can create later difficulties while working with the database.g.4.12). date etc. Arm right).13).11) and the window "Body" (Fig. 3. a window with a more detailed picture of a particular body part will be shown (Fig. 3. This will activate the “Body” window (Fig.) can be entered and stored in "Notes". 12). Fig. You will then see the window "Client" (Fig.

12 3. you must also enter the value in the box to the right. 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. the window "Muscle Dialog" appears (Fig.6. Fig. If this option is selected. 14). 14. 11 Fig.9 Fig. After choosing the muscle. the patient could hold a 5-pound weight or could isometrically contract against a hand-held dynamometer to a certain force level. 13. For instance. . Fig.

1. The "Client" window will appear (Fig. .10 Use the left mouse button to click on the desired conditions. In some instances (e. In these cases. 15) and in the section "Muscles" the name of the muscle and condition will be listed. A check mark will appear for each selected condition.g. 15 Fig.25 kg steps. Fig. This is done within the Force section of the Client window (Fig.5 kg in the Force window.7 Selection of Probe Forces: The User can set the amount of maximum pressure exerted by the probe during testing. press " OK". If needed. In this way you will be able to compile a list of muscles to be measured. The section "Muscles" will then show the list of muscles and conditions (Fig.g. 15). 16 3. children. debilitated individuals) the 2 kg force is too high and can be uncomfortable. choose the next muscle for investigation by clicking on the red-silhouetted figure and repeat the procedure described above.15). enter values of 1 or 1.0 and 2. Upon completing the description of the conditions. The default setting is 2 kg in . It is important to note that measurements obtained during different force values (e.0 kg) cannot be combined or compared in the Analysis portion of the program.

11 Fig. If you want to initiate a measurement session directly after entering patient information. 4. The same Fig. left mouse click "Save.3.16). Patient information will be displayed.16). and test force) will be stored in the database. notes. But. click "Close". the patient is asked to contract or relax the muscle (dependent on desired condition). click "Measure" in the window "Client" (Fig. After that you can exit the program or insert information about another patient. 4 Measurement Procedures 4. if you wish just to make a preliminary list of muscles and conditions without immediately performing any measurements. 4. 18.8 After you have completed all your selections within the Client window. and the condition (relax. . The title above the window indicates the name of the muscle. 3.2." The information you have entered (patient name. contract…) in which it is to be measured. list of muscles and conditions. The window "Measure" will open (Fig. Click “Measure” A window with a table and a chart will appear on the screen (Fig.17).1. 17 window will re-appear with the "Measure" button highlighted (Fig. after which the window "Client" will disappear and the “Main Window” will appear. 19). By clicking on it you will progress to the measurement mode. Use of the Probe: Before initiating a measurement with the probe.

You must exit out of the program and re-enter to set and save any changes made in this window 4. from 0.5. After each probe measurement. It is recommended that the user apply the pressure within a 2-3 second time period. There are several ways to accomplish this: 1) Pressing the button at the top of the probe will delete only the last trial taken. After every measurement a new line of the table and an additional curve is displayed. Several repetitions are needed for each measurement in order for an Fig. 19 average to be calculated. Deleting Measurements: If a measurement differs greatly from previous measurements. 4. . black curves – of each individual measurement.10). Measurements that deviate substantially from pervious measurements might indicate a source of error. When the pressure reaches 2 kg a sound will occur signaling the end of the measurement.g.6.25 kg to 2.4. Any number of repetitions can be selected with the “Options” button within the "Main Menu" window (Fig. perhaps the patient's condition has changed (e. Pressure should be exerted perpendicular to the muscle. The User should look at the graph after each probe measurement.g. A minimum of 5 to 8 repetitions is recommended. For instance. The red curve is the average of all measurements taken during the session. The table displays the depth of the plunging rod (mm) at 8 different pressures (e. results should be deleted. they contracted the muscle during a relaxed trial) or the probe head slipped off the muscle. the table and graph will immediately display the results.0 kg). 4.12 The probe should be gently pressed against the surface of the skin overlying the desired muscle. The graph reflects these numbers.

13 2) Left mouse click on "Reset Measure" will also delete last measure. a window will appear (Fig.9. 4.19) prior to taking measurements. Exiting measurement mode as soon as measurements are completed will ensure long battery life. 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. After data have been saved. Measurement procedures are then repeated. another measurement window will appear with the next muscle or condition listed. If many errors have occurred. 4) At the end of a testing session the window "Save Measure" will appear. of intensive work. 4. If there are long time delays between measurements after the initiation of the measuring mode. This is done by left clicking on "Exclude" located above the table (Fig. This is done to remind the user that the unit is still on and using power. 4. the program will produce intermittent sound signals. 3) Clicking "Reset All Measures" will delete all measurements taken to that point.11. select "Remeasure" and all trials will be deleted and program will automatically put you back in measure mode to repeat your measurements.19) asking if the data are to be saved (“Save”) or deleted ("Remeasure"). 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. After completing a cycle of measurements. Batteries should last for one year . 4.8. 4.10.7.

8). The Analysis program allows: data analysis in numerical and graphical form for a particular muscle or for a group of muscles.14 5 Analysis 5. select “ Work without device" if this is what you wish to do. The “Analysis” 5. "Display Groups of Measurements allows the User to merge data files and create a new group name for analysis (e. 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. exporting of data files in formats for import into other software packages (e.2. 5.3. When this mode is chosen the button “Measure” in Main Window is not activated.g. calculation of “Area Under the Curve” of any length-tension curve. . calculation of statistical parameters of a chosen muscle or group.g. summation of data from groups of muscles or conditions calculation of percent differences between tonograms of selected measurements.1. In order to initiate analysis. Systat. 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. combining pre or post treatment intervention data). Printout of data as text or graph.20) will appear. window (Fig. the saving of data as text (table) or graph. left click on “ Analysis” in the Main Window. At the start of the program (Fig. Excel.

21) will be displayed. release the left mouse button and the file will be rewritten into this window. Once you have done this. then." From here it is necessary to choose the file for analysis and drag it into the right-sided window.15 5.20) will bring up another window. highlight the desired file. muscle. Fig.21 . a smaller window "Analysis of Measurements" (Fig. while keeping the left mouse button depressed. "Display Measurements" Left mouse clicking on "Display Measurements" (Fig.4.g. To do this. "Measurements for Analysis. The file to be analyzed can come from any level within the “tree” of file: names (e. part of the body. patient name. use your mouse to move the file icon into the right window. condition). Once the icon is located anywhere within the window. 20 Fig.

"Cancel" will bring you back to "Analysis" window (Fig.16 5. See Figures 24 and 25.28). the data displayed in Figure 27 was summated and then automatically displayed as Figure 28.4.g. "Calculate Area Under the Curve" will calculate area under the curve (AUC) for each measurement selected. "Display Graph of Selected Muscles" Left clicking this button will display your selected data files in graph format (Fig. the message “Too many graphs" appears. When more than 10 tonograms are entered. 23 Fig.22). This window will also provide a statistical comparison of the % differences. You are limited to displaying and summating 10 individual trials. "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. "Display Table of Selected Muscles" will display data in table format with averages given of each force measurement. For instance. "Calculate % of Difference of Area" will compare each set of data and calculate the % difference between each (e.22 . the % difference between relaxed biceps brachii vs.1 "Analysis of Measurements" (Fig. contracted biceps brachii).20). Area Under the Curve (AUC) calculation is also given for each line.21) window allows you to select the desired analysis function and display. Fig.

Buttons to save or printout data are also located at the bottom of each window. 26 Fig. 27 Fig.BMP format and table/text files in . a window appears (Fig.TXT format.23) that will allow you to save your data. 28 .17 Fig." The graphic files will be saved in . When the button "Save" is pressed. 25 5. You will not be able to pull these data up again from within the Myotonus program.5 All of the windows allow switching among the windows by clicking on the buttons located at the bottom of each window. It is recommended that you place your data in a folder designated "Data. Fig. 24 Fig.

click "Add Group" located on the far right of the window.6 "Display Groups of Measurement" allows the user to merge data files and create a new group name for analysis (e. Highlighting is not necessary Fig. Then.1 “Remove All Groups” will remove all groups. 5.g.7. For instance. An example is shown in Figure 29.18 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. click and drag all files to be combined into the right window. Once this is done. the "Analysis of Groups of Measurements" window becomes active and all operations necessary for analysis are the same as described above. 29 . Once all files are listed in the right window. 5. you might want to combine all muscle activation patient data taken prior to a treatment intervention. press the button “Remove group”. combining pre or post treatment intervention data). First.

The file will automatically be listed on the Main Menu.1 Exporting Files: It is possible to export data to another user or another computer by using the "Export" button located on the Fig. This allows the user to change certain settings within the program.19 6. 31 Fig. 6.30). Clicking on "Save" completes the procedure. First. left mouse click on "Export.1. For instance.3 If a duplicate file name exists. The . 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. The program will import the data from the floppy and assign the new name "test1. Fig. 30 Main Window (Fig.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). 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. 31 6. highlight the desired file to be exported.1." The "Saving" window will appear and you can designate the location where you would like the file to be saved." 7.1 Options: Located within the Main Menu is the "Options" button. 7. click "Import" and then highlight and "Open" desired. Then.

MS Word or any other using .1. The option to switch X and Y axes is also available within the Analysis program. But.1. .1." the independent variable.e. There is an arrow box located on the top right of the graph which.7 Please note that you must exit out of the program and re-enter before any of your "Options" selected will become effective. If subsequent changes are made to the computer configuration it might be necessary to manually change the ComPort. Click "external printing program" box and use "Browse" to select appropriate path to your graphics editor. you press the probe onto the muscle 5 times to get the measurement of muscle tone during relaxation and 5 times during contraction). 7.BMP file structures). 7. PhotoShop.3 "Number of Measures" Typically it is recommended that the user obtain the average of 3 to 5 measurements for each condition (i. this number can be changed by the user.20 program typically defaults to having "Force. will switch the axes.1.5 "Port" The Communication Port to be used is typically detected automatically during setup.1. Imaging. located on the X-axis. 7.4 "Units" Clicking the right arrow key allows the user to select the unit of measurement to be used during Force measurements.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. Corel Draw. 7. 7. when activated.

" The "Client" window will appear with the information about the patient and with the list of previously listed muscles and conditions.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. Fig.33 . 8." The window will cue the user regarding whether your intention is to make a permanent file change.1. Fig. or just a change for this particular measurement session (Fig. select "OK". After completing the editing process.21 8.17).32 8.1.2 The "Edit" button allows the user to change the list of muscles by using "Add" or "Delete. Again the "Measure" button will be activated—click on it and the "Measure" window will appear (Fig.1 Main Window Options/Procedures:.18). 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.

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

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 blue line shows the stiffness of the 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). The green line shows the stiffness obtained from the non-surgical leg during a maximal voluntary contraction. Red line shows resting muscle tone. .

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

25 kg of force between the relaxed and contracted conditions can be computed.25 kg of force up to 2.5 0. the more severe the spastic condition (figs 1-3).5 1. In addition. 1 GROUP 1: CONTROLS BICEPS BRACHII 12 Displacement (mm) 10 8 6 4 2 Contracted Rest 0 0 0.75 2 .25 1.0 kg.25 0. The smaller the difference in measurements between the two conditions. contracted).75 1 Force (kg) 1. Fig. 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. Percent difference scores correlate with the modified Ashworth scale but Myotonometer measurements are more sensitive to smaller changes. Computational software generates force/displacement curves for each condition (relaxed. The percent difference at each .25 every .

26 Fig.5 1.5 0.75 1 1.75 2 Fig. 2 GROUP 2: INVOLVED EXTREMITY BICEPS BRACHII 12 10 Displacement (mm) 8 Rest 6 4 Contracted 2 0 0 0.5 1.25 1. 3 12 10 Displacement (mm) GROUP 3: UNINVOLVED EXTREMITY BICEPS BRACHII 8 6 4 Rest Contracted 2 0 0 0.5 0.25 0.25 Force (kg) 1.75 1 1.75 2 Force (kg) .25 0.

C.org/abstracts/pt2004. Fehrer S. Williams MD. Williams MD. Aarrestad DD. Ikeda. 83:1683. Brown. Journal of Electromyography and Kinesiology. Non-invasive measurement method for hardness in muscular tissues. Ebihara.27 Myotonometer Reference List Aarrestad DD. D. T. 32(1). Smith T.. E. Holland K. Lamb. C. Ditto. Fehrer.and inter-rater reliabilities of the Myotonometer for assessing the spastic condition of children with cerebral palsy. & Leonard. and Mannion AF. APTA-New Jersey State Conference Poster Presentation. Brown. (2003).. (2001) Myotonometer: A reliability study. Mikhailenok E. Coon. M. F. Leonard. Fehrer. 32(1). Intra. & Warley N.org/abstracts/pt2003. S. (2004). & Akiyama. & Price. Bendtsen L.. Mikhailenok EL.. S. C. T. Day M. J. Horikawa. Queen S. Intra. Med Biol Eng Comput. Sakai F. S. 4(2): 213-225. (2002).. J. A33. Leonard CT (2003). P. T.. 928-932. Myotonometer intra and inter-rater reliabilities. 84.. Fehrer S. 14(6):709-714. (2004) The effect of position on muscle tone in post stroke patients. Kato G. Queen SA. Applied Ergonomics. K.. Leonard. Comparison of surface electromyography and myotonometric measurements during isometric contractions. Child Neurology (In press). Romo. Myotonometer assessment of changes in the triceps surae musculotendinous unit following a stretch intervention. Archives Phys Med and Rehabil. 623-627. Leonard CT (2004). (2002). A29. Olesen J (1999). Effect of visual display terminal height on the trapezius muscle hardness: quantitative evaluation by a newly developed muscle hardness meter. (2004) Reliability and validity of a device to measure muscle hardness. Jensen R. In press: Electronic publication: ptjournal. Journal of Orthopedic and Sports Physical Therapy. Chernyavasky G.. 32:473-478.. (2001). C... Bizzini M. Pancholi C. J. Muscle hardness in patients with chronic tension-type headache: relation to actual headache state. Spafford N. 459-461. Fischer. Comparison of surface electromyography and myotonometric measurements during isometric contractions. & Mikhailenok. hand-held device for assessing skeletal muscle stiffness. The effects of strain-counterstrain on muscle hardness and tenderness in subjects with neck pain. W. Arch Phys Med Rehabil. Horikawa M. Journal of Mechanics in Medicine and Biology. .. Journal of Orthopedic and Sports Physical Therapy. & Price. Sato H. M. Leonard.. Kaplan. Suoja.and inter-rater reliabilities of the Myotonometer for assessing the spastic condition of children with cerebral palsy.. Ashina M. Deshner.. (2002). S. Electronic publication: ptjournal. (1993). Kitzman. E. Clinical Biomechanics.. Mikhailenok E. 79:201-205. M.. (2003) Reliability of a new. 31. Sakai. Palgi K. Andrew PD. Pain 1999. J. E.. & Sebastian.

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

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