Transcutaneous vagus nerve stimulation at nonspecific timings during training can compromise motor adaptation in healthy humans.

Adding afferent vagus nerve stimulation to motor training via implanted electrodes can modify neuromotor adaptation depending on the stimulation timing. This study aimed to understand neuromotor adaptations when transcutaneous vagus nerve stimulation (tVNS) is applied at nonspecific timings during motor skill training in healthy humans. Twenty-four healthy young adults performed visuomotor training to match a complex force trajectory pattern with the index and little finger abduction forces concurrently. Participants were assigned to the tVNS group receiving tVNS at the tragus or the sham group receiving sham stimulation to the earlobe. The corresponding stimulations were applied at nonspecific timings throughout the training trials. Visuomotor tests were performed without tVNS or sham stimulation before and after training sessions across days. The reduction in the root mean square error (RMSE) against the trained force trajectory was attenuated in the tVNS group compared with the sham group, while its in-session reduction was not different between groups. The reduction of RMSE against an untrained trajectory pattern was not different between groups. No training effect was observed in corticospinal excitability or GABA-mediated intracortical inhibition. These findings suggest that adding tVNS at nonspecific timings during motor skill training can compromise motor adaptation but not transfer in healthy humans.NEW & NOTEWORTHY Adding vagus nerve stimulation via implanted electrodes during motor training can facilitate motor recovery in disabled animals and humans. No study examined the effect of transcutaneous vagus nerve stimulation (tVNS) during training on neuromotor adaptation in healthy humans. We have found that adding tVNS at nonspecific timings during motor skill training can compromise motor adaptation but not transfer in healthy humans.

Design and Preliminary Evaluation of a Tongue-Operated Exoskeleton System for Upper Limb Rehabilitation.

Stroke is a devastating condition that may cause upper limb paralysis. Robotic rehabilitation with self-initiated and assisted movements is a promising technology that could help restore upper limb function. Previous studies have established that the tongue motion can be used to communicate human intent and control a rehabilitation robot/assistive device. The goal of this study was to evaluate a tongue-operated exoskeleton system (TDS-KA), which we have developed for upper limb rehabilitation. We adopted a tongue-operated assistive technology, called the tongue drive system (TDS), and interfaced it with the exoskeleton KINARM. We also developed arm reaching and tracking tasks, controlled by different tongue operation modes, for training and evaluation of arm motor function. Arm reaching and tracking tasks were tested in 10 healthy participants (seven males and three females, 23-60 years) and two female stroke survivors with upper extremity impairment (32 and 58 years). All healthy and two stroke participants successfully performed the tasks. One stroke subject demonstrated a clinically significant improvement in Fugl-Meyer upper extremity score after practicing the tasks in six 3-h sessions. We conclude that the TDS-KA system can accurately translate tongue commands to exoskeleton arm movements, quantify the function of the arm, and perform rehabilitation training.

Reconstruction of net force fluctuations from surface EMGs of multiple muscles in steady isometric plantarflexion.

The purposes of this study were to clarify if force fluctuations during steady multi-muscle contractions have a temporal correlation with a low-frequency component of rectified surface EMG (rEMG) in the involved muscles and collection of that component across muscles allows for the reconstruction of force fluctuations across a wide range of contraction intensities. Healthy young men (n = 15) exerted steady isometric plantarflexion force at 5-60% of maximal force. Surface EMG was recorded from the medial and lateral gastrocnemii, soleus, peroneus longus, abductor hallucis, and tibialis anterior muscles. The cross-correlation function (CCF) between plantarflexion force fluctuations and low-pass filtered rEMG in each muscle was calculated for 8 s. To reconstruct force fluctuations from rEMGs, the product of rEMG and an identified constant factor were summed across muscles with time-lag compensation for electro-mechanical delay. A distinct peak of the CCF was found between plantarflexion force fluctuations and rEMG in most cases except for the tibialis anterior. The CCF peak was greatest in the medial gastrocnemius and soleus. Reconstructed force from rEMGs was temporally correlated with measured force fluctuations across contraction intensities (average CCF peak: r = 0.65). The results indicate that individual surface rEMG has a low-frequency component that is temporally correlated with net force fluctuations during steady multi-muscle contractions and contributes to the reconstruction of force fluctuations across a wide range of contraction intensities. It suggests a potential applicability of individual surface EMGs for identifying the contributing muscles to controlling or disturbing isometric steady force in multi-muscle contractions.

Statistical Inter-stimulus Interval Window Estimation for Transient Neuromodulation via Paired Mechanical and Brain Stimulation.

For achieving motor recovery in individuals with sensorimotor deficits, augmented activation of the appropriate sensorimotor system, and facilitated induction of neural plasticity are essential. An emerging procedure that combines peripheral nerve stimulation and its associative stimulation with central brain stimulation is known to enhance the excitability of the motor cortex. In order to effectively apply this paired stimulation technique, timing between central and peripheral stimuli must be individually adjusted. There is a small range of effective timings between two stimuli, or the inter-stimulus interval window (ISI-W). Properties of ISI-W from neuromodulation in response to mechanical stimulation (Mstim) of muscles have been understudied because of the absence of a versatile and reliable mechanical stimulator. This paper adopted a combination of transcranial magnetic stimulation (TMS) and Mstim by using a high-precision robotic mechanical stimulator. A pneumatically operated robotic tendon tapping device was applied. A low-friction linear cylinder achieved high stimulation precision in time and low electromagnetic artifacts in physiological measurements. This paper describes a procedure to effectively estimate an individual ISI-W from the transiently enhanced motor evoked potential (MEP) with a reduced number of paired Mstim and sub-threshold TMS trials by applying statistical sampling and regression technique. This paper applied a total of four parametric and non-parametric statistical regression methods for ISI-W estimation. The developed procedure helps to reduce time for individually adjusting effective ISI, reducing physical burden on the subject.

Anti-phase cocontraction practice attenuates in-phase low-frequency oscillations between antagonistic muscles as assessed with phase coherence.

Voluntary contraction of skeletal muscles involves common in-phase neural oscillations in low frequencies (around 1-2 Hz) across muscles. The purpose of this study was to determine if anti-phase antagonistic cocontraction practice can attenuate the occurrence of in-phase low-frequency oscillations in antagonistic muscle activity. For this purpose, we determined the probability density function of phase coherence in surface electromyogram (EMG) between antagonistic muscles. Healthy young adults were assigned to one of three intervention groups. They performed an isometric transient and steady cocontraction test with elbow flexors and extensors before and after a session of distinct intervention. In the Cocontraction group, subjects practiced alternating anti-phase isometric cocontraction with the flexors and extensors concurrently. In the Contraction group, subjects practiced alternating isometric contraction levels with flexors or extensors independently. Subjects in the Control group did not perform motor practice. The occurrence of in-phase coherence < 3 Hz during the cocontraction test (including transient and steady portions) was determined from the probability density function of phase coherence in rectified EMG between pairs of elbow flexor and extensor muscles. The change in the probability of in-phase coherence after the intervention period was greatest in the Cocontraction group, followed by Contraction group, and then Control group, on average. The Cocontraction group showed significantly greater reductions than the Control group across the cocontraction test portions. The results suggest that a session of anti-phase cocontraction practice can consistently attenuate the occurrence of in-phase low-frequency oscillations between cocontracting antagonistic muscles across steady and non-steady cocontractions in healthy young adults.

Lumbar muscle stiffness is different in individuals with low back pain than asymptomatic controls and is associated with pain and disability, but not common physical examination findings.

BACKGROUND: Lumbar muscle dysfunction is commonly implicated in low back pain (LBP). Shear-wave elastography (SWE) uses ultrasound technology to quantify absolute soft tissue stiffness (shear modulus), thereby allowing for estimation of individual muscle contraction and function. OBJECTIVES: To compare resting and contracted stiffness of lumbar spine musculature in individuals with and without LBP using SWE. A secondary aim was to explore for relationships between common self-report and physical examination measures and resting and contracted muscle stiffness in individuals with LBP. DESIGN: Cross-sectional. METHODS: Shear modulus of the lumbar musculature was measured in 60 participants with LBP and 60 asymptomatic controls (120 total) using SWE. The lumbar erector spinae were imaged at rest only, while the lumbar multifidus was imaged at rest and during contraction. Before imaging, participants with LBP underwent a standardized clinical examination including a brief history, self-report questionnaires, and a physical examination. Lumbar muscle shear modulus was compared between participants with LBP and asymptomatic controls using ANCOVA. Potential associations between shear modulus and selected self-report and physical examination measures were assessed using correlation analysis. RESULTS: Stiffness of the erector spinae and lumbar multifidus at rest (but not during contraction) was greater in participants with LBP than in asymptomatic controls (p < 0.05). Many of the self-report measures, but none of the physical examination findings were associated with muscle stiffness. CONCLUSION: Resting lumbar muscle stiffness is greater in individuals with LBP than asymptomatic controls and is associated with self-reported pain and disability, but not physical exam findings.

Corticospinal excitability for flexor carpi radialis decreases with baroreceptor unloading during intentional co-contraction with opposing forearm muscles.

Concurrent activation of antagonistic muscles (co-contraction) is used for stiffening a joint, whereas its neural control under hemodynamic stress (e.g., posture change, high gravity, and hemorrhage) is unknown. Corticospinal excitability during co-contraction may be altered with baroreceptor unloading due to potential modulations in spinal and/or inhibitory pathways (e.g., disynaptic group I inhibition and GABA-mediated intracortical inhibition). The purpose of this study was to understand the effect of baroreceptor unloading on corticospinal excitability during co-contraction in humans. Motor evoked potential and cortical silent period in a wrist flexor muscle were examined using transcranial magnetic stimulation in two groups of healthy young adults. All subjects performed isometric contraction of the wrist flexors (flexion) and co-contraction of the wrist flexors and extensors (co-contraction). Spinal disynaptic inhibition was also assessed with the ratio of H-reflex responses to unconditioned and conditioned electrical stimulations of the peripheral nerves for the muscles. In one of the groups, baroreflex unloading was induced by applying lower body negative pressure. There was no significant effect of baroreflex unloading on cortical silent period or H-reflex measure of disynaptic inhibition. With baroreflex unloading, motor evoked potential area in the flexor carpi radialis was decreased during co-contraction but not during flexion. The results indicated that baroreceptor unloading decreases corticospinal excitability during co-contraction of antagonistic muscles, apparently by influencing neural pathways that were not probed with cortical silent period or spinal disynaptic inhibition.

Normative parameters and anthropometric variability of lumbar muscle stiffness using ultrasound shear-wave elastography.

BACKGROUND: Quantifying stiffness of the lumbar spine musculature using shear-wave elastography (SWE) maybe beneficial in the diagnosis and treatment of non-specific low back pain (LBP). The primary purpose of this study was to establish normative parameter and variance estimates of lumbar spine muscle stiffness at rest and during submaximal contraction levels using SWE in healthy individuals. A second aim was to determine the relationship between lumbar spine muscle stiffness and a variety of demographic, anthropometric, and medical history variables. METHODS: This cross-sectional study included stiffness measurements of the lumbar musculature in 120 asymptomatic individuals using ultrasound SWE. The lumbar erector spinae muscle was measured during rest only and lumbar multifidus muscle was measured during rest and during submaximal contraction using a prone contralateral arm lift. Statistical comparisons of shear modulus were made between sex (male vs. female) and muscle condition (erector spinae rest, lumbar multifidus rest, lumbar multifidus contracted) using 2 × 3 repeated measures analysis of variance (ANOVA). Univariate associations between shear modulus and age, sex, BMI, activity level, and history of back pain were assessed using correlation analysis. FINDINGS: Shear modulus at rest was approximately 4 kPa for the erector spinae muscles and approximately 6 kPa for the lumbar multifidus muscles. Shear modulus substantially increased during contraction, and varied by sex, BMI, and self-reported activity level, with men and more active individuals generally having stiffer muscles. INTERPRETATION: Variability in shear modulus of the lumbar musculature may be mediated through a combination of muscle size and contractile state, which is consistent with our findings of higher stiffness in the more postural lumbar multifidi muscles, during contraction, and in larger and more active individuals. These findings should inform and be accounted for in future comparative clinical studies.

Reliability of ultrasound shear-wave elastography in assessing low back musculature elasticity in asymptomatic individuals.

Patients with low back pain commonly exhibit impaired morphology and function of spinal musculature that may be quantifiable using shear-wave elastography (SWE). The purpose of this study was to assess the intra-rater and test-retest reliability of SWE elasticity measures of the lumbar erector spinae and multifidus muscles during rest and differing levels of contraction in asymptomatic individuals. This single-group repeated-measures design involved a baseline measurement session and a follow-up session 3 days later. The lumbar multifidus was imaged at rest and during three levels of contraction (minimal, moderate, and maximum). The lumbar erector spinae (illiocostalis and longissimus muscles) were imaged at rest only. Overall reliability estimates were fair to excellent with ICCs ranging from 0.44 to 0.92. Reliability was higher in the lumbar multifidus muscles than the erector spinae muscles, slightly higher during contraction than during rest, and substantially improved by using the mean of 3 measurements. By reliably quantifying impaired spinal musculature, SWE may facilitate an improved understanding of the etiology and treatment of low back pain and other muscle pain-related conditions such as trigger points and fibromyalgia.

Robotic finger perturbation training improves finger postural steadiness and hand dexterity.

The purpose of the study was to understand the effect of robotic finger perturbation training on steadiness in finger posture and hand dexterity in healthy young adults. A mobile robotic finger training system was designed to have the functions of high-speed mechanical response, two degrees of freedom, and adjustable loading amplitude and direction. Healthy young adults were assigned to one of the three groups: random perturbation training (RPT), constant force training (CFT), and control. Subjects in RPT and CFT performed steady posture training with their index finger using the robot in different modes: random force in RPT and constant force in CFT. After the 2-week intervention period, fluctuations of the index finger posture decreased only in RPT during steady position-matching tasks with an inertial load. Purdue pegboard test score improved also in RPT only. The relative change in finger postural fluctuations was negatively correlated with the relative change in the number of completed pegs in the pegboard test in RPT. The results indicate that finger posture training with random mechanical perturbations of varying amplitudes and directions of force is effective in improving finger postural steadiness and hand dexterity in healthy young adults.

Optimal inter-stimulus interval for paired associative stimulation with mechanical stimulation.

In this paper, inter-stimulus interval (ISI) of paired associative stimulation (PAS) with mechanical stimulation was analyzed. PAS is a prominent therapeutic intervention for individuals after stroke and helps to improve limb function by strengthening excitatory synapses and inducing neural plasticity. This intervention involves repeated application of transcranial magnetic stimulation (TMS) followed by peripheral stimulation. When responses to both stimulations are overlapped in the brain at the same time, this successful PAS is expected to induce long term potentiation (LTP) which leads to a neural plasticity phenomenon. Therefore ISI between these two stimulations is very crucial in this treatment. Instead of electrical stimulation in general PAS, mechanical stimulation was used in this study due to some promising aspects of mechanical stimulation. Long latency stretch response (LLSR) was observed in electromyography (EMG) during the PAS with mechanical stimulation, since LLSR reflects successful overlapping of two stimulations. Each subject had specific range of ISIs, or a time window, that leads to successful overlapping of paired stimulations. These time window lengths varied between 5ms and 105 ms, and within this range it can be guaranteed to obtain LLSR in EMG at least 40% among the all PAS trials. In addition, normally distributed responses within time window suggests that the optimal ISI which results in the highest number of LLSRs is the average of the time window. This result suggests that PAS with mechanical stimulation could lead to a rehabilitation effect by regaining motor functionality when the two stimulations are paired with the optimal ISI and it could provide a significant advancement in neuromodulation.

Slow Intermuscular Oscillations are Associated with Cocontraction Steadiness.

PURPOSE: Voluntary muscle contraction often involves low-frequency correlated neural oscillations across muscles, which may degrade steady cocontraction between antagonistic muscles with distinct levels of activation per each muscle (unbalanced cocontraction). The purposes of the study were 1) to determine whether there is an association between the low-frequency correlated EMG oscillations and the performance of steady unbalanced cocontraction across individuals and 2) to determine whether a bout of out-of-phase cocontraction practice reduces the in-phase low-frequency correlated neural oscillations and improves the performance of steady unbalanced cocontraction. METHODS: Healthy young adults were divided into three intervention groups: cocontraction, contraction, and control. All participants were tested for unbalanced steady cocontractions with antagonistic muscles about the elbow joint before and after a bout of intervention with the visual feedback of surface EMG. During the intervention period, the cocontraction group practiced an out-of-phase cocontraction, whereas the contraction group practiced agonist contractions. RESULTS: Mean squared error and variance of EMG amplitude were positively correlated with low-frequency EMG coherence <3 Hz across subjects, which became more prevalent after the intervention period. There was no specific effect of the cocontraction intervention on these variables. CONCLUSION: These findings suggest that individuals with less low-frequency correlated neural oscillations tend to perform steady cocontraction more skillfully, and the low-frequency correlated oscillations may not be acutely modulated by one bout of out-of-phase cocontraction practice.

Correlated EMG Oscillations between Antagonists during Cocontraction in Men.

PURPOSE: The purpose of this study was to determine the modulation of common low-frequency oscillations in pools of motor units across antagonistic muscles because of the difference in the activation level of pools of spinal motor neurons and the presence of neuromuscular fatigue during intended cocontraction. METHODS: Ten healthy young men (21.8 ± 1.5 yr) performed intended steady cocontractions of elbow flexors and extensors at maximal and a submaximal (10% of maximal EMG) effort. The submaximal cocontraction was repeated after sustained maximal contraction of elbow flexors. Surface EMG was recorded from the biceps brachii and triceps brachii muscles. Correlated EMG oscillations between the antagonistic muscles were quantified by the cross-correlation function (CCF) using rectified EMG for the <3-Hz band and using rectified and unrectified EMG for the 3- to 15-Hz bands. RESULTS: The positive CCF peak in rectified EMG <3 Hz with little time lag (i.e., in-phase oscillations) during submaximal cocontraction was smaller compared with maximal cocontraction, but increased after the sustained contraction. In the 3- to 15-Hz band of both unrectified and rectified EMG, a negative CCF peak (i.e., out-of-phase oscillations) during submaximal cocontraction was smaller compared with maximal cocontraction but increased after the sustained contraction. Across subjects, the degree of reduction in maximal EMG amplitude after the sustained contraction was correlated with the amount of change in the CCF peak in <3 Hz but not in the 3- to 15-Hz band. CONCLUSION: The results indicate that 1) in-phase <3-Hz and out-of-phase 3-15-Hz correlated EMG oscillations between antagonistic muscles occur during intended cocontraction, and 2) the magnitude of these correlated oscillations increases with the activation level of pools of spinal motor neurons and neuromuscular fatigue.

A single bout of resistance exercise can enhance episodic memory performance.

Acute aerobic exercise can be beneficial to episodic memory. This benefit may occur because exercise produces a similar physiological response as physical stressors. When administered during consolidation, acute stress, both physical and psychological, consistently enhances episodic memory, particularly memory for emotional materials. Here we investigated whether a single bout of resistance exercise performed during consolidation can produce episodic memory benefits 48 h later. We used a one-leg knee extension/flexion task for the resistance exercise. To assess the physiological response to the exercise, we measured salivary alpha amylase (a biomarker of central norepinephrine), heart rate, and blood pressure. To test emotional episodic memory, we used a remember-know recognition memory paradigm with equal numbers of positive, negative, and neutral IAPS images as stimuli. The group that performed the exercise, the active group, had higher overall recognition accuracy than the group that did not exercise, the passive group. We found a robust effect of valence across groups, with better performance on emotional items as compared to neutral items and no difference between positive and negative items. This effect changed based on the physiological response to the exercise. Within the active group, participants with a high physiological response to the exercise were impaired for neutral items as compared to participants with a low physiological response to the exercise. Our results demonstrate that a single bout of resistance exercise performed during consolidation can enhance episodic memory and that the effect of valence on memory depends on the physiological response to the exercise.

Motor cortical disinhibition with baroreceptor unloading induced by orthostatic stress.

Unloading of the baroreceptors due to orthostatic stress increases corticospinal excitability. The purpose of this study was to examine the effects of baroreceptor unloading due to orthostatic stress on intracortical excitatory and inhibitory pathways in the motor cortex. With transcranial magnetic stimulation, measures of intracortical excitability for a hand muscle were tested on 2 days in healthy young adults. Lower body negative pressure (LBNP) of 40 mmHg was applied during one of the days and not during the Control day. During application of LBNP heart rate and the low-frequency component of heart rate variability increased, while mean arterial blood pressure was maintained. In the resting state, LBNP decreased short-interval intracortical inhibition (SICI) and had no effect on intracortical facilitation (ICF) or short-interval intracortical facilitation (SICF) compared with the Control day. During isometric contraction, no effects of LBNP were observed on tested measures of intracortical excitability including SICI, SICF, and cortical silent period. It was concluded that baroreceptor unloading due to orthostatic stress results in diminished intracortical inhibition, at least in the resting muscle.

Assessment of muscle stiffness using a continuously scanning laser-Doppler vibrometer.

INTRODUCTION: A stand-alone and low-cost elastography technique has been developed using a single continuously scanning laser Doppler vibrometer. METHODS: This elastography technique is used to measure the propagation velocity of surface vibrations over superficial skeletal muscles to assess muscle stiffness. RESULTS: Systematic variations in propagation velocity depending on the contraction level and joint position of the biceps brachii were demonstrated in 10 subjects. CONCLUSIONS: This technique may assist clinicians in characterizing muscle stiffness (or tone) changes due to neuromuscular disorders.

Muscle shear modulus measured with ultrasound shear-wave elastography across a wide range of contraction intensity.

INTRODUCTION: In this study we examine the repeatability of measuring muscle shear modulus using ultrasound shear-wave elastography between trials and between days, and the association between shear modulus and contraction intensity over a wide range of intensities. METHODS: Shear modulus of the biceps brachii was determined using ultrasound shear-wave elastography during static elbow flexion (up to 60% of maximal contraction) in healthy young adults. RESULTS: The correspondence of shear modulus was confirmed in phantoms between the manufacturer-calibrated values and the shear-wave elastography values. The intraclass correlation coefficient of muscle shear modulus was high: 0.978 between trials and 0.948 between days. Shear modulus increased linearly with elbow flexion torque across contraction intensity, and its slope was associated negatively with muscle strength. CONCLUSIONS: Muscle shear modulus measured with ultrasound shear-wave elastography may be useful for inferring muscle stiffness across a wide range of contraction intensity. In addition, it has high repeatability between trials and between days.

Oscillations in motor unit discharge are reflected in the low-frequency component of rectified surface EMG and the rate of change in force.

Common drive to a motor unit (MU) pool manifests as low-frequency oscillations in MU discharge rate, producing fluctuations in muscle force. The aim of the study was to examine the temporal correlation between instantaneous MU discharge rate and rectified EMG in low frequencies. Additionally, we attempted to examine whether there is a temporal correlation between the low-frequency oscillations in MU discharge rate and the first derivative of force (dF/dt). Healthy young subjects produced steady submaximal force with their right finger as a single task or while maintaining a pinch-grip force with the left hand as a dual task. Surface EMG and fine-wire MU potentials were recorded from the first dorsal interosseous muscle in the right hand. Surface EMG was band-pass filtered (5-1,000 Hz) and full-wave rectified. Rectified surface EMG and the instantaneous discharge rate of MUs were smoothed by a Hann-window of 400 ms duration (equivalent to 2 Hz low-pass filtering). In each of the identified MUs, the smoothed MU discharge rate was positively correlated with the rectified-and-smoothed EMG as confirmed by the distinct peak in cross-correlation function with greater values in the dual task compared with the single task. Additionally, the smoothed MU discharge rate was temporally correlated with dF/dt more than with force and with rectified-and-smoothed EMG. The results indicated that the low-frequency component of rectified surface EMG and the first derivative of force provide temporal information on the low-frequency oscillations in the MU discharge rate.

Motor performance of tongue with a computer-integrated system under different levels of background physical exertion.

The purpose of this study was to compare the motor performance of tongue, using Tongue Drive System, to hand operation for relatively complex tasks under different levels of background physical exertion. Thirteen young able-bodied adults performed tasks that tested the accuracy and variability in tracking a sinusoidal waveform, and the performance in playing two video games that require accurate and rapid movements with cognitive processing using tongue and hand under two levels of background physical exertion. Results show additional background physical activity did not influence rapid and accurate displacement motor performance, but compromised the slow waveform tracking and shooting performances in both hand and tongue. Slow waveform tracking performance by the tongue was compromised with an additional motor or cognitive task, but with an additional motor task only for the hand.

Quantification of dry needling and posture effects on myofascial trigger points using ultrasound shear-wave elastography.

OBJECTIVES: To determine (1) whether the shear modulus in upper trapezius muscle myofascial trigger points (MTrPs) reduces acutely after dry needling (DN), and (2) whether a change in posture from sitting to prone affects the shear modulus. DESIGN: Ultrasound images were acquired in B mode with a linear transducer oriented in the transverse plane, followed by performance of shear-wave elastography (SWE) before and after DN and while sitting and prone. SETTING: University. PARTICIPANTS: Women (N=7; mean age ± SD, 46±17y) with palpable MTrPs were recruited. INTERVENTION: All participants were dry needled in the prone position using solid filament needles that were inserted and manipulated inside the MTrPs. SWE was performed before and after DN in the sitting and prone positions. MAIN OUTCOME MEASURE: MTrPs were evaluated by shear modulus using SWE. RESULTS: Palpable reductions in stiffness were noted after DN and in the prone position. These changes were apparent in the shear modulus map obtained with ultrasound SWE. With significant main effects, the shear modulus reduced from before to after DN (P<.01) and from the sitting to the prone position (P<.05). No significant interaction effect between time and posture was observed. CONCLUSIONS: The shear modulus measured with ultrasound SWE reduced after DN and in the prone position compared with sitting, in agreement with reductions in palpable stiffness. These findings suggest that DN and posture have significant effects on the shear modulus of MTrPs, and that shear modulus measurement with ultrasound SWE may be sensitive enough to detect these effects.