Shear wave elastography to assess the effect of botulinum toxin in muscle hypertonia following stroke

Introduction Sonoelastography is a method capable of evaluating the mechanical properties of soft tissues by ultrasound (US). A further development of this technique is shear wave elastography (SWE), which provides a quantitative evaluation of the elastic properties - in terms of tissutal stiffness - by measuring the propagation velocities of the directional shear waves, produced by an ultrasound pulse. Spasticity often appears in stroke patients in the affected limbs. It corresponds to velocity-dependent muscle hypertonia in relation to the hyperexcitability of the stretch reflex. Over time, the paretic muscles develop intrinsic alterations with consequent muscle shortening and increased fibrosis related to reduced use and immobilization. Intramuscular injections of botulinum toxin A (BoNT-A) is an effective treatment which reduces muscle activity by inhibiting the release of acetylcholine at the neuromuscular junction level and is therefore able to reduce neuromediated muscle hypertonicity. The study aims to evaluate the effectiveness of SWE to appreciate changes in stiffness in spastic muscles after treatment with BoNT-A and possibly detect differences between affected muscles and unaffected contralateral ones related to fibrous-fatty remodeling. Materials & Methods 14 adult patients (5F; age: 58,4\ub114,1 years, m\ub1SD; range:46-78) affected by spasticity were recruited after ischemic or hemorrhagic stroke diagnosed for at least 3 months and with a time interval from the last injection of at least 4 months, if already treated with BoNT-A. They patients underwent a physical examination in which muscle hypertonia was assessed using the modified Ashworth scale (MAS). The assessments were carried out on a sample muscle among the spastic ones favoring the greater volume and better accessibility to the ultrasound probe. SWE was also performed on the homologue non-paretic contralateral muscle. Spasticity was measured as the average electromyographic activity recorded during stretching (reflex by stretching) of the selected muscle at a reproducible speed, according to a previously validated methodology. The SWE evaluation was carried out with US scans across and along the direction of muscular fibers - as assessed by conventional US - covering the entire belly of the selected muscle to obtain a comprehensive estimate of the muscle stiffness both with the maximum shortened and elongated muscle position. Muscle fibrosis was also estimated on conventional B-mode US using the modified Heckmatt scale. All evaluations were performed shortly before botulinum toxin infiltration (T0) and one month later (T1). Clinical, electromyographic and ultrasound evaluation were performed by three different blinded examiners. Depending on data distribution, non-parametric statistical tests for paired data were performed for comparison; Spearman\u2019s r was calculated to assess data correlations. Results A total of 224 SWE values resulted considering both time points. Overall, SWE measurements on paretic muscles assessed with a longitudinal positioning of the probe showed statistically significant reduction at T1 versus T0 both in non stretched conditions (p=0.001) and in stretched conditions (p=0.0029). After BoNT-A injection, a significant reduction in MAS (p=0.009), spastic dystonia (p=0.0043), spasticity (p=0.0019) and longitudinal SWE measurements, both in non stretched conditions (p=0.001) and in stretched conditions (p=0.0029), was observed. No significant changes in SWE parameters were observed on non-paretic versus contralateral muscle . All SWE measurements were higher in the paretic limb than in the contralateral one (p<0.01); higher SWE measurements resulted along the direction of muscular fibers versus across them (p<0.01). Cohen\u2019s d estimate a larger effect on EMG values than longitudinal SWE ones (either in non stretched and in stretched condition), with narrower 95%CI for SWE measurements. No changes resulted by the modified Heckmatt scale US assessments; there was a positive correlation (r: 0.46-0.84) between MHS scores and SWE values. Conclusion This is the first study evaluating the effect of BoNT-A on muscle hypertonia following stroke, assessed by mean of SWE and compared with the stretch reflex. The treatment resulted in a reduction of MAS, stretch reflex and muscular stiffness, in relation to the reduction of the neuro-mediated hypertonia. We have therefore shown that SWE is able to appreciate a reduction in neuro-mediated stiffness. Abolishing the neuro-mediated contribution by keeping the limb in a shortened position and moreover after BoNT-A injection, the SWE values resulted higher in the paretic muscle than in the healthy muscle in the same position. Hence, SWE-driven comparison between the spastic muscle and the contralateral unaffected homologous one is able to disclose the amount of stiffness due only to intrinsic muscular involutive remodeling. Alongside sEMG, SWE could therefore constitute an added-value to clinicians who manage spasticity for the assessment of responses to treatments and monitoring therapeutic interventions

Effects of neural tension in the sciatic nerve stiffness, in healthy people and people with low back related leg pain

Neurodynamics techniques, such as neural tension maneuvers, are often used by health professionals to assess the peripheral nerves properties. They are also used in the rehabilitation of several lower body quadrant disorders (i.e. as in low back related leg pain – LBRLP), or as a training method in healthy individuals. Nevertheless, there is insufficient evidence of the neurodynamics effects, mainly neural tension, when applied to the lower body quadrant. This thesis aimed to determine the immediate effects of neural tension in the sciatic nerve stiffness, estimated by shear wave elastography, in both healthy people and people with LBRLP. Three studies were conducted to meet with this purpose: 1) a systematic review, with meta-analysis, which revealed evidence favoring the use of neurodynamics techniques for pain relief and disability improvement in people with low back pain, and for flexibility improvements in healthy people; 2) a study that showed no significant effects of neural tension in a slump position in reducing the sciatic nerve stiffness of healthy people; and 3) a study which determined that people with LBRLP present greater sciatic nerve stiffness in the affected limb compared to the unaffected limb, and to healthy controls; and that neural tension immediatly reduced the sciatic nerve stiffness of the affected limb. This thesis provides evidence of the clinical and mechanical effects of neurodynamics techniques, mainly neural stiffness. The effect of neural tension in reducing the sciatic stiffness in people with LBRLP seems to be related with changes in the nerve mechanical properties, however future research should confirm this finding while also determining the longterm effects of neurodynamics techniques.As manobras de neurodinâmica são utilizadas no âmbito clínico como forma de avaliação dos nervos periféricos, bem como de intervenção em patologias que afectam o quadrante inferior (e.g. dor lombar irradiada para o membro inferior - DLIMI), e ainda como treino de flexibilidade em populações saudáveis. Contudo, não existe evidência suficiente sobre os efeitos clínicos e mecânicos das manobras de neurodinâmica, nomeadamente das de tensão neural, dirigidas ao quadrante inferior. Assim, o objectivo principal desta tese foi determinar os efeitos agudos de uma técnica de tensão neural na rigidez do nervo ciático, estimada por elastografia de shear wave, em pessoas saudáveis e em pessoas com DLIMI. Para tal, três estudos foram realizados: 1) Uma revisão sistemática, com meta-análise, que demonstrou elevada evidência das manobras de neurodinâmica no alívio da dor e melhoria da incapacidade em pessoas com lombalgia, bem como evidência moderada no aumento da flexibilidade em pessoas saudáveis; 2) Um estudo em sujeitos saudáveis e sem história de dor lombar que revelou ausência de efeitos imediatos significativos da aplicação de tensão neural na posição de slump na redução da rigidez do nervo ciático; 3) Um estudo onde se verificou que pessoas com DLIMI apresentaram uma rigidez do nervo ciático mais elevada no membro afectado comparativamente ao não afectado, e a controlos saudáveis; e que uma técnica de tensão neural permitiu restabelecer a simetria de rigidez do nervo ciático entre membros. Estes resultados evidenciam os efeitos clínicos e mecânicos das manobras de neurodinâmica, nomeadamente de tensão neural. Os efeitos da tensão neural na redução da rigidez do nervo ciático em pessoas com DLIMI parecem estar relacionados com alterações nas propriedades mecânicas do nervo. No entanto, investigações futuras deverão confirmar esta hipótese, bem como analisar os efeitos a médio e longo prazo das manobras de neurodinâmica sobre as propriedades mecânicas do nervo ciático

Imaging Sensors and Applications

In past decades, various sensor technologies have been used in all areas of our lives, thus improving our quality of life. In particular, imaging sensors have been widely applied in the development of various imaging approaches such as optical imaging, ultrasound imaging, X-ray imaging, and nuclear imaging, and contributed to achieve high sensitivity, miniaturization, and real-time imaging. These advanced image sensing technologies play an important role not only in the medical field but also in the industrial field. This Special Issue covers broad topics on imaging sensors and applications. The scope range of imaging sensors can be extended to novel imaging sensors and diverse imaging systems, including hardware and software advancements. Additionally, biomedical and nondestructive sensing applications are welcome

Quantifying Spasticity: A Review

A precise method to measure spasticity is fundamental in improving the quality of life of spastic patients. The measurement methods that exist for spasticity have long been considered scarce and inadequate, which can partly be explained by a lack of consensus in the definition of spasticity. Spasticity quantification methods can be roughly classified according to whether they are based on neurophysiological or biomechanical mechanisms, clinical scales, or imaging techniques. This article reviews methods from all classes and further discusses instrumentation, dimensionality, and EMG onset detection methods. The objective of this article is to provide a review on spasticity measurement methods used to this day in an effort to contribute to the advancement of both the quantification and treatment of spasticity

Book of Abstracts 15th International Symposium on Computer Methods in Biomechanics and Biomedical Engineering and 3rd Conference on Imaging and Visualization

In this edition, the two events will run together as a single conference, highlighting the strong connection with the Taylor & Francis journals: Computer Methods in Biomechanics and Biomedical Engineering (John Middleton and Christopher Jacobs, Eds.) and Computer Methods in Biomechanics and Biomedical Engineering: Imaging and Visualization (JoãoManuel R.S. Tavares, Ed.). The conference has become a major international meeting on computational biomechanics, imaging andvisualization. In this edition, the main program includes 212 presentations. In addition, sixteen renowned researchers will give plenary keynotes, addressing current challenges in computational biomechanics and biomedical imaging. In Lisbon, for the first time, a session dedicated to award the winner of the Best Paper in CMBBE Journal will take place. We believe that CMBBE2018 will have a strong impact on the development of computational biomechanics and biomedical imaging and visualization, identifying emerging areas of research and promoting the collaboration and networking between participants. This impact is evidenced through the well-known research groups, commercial companies and scientific organizations, who continue to support and sponsor the CMBBE meeting series. In fact, the conference is enriched with five workshops on specific scientific topics and commercial software.info:eu-repo/semantics/draf

Mechanical characterization of aortas using 2D ultrasound elastography

Rupture of aortic aneurysms (AA) is a major cause of death in the Western world. Currently, clinical decision upon surgical intervention is based on the diameter of the aneurysm. However, this method is not fully adequate. Noninvasive assessment of the elastic properties of the arterial wall can be a better predictor for AA growth and rupture risk. The purpose of this study is to estimate mechanical properties of the aortic wall using in vitro inflation testing and 2D ultrasound (US) elastography, and investigate the performance of the proposed methodology for physiological conditions. Two different inflation experiments were performed on twelve porcine aortas: 1) a static experiment for a large pressure range (0 – 140 mmHg); 2) a dynamic experiment closely mimicking the in vivo hemodynamics at physiological pressures (70 – 130 mmHg). 2D raw radiofrequency (RF) US datasets were acquired for one longitudinal and two cross-sectional imaging planes, for both experiments. The RF-data were manually segmented and a 2D vessel wall displacement tracking algorithm was applied to obtain the aortic diameter–time behavior. The shear modulus G was estimated assuming a Neo-Hookean material model. In addition, an incremental study based on the static data was performed to: 1) investigate the changes in G for increasing mean arterial pressure (MAP), for a certain pressure difference (30, 40, 50 and 60 mmHg); 2) compare the results with those from the dynamic experiment, for the same pressure range. The resulting shear modulus G was 94 ± 16 kPa for the static experiment, which is in agreement with literature. A linear dependency on MAP was found for G, yet the effect of the pressure difference was negligible. The dynamic data revealed a G of 250 ± 20 kPa. For the same pressure range, the incremental shear modulus (Ginc) was 240 ± 39 kPa, which is in agreement with the former. In general, for all experiments, no significant differences in the values of G were found between different image planes. This study shows that 2D US elastography of aortas during inflation testing is feasible under controlled and physiological circumstances. In future studies, the in vivo, dynamic experiment should be repeated for a range of MAPs and pathological vessels should be examined. Furthermore, the use of more complex material models needs to be considered to describe the non-linear behavior of the vascular tissue

Experimental and computational biomedicine : Russian Conference with International Participation in memory of Professor Vladimir S. Markhasin : abstract book

Toward 100 Anniversary of I. P. Pavlov's Physiological Society.The volume contains the presentations that were made during Russian conference with international participation "Experimental and Computational Biomedicine" dedicated to corresponding member of RAS V.S. Markhasin (Ekaterinburg, April 10‒12, 2016). The main purpose of the conference is the discussion of the current state of experimental and theoretical research in biomedicine. For a wide range of scientists, as well as for lecturers, students of the biological and medical high schools.Сборник содержит тезисы докладов, представленных на российской конференции с международным участием «Экспериментальная и компьютерная биомедицина», посвященной памяти члена‐корреспондента РАН В. С. Мархасина (г. Екатеринбург, 10‒12 апреля 2016 г.). Основной целью конференции является обсуждение современного состояния экспериментальных и теоретических исследований в области биомедицины. Сборник предназначен для ученых, преподавателей, студентов и аспирантов биологического и медицинского профиля.МАРХАСИН ВЛАДИМИР СЕМЕНОВИЧ (1941-2015)/ MARKHASIN VLADIMIR SEMENOVICH (1941-2015). [3] PROGRAMM COMMITTEE. [5] ORGANIZING COMMITTEE. [6] KEYNOTE SPEAKERS. [7] CONTENTS. [9] PLENARY LECTURES. [10] Fedotov S. Non-Markovian random walks and anomalous transport in biology. [10] Hoekstra A. Multiscale modelling in vascular disease. [10] Kohl P. Systems biology of the heart: why bother? [10] Meyerhans A. On the regulation of virus infection fates. [11] Panfilov A.V., Dierckx H., Kazbanov I., Vandersickel N. Systems approach to studying mechanisms of ventricular fibrillationusing anatomically accurate modeling. [11] Revishvili A.S. Atrial fibrillation. Noninvasive diagnostic and treatment:from fundamental studies to clinical practice. [12] Rice J. Life sciences research at IBM. [12] Roshchevskaya I.M., Smirnova S., Roshchevsky M.P. Regularities of the depolarization of an atria:an experimental comparative-physiological study. [12] Rusinov V.L., Chupahin O.N., Charushin V.N Scientific basis for development of antiviral drugs. [13] Solovyova O.E. Tribute Lecture. Mechano-electric heterogeneity of the myocardiumas a paradigm of its function. [13] Veksler V. Myocardial energy starvation in chronic heart failure:perspectives for metabolic therapy. [13] Wladimiroff J.W. Fetal cardiac assessment using new methodsof ultrasound examination. [14] Yushkov B.G., Chereshnev V.A. The important questions of regeneration theory. [14] EXPERIMENTAL AND COMPUTATIONAL MODELS IN CARDIOVASCULARPHYSIOLOGY AND CARDIOLOGY. [15] EXPERIMENTAL AND COMPUTATIONAL MODELS IN CARDIOVASCULARPHYSIOLOGY AND CARDIOLOGY. [15] Arteyeva N. T-wave area along with Tpeak-Tend interval is the most accurateindex of the dispersion of repolarization. [15] Borodin N., Iaparov B.Y., Moskvin A. Mathematical modeling of the calmodulin effect on the RyR2 gating. [15] Dokuchaev A., Katsnelson L.B., Sulman T.B., Shikhaleva E.V., Vikulova N.A. Contribution of cooperativity to the mechano-calcium feedbacksin myocardium. Experimental discrepancy and mathematicalapproach to overcome it. [16] Elman K.A., Filatova D.Y., Bashkatova Y.V., Beloschenko D.V. The stochastic and chaotic estimation of parametersof cardiorespiratory system of students of Ugra. [16] Erkudov V.O., Pugovkin A.P., Verlov N.A., Sergeev I.V., Ievkov S.A., Mashood S., Bagrina J.V. Characteristics of the accuracy of calculation of values of systemic blood pressure using transfer functions in experimental blood loss and its compensation. [16] Ermolaev P., Khramykh T.Mechanisms of cardiodepression after 80% liver resection in rats. [17] Filatova O.E., Rusak S.N., Maystrenko E.V., Dobrynina I.Y. Aging dynamics of cardio-vascular parameters аboriginal systemand alien population of the Russian North. [17] Frolova S., Agladze K.I., Tsvelaya V., Gaiko O. Photocontrol of voltage-gated ion channel activity by azobenzenetrimethylammonium bromide in neonatal rat cardiomyocytes. [18] Gorbunov V.S., Agladze K.I., Erofeev I.S. The application of C-TAB for excitation propagation photocontrolin cardiac tissue. [18] Iribe G. Localization of TRPC3 channels estimated by in-silicoand cellular functional experiments. [19] Kachalov V.N., Tsvelaya V., Agladze K.I. Conditions of the spiral wave unpinning from the heterogeneitywith different boundary conditions in a model of cardiac tissue. [19] Kalita I., Nizamieva A.A., Tsvelaya V., Kudryashova N., Agladze K.I. The influence of anisotropy on excitation wave propagationin neonatal rat cardiomyocytes monolayer. [19] Kamalova Y. The designing of vectorcardiograph prototype. [20] Kapelko V., Shirinsky V.P., Lakomkin V., Lukoshkova E., Gramovich V.,Vyborov O., Abramov A., Undrovinas N., Ermishkin V. Models of chronic heart failure with acute and gradual onset. [20] Khassanov I., Lomidze N.N., Revishvili A.S. Remote Patient Monitoring and Integration of Medical Data. [20] Kislukhin V. Markov chain for an indicator passing throughoutcardio-vascular system (CVS). [21] Konovalov P.V., Pravdin S., Solovyova O.E., Panfilov A.V. Influence of myocardial heterogeneity on scroll wave dynamicsin an axisymmetrical anatomical model of the left ventricle of thehuman heart. [21] Koshelev A., Pravdin S., Ushenin K.S., Bazhutina A.E. An improved analytical model of the cardiac left ventricle. [22] Lookin O., Protsenko Y.L. Sex-related effects of stretch on isometric twitch and Ca2+ transientin healthy and failing right ventricular myocardiumof adult and impuberal rats. [22] Moskvin A. Electron-conformational model of the ligand-activated ion channels. [22] Nezlobinsky T., Pravdin S., Katsnelson L.B. In silico comparison of the electrical propagation wave alongmyocardium fibers in the left ventricle wall vs. isolation. 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Dynamics of scroll wave filaments in personalized modelsof the left ventricle of the human heart. [28] Vasserman I.N., Shardakov I.N., Shestakov A.P. Deriving of macroscopic intracellular conductivity of deformedmyocardium based on its microstructure. [28] Vassilevski Y.V., Pryamonosov R., Gamilov T. Personalized 3D models and applications. [29] Zun P.S., Hoekstra A., Anikina T.S. First results of fully coupled 3D models of in-stent restenosis. [29] BIOMECHANICS. EXPERIMENTAL AND MATHEMATICAL MODELSSBIOMECHANICS. EXPERIMENTAL AND MATHEMATICAL MODELS. EXPERIMENTAL AND MATHEMATICAL MODELS. [30] Balakin A., Kuznetsov D., Protsenko Y.L. The ‘length-tension’ loop in isolated myocardial preparations of theright ventricle of normal and hypertrophied hearts of male rats. [30] Belousova M.D., Kruchinina A.P., Chertopolokhov V.A. Automatic control model of the three-tier arm type manipulatorin the aimed-movement task. [30] Berestin D.K., Bazhenova A.E., Chernikov N.A., Vokhmina Y.V. Mathematical modeling of dynamics of development of Parkinson'sdisease on the tremor parameters. [31] Dubinin A.L., Nyashin Y.I., Osipenko M.A. Development of the biomechanical approach to tooth movementunder the orthodontic treatment. [31] Galochkina T., Volpert V. Reaction-diffusion waves in mathematical model of bloodcoagulation. [31] Golov A.V., Simakov S., Timme E.A. Mathematical modeling of alveolar ventilationand gas exchange during treadmill stress tests. [32] Gurev V., Rice J. Strain prediction in 3D finite element models of cardiac mechanics. [32] Kamaltdinov M.R. Simulation of digestion processes in antroduodenum:food particles dissolution in consideration of functional disorders. [33] Khamzin S., Kursanov A., Solovyova O.E. Load-dependence of the electromechanical function of myocardiumin a 1D tissue model. [33] Khokhlova A., Iribe G., Solovyova O.E Transmural gradient in mechanical properties of isolatedsubendocardial and subepicardial cardiomyocytes. [33] Kruchinin P.A. Optimal control problem and indexesof stabilometric "test with the visual step input". [34] Kruchinina A.P., Yakushev A.G. A study of the edge segments of saccadic eye trajectory. [34] Kursanov A., Khamzin S., Solovyova O.E. Load-dependence of intramyocardial slow force responsein heterogeneous myocardium. [35] Lisin R.V., Balakin A., Protsenko Y.L. Experimental study of the intramyocardial slow force response. [35] Melnikova N.B., Hoekstra A. The mechanics of a discrete multi-cellular model of arterial in‐stent restenosis. [35] Murashova D.S., Murashov S.A., Bogdan O.P., Muravieva O.V., Yugova S.O. Modelling of soft tissue deformation for static elastometry. [36] Nikitin V.N., Tverier V.M., Krotkikh A.A. Occlusion correction based on biomechanical modelling. [36] Nyashin Y.I., Lokhov V.A. Development of the “Virtual physiological human” concept. [37] Shulyatev A.F., Akulich Y.V., Akulich A.Y., Denisov A.S. 3D FEA simulation of the proximal human femur. [37] Smoluk A.T., Smoluk L.T., Balakin A., Protsenko Y.L., Lisin R.V. Modelling viscoelastic hysteresis of passive myocardial sample. [37] Svirepov P.I. Mathematical modeling of the left atria mechanical actionwith mitral regurgitation. [38] Svitenkov A., Rekin O., Hoekstra A. Accuracy of 1D blood flow simulations in relation to level of detailof the arterial tree model. [38] Tsinker M. Mathematical modelling of airflow in human respiratory tract. [39] Wilde M.V. Influence of artificial initial and boundary conditionsin biomechanical models of blood vessels. [39] ELECTROPHYSIOLOGY. EXPERIMENTAL AND COMPUTATIONAL MODELS. CLINICAL STUDIES. [40] Agladze K.I., Agladze N.N. Arrhythmia modelling in tissue culture. [40] Golovko V., Gonotkov M.A. Pharmacological analysis of transmembrane action potential'smorphology of myoepitelial cells in the spontaneously beating heartof ascidia Styela rustica. [40] Gonotkov M.A., Golovko V. 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Valoración y tratamiento con punción seca profunda de puntos gatillo miofasciales latentes: efectos sobre las propiedades biomecánicas y neurofisiológicas

Los puntos gatillo miofasciales (PGMs) son nódulos hiperirritables en una banda tensa (BT) del músculo esquelético, pudiendo distinguirse PGMs activos y PGMs latentes. Pueden dar lugar a dolor local y referido, síntomas autonómicos, rangos de movimiento restringidos y afectación de los patrones de activación muscular. Cuando esos nódulos palpables se estimulan mecánicamente, además del dolor local y en ocasiones de dolor referido, pueden obtenerse respuestas de espasmo local (RELs) visibles o palpables. Una de las técnicas más empleadas para el tratamiento de los PGMs es la punción seca profunda (PSP), una técnica mínimamente invasiva que consiste en la inserción de una aguja sólida y filiforme en el PGM. Se postula que el efecto de la PSP se produce por la estimulación mecánica del PGM con la aguja. Estudios recientes han valorado los cambios sobre la rigidez/tono muscular y la excitabilidad de la motoneurona alfa provocados por los PGMs, pero no nos consta la existencia de estudios que hayan valorado las diferencias de los PGMs respecto al tejido circundante (banda tensa) en sujetos sanos con un PGM latente. Tampoco existen estudios que valoren el efecto de la PSP sobre el PGM o la BT en relación a cambios en la excitabilidad de la motoneurona. Asimismo, a pesar de que la rigidez/tono muscular han sido ampliamente estudiados en la literatura, no tenemos constancia de estudios clínicos que evalúen la repercusión de la aplicación de la técnica de PSP cuando se realiza sobre el PGM o cuando se realiza en su BT. Objetivos: El objetivo principal de esta tesis doctoral fue analizar la efectividad de la PSP sobre el PGM medial latente del músculo sóleo y su BT sobre los parámetros de rigidez, fuerza, extensibilidad muscular y sobre la excitabilidad de la motoneurona. Asimismo, se evaluó si el miotonómetro es un instrumento válido y fiable para diferenciar las propiedades mecánicas de los PGMs y sus BTs. Material y Métodos: Tres estudios han sido llevados a cabo en la presente tesis doctoral, siendo uno de ellos un estudio descriptivo transversal y los otros dos, ensayos clínicos aleatorizados doble ciego. La población de elección en los tres estudios fueros sujetos sanos voluntarios con un PGM latente del músculo sóleo. En el estudio I participaron 50 voluntarios y se analizaron las diferencias en las propiedades mecánicas entre los PGMs latentes y sus bandas tensas por medio de la miotonometría (parámetros de frecuencia, rigidez y decremento), se evaluó la reproducibilidad inter-examinador de las mediciones de miotonometría y se examinó la asociación entre la miotonometría y la dinamometría isocinética pasiva (rigidez muscular y extensibilidad muscular). En el estudio II, participaron 46 sujetos que se asignaron aleatoriamente a dos grupos, el grupo intervención que recibió 1 sesión de PSP en el PGM medial latente del músculo sóleo derecho y el grupo control que recibió 1 sesión de PSP en la BT del PGM medial latente del músculo sóleo. Se registró la rigidez muscular (fuerza de resistencia pasiva), la extensibilidad muscular (rango pasivo de movimiento) y la fuerza isométrica máxima voluntaria mediante dinamometría isocinética y la evaluación neurofisiológica mediante la evaluación del reflejo H del sóleo (antes de la PSP, posterior a los 30 minutos y 1 semana después). En el estudio III, participaron 50 sujetos que se asignaron aleatoriamente a dos grupos, el grupo intervención que recibió 1 sesión de PSP en el PGM medial latente del músculo sóleo derecho y el grupo control que recibió 1 sesión PSP en la BT del PGM medial latente del músculo sóleo. Se evaluó la rigidez muscular pasiva (frecuencia, decremento y rigidez) mediante miotonometría tanto en el PGM medial latente del músculo sóleo derecho como en la BT (antes de la PSP y después a los 30 minutos). Resultados: En el estudio I se obtuvieron valores más altos para el parámetro de rigidez en la BT (328,56±53,22) con respecto al PGM (304,84±48,77; p0,75). El error de medición estándar (SEM) y la diferencia mínima detectable (MDD) indicaron un pequeño error de medición para las variables de frecuencia y rigidez (SEM%0,05) y solamente se observó un aumento de la fuerza isométrica voluntaria máxima de los flexores plantares en el análisis intragrupo en el grupo intervención (p<0,0125; 0,2<d<0,5). En el estudio III los resultados mostraron que el parámetro rigidez se redujo significativamente con un gran tamaño del efecto después de la PSP en el PGM cuando se midió en la localización del PGM (p=0,002; d=0,928), pero no cuando se midió en la localización Por el contrario, no se observaron cambios significativos en ningún lugar cuando se pinchó la BT (p>0,05). Conclusiones: Se demostró que el miotonómetro es una herramienta fiable que fue capaz de cuantificar diferencias entre las propiedades mecánicas del PGM y la BT. Además, una sesión de PSP en el PGM medial latente del músculo sóleo derecho no modificó la rigidez muscular, la extensibilidad muscular y la excitabilidad de la motoneurona pero sí que fue efectiva para disminuir el parámetro de rigidez de la miotonometría en el área del PGM. Futuros estudios deberían valorar el efecto de la aplicación de la PSP en un mayor número de PGMs y/o en un mayor número de sesiones; así como evaluar cambios en la rigidez, la fuerza, la extensibilidad muscular y en la excitabilidad de la motoneurona en sujetos con síndrome de dolor miofascial o con trastornos del tono muscular