**5. Conclusion**

46 Rehabilitation Medicine

posttreatment, which indicates that they might measure similar constructs. Our present findings were compatible with those from a previous study reporting a correlation between muscle stiffness and muscle strength of the quadriceps (Bizzini & Mannion, 2003). In this study, the elasticity of the two wrist flexors tended to increase with greater grip strength at posttreatment. At posttreatment, the elasticity of the extensor digitorum and muscle tone and stiffness of the two wrist flexors tended to increase with greater lateral pinch strength. The muscle tone and stiffness of the extensor digitorum and the two wrist flexors appeared to increase with greater palmar pinch strength. The pretreatment and posttreatment muscle tone and stiffness of the flexor carpi radialis were correlated to palmar pinch strength and

**4.6.4 Responsiveness of the Myoton-3 myometer in patients with stroke receiving** 

The responsiveness of the extensor digitorum was higher than those of the flexor carpi radialis and ulnaris, with moderate to high for the affected extensor digitorum and small to moderate for the affected flexor carpi radialis and ulnaris. The responsiveness of the muscle tone and elasticity was moderate for the affected extensor digitorum and small for the affected flexor carpi radialis and ulnaris (tone: –0.57 vs –0.39 vs –0.35; elasticity: –0.75 vs – 0.44 vs –0.31). The responsiveness of the elasticity of the affected extensor digitorum was significantly higher than that of the affected flexor carpi ulnaris (difference in SRM, 0.44; 95% CI, –0.78 to –0.11). The responsiveness of muscle stiffness was high for the affected extensor digitorum (–0.83) and moderate for the affected flexor carpi radialis (–0.71) and

The responsiveness of the Myoton-3 is an important outcome measure and may serve as the foundation for therapy guidance and evaluation. The responsiveness to change of myotonometric measurements can be calculated through numeric data, provide a basis for estimates of whether the changes of muscle parameters over time are in the desired direction, and thus permit rehabilitation therapies to be adjusted accordingly. Our SRM calculations showed the affected extensor digitorum appears to be more responsive than the affected flexor carpi radialis and ulnaris in muscle tone, elasticity, and stiffness, and especially elasticity (–0.75 vs –0.44 vs –0.31). This result may arise from an emphasis on activation of wrist and finger extensor muscles elicited by the rehabilitation program the patients received. Thus, the extensor digitorum was much facilitated after treatments, and the flexor carpi muscles were not as sensitive as the extensor digitorum. Given that the ability to sustain finger extension is necessary in most functional hand activities; active finger extension is an important prognostic determinant and an early valid indicator of favorable UE function after stroke (Fritz et al., 2005; Nijland et al., 2010). Stroke patients with early finger extension after onset had a 98% probability of regaining some dexterity and a 60% probability of achieving full functional recovery of the hemiplegic arm at 6 months after

 Different treatment effects across treatment groups could adversely affect variability. Future studies with a larger sample size may analyze changes after specific treatment.

ARAT.

**rehabilitation** 

ulnaris (–0.77).

stroke (Nijland et al., 2010).

**4.6.5 Future directions** 

The Myoton-3 myometer measures mechanical properties of the skeletal muscle, which may provide new insights into muscle functions to diagnose and treat muscle pathophysiology. In clinical practice and research settings, performance documented by the Myoton-3 myometer might be a useful indicator of muscle changes. This overview showed that the Myoton-3 myometer could be applied as a reliable, valid, and responsive device for objectively quantifying muscle tone, elasticity, and stiffness of resting forearm muscles in patients with stroke. These findings support the use of myotonometric measurement in stroke rehabilitation and further clinical trials.
