The Use of a Portable Muscle Tone Measurement Device to Measure the Effects of Botulinum Toxin Type A on Elbow Flexor Spasticity Jia-Jin Jason Chen,

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The Use of a Portable Muscle Tone Measurement Device to Measure the Effects of Botulinum Toxin Type A on Elbow Flexor Spasticity Jia-Jin Jason Chen, PhD, Yi-Ning Wu, PT, Sheng-Chih Huang, MS, Hsin-Min Lee, PhD, Yu-Lin Wang, MD Archives of Physical Medicine and Rehabilitation Volume 86, Issue 8, Pages 1655-1660 (August 2005) DOI: 10.1016/j.apmr.2005.03.019 Copyright © 2005 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 1 The portable muscle tone measurement system consists of the air bags, a differential pressure sensor, and an angular velocity sensor. The muscle activities are recorded by using 2 surface electromyography electrodes. The reactive resistance, angular displacement, and electromyographic activities are recorded by an analog-to-digital converter during the quasisinusoidal movement limited between 60° and 120° of flexion by an elbow limiter. Abbreviations: AD, analog-to-digital; BB, biceps brachii; EMG, electromyographic activity; TB, triceps brachii. Archives of Physical Medicine and Rehabilitation 2005 86, 1655-1660DOI: (10.1016/j.apmr.2005.03.019) Copyright © 2005 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 2 Typical examples of (A) reactive resistance and (B) displacement measurements stretched at 32 Hz. The dotted lines determine 1 complete stretch cycle from the peak values of angular displacement. Obvious phase shift can be observed between reactive resistance and angular displacement, which shows the viscous property of the targeted muscle. From the displacement-resistance plot (C), the viscous component can be obtained by fitting a straight line to the displacement-resistance plot after phase shift, (D), in a typical spastic patient. Archives of Physical Medicine and Rehabilitation 2005 86, 1655-1660DOI: (10.1016/j.apmr.2005.03.019) Copyright © 2005 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 3 The viscosity (B) (slopes of the dotted and the solid lines) is derived from a regression line of the viscous component parameter across 4 different stretch frequencies for 2 representative CVA subjects with severe (MAS score 3) (circle data) and mild (MAS score 1) spasticity (cross data), respectively. The viscosity of subject with severe spasticity (dotted line) is higher than that of subject with mild spasticity (solid line). Archives of Physical Medicine and Rehabilitation 2005 86, 1655-1660DOI: (10.1016/j.apmr.2005.03.019) Copyright © 2005 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 4 A complete session of 15 sinusoid stretching cycles can be observed from (A) the angular displacement. Clear electromyographic activities are found in (B) the biceps brachii compared with (C) triceps brachii. Archives of Physical Medicine and Rehabilitation 2005 86, 1655-1660DOI: (10.1016/j.apmr.2005.03.019) Copyright © 2005 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 5 The electromyographic activities and their corresponding stretch angles are processed to determine the reflex electromyographic threshold (vertical dotted line) for subject E at 32Hz of stretch frequency for (A) preinjection and (B) 2 weeks after BTX-A injection. Abbreviation: LE, linear envelope. Archives of Physical Medicine and Rehabilitation 2005 86, 1655-1660DOI: (10.1016/j.apmr.2005.03.019) Copyright © 2005 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions