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. 2021 Jan 30:27:e928109.
doi: 10.12659/MSM.928109.

Quantification of the Masseter Muscle Hardness of Stroke Patients Using the MyotonPRO Apparatus: Intra- and Inter-Rater Reliability and Its Correlation with Masticatory Performance

Chao Song  1 , Yi-Fu Yu  1 , Wen-Long Ding  1 , Jian-Yong Yu  2 , Li Song  1 , Ya-Nan Feng  3 , Zhi-Jie Zhang  3
Affiliations

Quantification of the Masseter Muscle Hardness of Stroke Patients Using the MyotonPRO Apparatus: Intra- and Inter-Rater Reliability and Its Correlation with Masticatory Performance

Chao Song et al. Med Sci Monit. .

Abstract

BACKGROUND Chewing dysfunction is one of the most common serious complications after a stroke. It may be influenced by the hardness of the masseter muscle and masticatory performance; however, the association between these 2 factors is not explicit. Thus, it is meaningful to explore the functional status of the masseter muscle among stroke patients. The main objectives of this study were to examine the intra- and inter-rater reliability of the MyotonPRO apparatus in measuring masseter muscle hardness in stroke patients and to investigate the correlation between the bilateral masseter muscle hardness and masticatory performance in these patients. MATERIAL AND METHODS A total of 20 stroke patients participated in our study. The hardness of the masseter muscle was measured by 2 physiotherapists using the MyotonPRO apparatus. Overall, each patient masticated 2 pieces of red-blue bicolor chewing gum for 20 chewing cycles each. The chewing pieces were analyzed using ViewGum software for masticatory performance. RESULTS The intra- and inter-rater reliability of the MyotonPRO apparatus for measuring bilateral masseter hardness of stroke patients was excellent. The correlation analysis showed that the hardness index of the masseter muscle on the affected side was moderately correlated with the masticatory performance of the same side. CONCLUSIONS The MyotonPRO device can be used for measuring the masseter muscle hardness of stroke patients, with excellent reliability. This study established the construct validity between the stiffness of the masseter muscle and masticatory performance.

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Figures

Figure 1
Figure 1
(A) The measurement position of the masseter muscle. (B) The direction of the probe of the MyotonPRO apparatus.
Figure 2
Figure 2
(A) The images of bicolor mixture bolus were imported into the ViewGum software. (B) The results of the image color analysis for masticatory performance.
Figure 3
Figure 3
Bland-Altman image of intra-rater credibility and inter-rater credibility of bilateral masseter muscle hardness in stroke patients. The agreement in the hardness value of the bilateral masseter muscle in stroke patients between 2 tests is presented by the mean value of the masseter muscle stiffness (mean value of test for assessor A) for each patient on the affected side (A) and the unaffected side (B). The agreement in the hardness value of the bilateral masseter muscle of stroke patients between different assessors (assessor A and assessor B) is presented by the mean value of the masseter muscle hardness for each patient on the affected side (C) and unaffected side (D). In each Bland-Altman image, the solid line represents the discrepancy of the mean value of the masseter muscle hardness and the dummy lines represent the range of standard deviations.
Figure 4
Figure 4
Comparison of the masseter muscle hardness values of the affected side and the unaffected side.
See this image and copyright information in PMC

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