**11. References**


showed complete recovery rate without residual impairment in 14% of patients with nonhemorrhagic stroke90 and 25% in hemorrhagic stroke91, respectively. In adult strokes,

In the long-term, cognitive impairment is significant in childhood stroke, and IQ (Intellectual Quotation) ranges widely and is lower than average90, 92, 93. As imagined, VIQ (Verbal IQ) is higher than PIQ (Performance IQ) in children with right hemisphere lesion, and PIQ is higher than VIQ in left hemisphere lesion90, 93. In spite of cognitive impairment, most of children return to mainstream school with/without support57, 90. Regardless of residual impairments and disabilities, they feel healthy and happy as normal children

General survival rate of pediatric stroke is better than adults95, 96. 5 year survival rate is 85%, and residual neurological deficits of 75% (hemiparesis, epilepsy, learning disabilities, visual field deficits, mental retardation)97. Idiopathic stroke have better prognosis than stroke associated with cardiac disease98. It is controversial but generally age is also an important prognostic factor98. The functional outcome of childhood stroke is more favorable than that of adult one. However, it is reported that infant stroke has poorer outcome than childhood

Poor outcome predictors are multiple cortical dysfunction, initial symptoms with altered level of consciousness with/without seizure, middle cerebral artery lesion, infant age onset, persistence of hemiparesis 1 month after stroke, and bilateral hemisphere lesions57,90, 93,99, 100. School re-entry is the final rehabilitation goal for children with stroke. A neuropsychological test including IQ indicates the details of the cognitive impairments. Based on the test results, school re-entry might be planned. Depending on medical conditions and the test results, home bound education, part time student, full time student, or classroom modification

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**3** 

*Taiwan* 

**Myotonometric Measurement of Muscular** 

Stroke is the leading cause of functional disability. The most significant impairment developed in individuals with stroke is the loss of normal skeletal muscle tone on the affected side, which leads to the lack of normal, controlled movements and further limits the individual's ability to carry out tasks of daily living. Session 1 of this chapter describes skeletal muscle changes after stroke and defines functional roles of muscle tone, elasticity, and stiffness. Session 2 discusses methods for measuring muscle tone, elasticity, and stiffness, including common clinical measure, laboratory measure, and a new novel myotonometer. Session 3 presents metric properties of the myotonometric measurements in previous studies. Session 4 provides an overview of myotonometric measurement relevant to stroke motor rehabilitation and future research directions, with special attention on the reliability, validity, and sensitivity to treatment-induced change of using the myotonometer to measure muscle properties of relaxed extensor digitorum, flexor carpi radialis, and flexor carpi ulnaris muscles in patients with stroke. Session 5 concludes the clinical value of

**1.1 The definition and functional role of muscle tone, elasticity, and stiffness**

Muscle tone involves active tension and passive (resting) intrinsic viscoelastic tone (Ditroilo et al., 2011; Masi & Hannon, 2008; Simons & Mense, 1998). Human resting muscle tone was defined as the passive tonus or tension of skeletal muscle that derives from its intrinsic molecular viscoelastic properties (Masi & Hannon, 2008); that is, resting muscle tone is the viscoelastic stiffness without contractile activity (Simons & Mense, 1998). The functional roles of passive muscle tone are for maintaining balanced stability posture and for achieving energy-efficient costs for prolonged duration without fatigue (Masi & Hannon, 2008).

Muscle elasticity is defined as the property of a muscle to return to its original form or shape after removing a deforming force, and muscle stiffness is a muscle's resistance to deformation (Masi & Hannon, 2008; Panjabi, 1992; Simons & Mense, 1998). Factors that affect resting muscle tone, elasticity, and stiffness include neuromuscular disorders (Alhusaini et al., 2010; Hafer-Macko et al., 2008; Ratsep & Asser, 2011), massage (Huang et

myotonometric measurements in stroke rehabilitation.

**1. Introduction** 

**Properties of Hemiparetic Arms** 

Li-Ling Chuang1, Ching-Yi Wu2 and Keh-Chung Lin1

**in Stroke Patients** 

*1National Taiwan University, Taipei, 2Chang Gung University, Taoyuan,* 

