Fleuren suggested that the modified ashworth scale does not provide a valid measure of spasticity 11, 12. Pdf comparison of modified ashworth scale and hoffmann. The more famously used tool found in the practice is the ashworth scale or the modified ashworth scale, 15. Originally developed as a measure of spasticity to assess the antispastic effects of carisoprodol in multiple sclerosis, the ashworth and modified ashworth. Tardieu scale measures the spasticity angle, which is the difference between the angle at the end of passive range of motion at slow stretch and the angle of catch at fast stretch. Research article comparison of modified ashworth scale with. The mas is performed in the supine position this will garner the most accurate and the lowest score as any.
Tardieu scale and modified tardieu scale mts strokengine. Validity of modified ashworth scale as a measure of wrist spasticity. One quick and easy way to measure spasticity is the modified ashworth scale mas. Tardieu scale this scale quantifies muscle spasticity by assessing the response of the muscle to stretch applied at specified velocities. During mas application, the evaluator performs passive movements on and assigns levels of spasticity to joints of interest according to the perceived muscle resistance to passive stretching 11. Intraobserver reliability of modified ashworth and tardieu scales in assessing spasticity 197 ty. Modified ashworth scale mas is used to assess spasticity intended population. Clinical spasticity was assessed using the modified ashworth scale mas.
This scale measures the presence of velocitydependent resistance on a 0 to 4 scale, with zero representing normal muscle tone, and four representing a limb that is fixed in flexion or extension. The modified ashworth scale was slightly more reliable than was the original scale but this difference was not significant p 0. The most widely used clinical tools are the ashworth scale 9, modified ashworth scale 10 and tardieu scale 1112. May 26, 2016 the modified ashworth scale does not comply with the concept of spasticity a velocitydependent increase in muscle tone scholtes, 2007 the modified ashworth scale measures muscle tone intensity at one, unspecified, velocity which can make comparisons difficult scholtes, 2007. The modified ashworth scale is the most universally accepted clinical tool used to measure the increase of muscle tone. Spasticity is one of the common complications in upper motor neuron lesions and without appropriate treatment it causes disturbances in movement pattern. We undertook this investigation to determine the interrater reliability of manual tests of elbow flexor muscle spasticity graded on a modified ashworth scale. The relation between ashworth scale scores and the. Intraobserver reliability of the modified tardieu scale in the upper limb of children with hemiplegia. Management of spasticity in multiple sclerosis ms ms.
From 04 normal to rigid tone physicians rating scale. Modified ashworth scale instructions general information derived bohannon and smith, 1987. Intraobserver reliability of modified ashworth scale and modified tardieu scale in the assessment of spasticity in children with cerebral palsy. The modified ashworth scale mas is the most used scale to determine spasticity. Evaluation of spasticity using the ashworth scale with. Examplesofmisapplicationofthe ashworth and modified ashworth scales three studies exemplify the prevailing misunderstanding of the lack of validity of the mas as a spasticity measure. Score comments score comments clinical outcomes variable scale covs. Stop using the ashworth scale for the assessment of spastisity letter. The ashworth scale was originally developed in 1964, and modi.
The study included 65 participants aged between 18 and 88 years with sci with spasticity. Scale is not reliable for measuring posture and associated. Spasticity, defined herein as a velocitydependent response of muscle to passive stretching,1,2 may be among the most commonly acknowledged sequelae of central nervous system. Research article comparison of modified ashworth scale. The purpose of the present study was to investigate the interrater reliability of the mmas during the assessment of elbow flexor spasticity in adult patients with poststroke hemiplegia. Botox onabotulinumtoxina treatment record for focal. Ashworth scale modified ashworth scale rehabmeasures database. Modified ashworth scale mas is one of the criteria in qualitative assessment of spasticity, and there are lots of controversies about its validity. The modified ashworth scale mas uses a similar scoring system as the ashworth scale. Pdf modified ashworth scale instructions huda muhammad.
The modified tardieu scale mts are clinical measures of muscle spasticity in patients with neurological conditions and it quantify spasticity by assessing the. Spasticity is one of the most common symptoms of multiple sclerosis ms. Comparison of modified ashworth scale and hoffmann reflex in. The modified ashworth scale mas purports to measure spasticity in patients with lesions of the central nervous system. The mas is performed in the supine position this will. Is not a measure of spasticity, but scores may by influenced by spasticity 2. To compare the mas with objective neurophysiological tests of spasticity. Assessment and treatment of spasticity barrow neurological institute.
Interrater reliability of a modified ashworth scale of. Testretest reliability and interrater reliability of the modified tardieu scale and the modified ashworth scale in hemiplegic patients with stroke. The most commonly used clinical measurement of spasticity is the ashworth scale as and its modified versions mas, bohannon and smith, 1987. The expanded ashworth scale allows investigators to score halfpoint increments between each of the above categories. Hosseini, journaliranian rehabilitation journal, year2011, volume10, pages2630. When considering correlation of the ashworth scale when used as a tool for the assessment of analysis, a nice correlation was found 0. This new scale is commonly referred to as the modified ashworth scale mas. Pdf interrater reliability of a modified ashworth scale of muscle. Pdf interrater reliability of the modified modified. Reliability and validity of the modified heckmatt scale in. Modified ashworth scale measures resistance to passive stretch commonly used as a primary or secondary outcome measurement in clinical trials the most universally recognized metric easy to perform and has a long history of use tardieu scale actually measures spasticity nonpharmacological treatment. Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected parts is moved in flexion or. Age, mental status and cooperation of the children can affect the evaluation.
Botox onabotulinumtoxina treatment record for focal spasticity. The scale measures the resistance and spasticity or catch in the joint during passive movement. Further development of a measure of spasticity at the ankle is required. The mas is a quick and easy measure that can assist a clinicians assessment of spasticity during passive softtissue stretching. The need for reliable and valid measures of spasticity to be used in the clinic and research has been recognized. Modified ashworth scale mas have been utilized in the following populations. It provides an additional scoring category in the mild range. Deglado and coworkers proposed a number of tools for assessment of spasticity. Modified ashworth scale octh 6260spring assessment rating. However, the validity of this scale has been challenged.
Ashworth and modified ashworth scale mas assessment overview assessment area icf domain. However, because of its nature, it is difficult to determine the severity of spasticity in children with cp. Nov 27, 2012 the modified ashworth scale mas is a commonly used, and easily applicable scale used to score passive individual muscle movement as the limb is moved through its entire arc of joint motion over a onesecond time period. To assess the reliability of the modified ashworth scale mas and modified tardieu scale mts in patients with spinal cord injuries scis. Apr 02, 2021 spasticity is difficult to quantify,ref3 but clinically useful scales include the following. Pdf spasticity is common symptom presented amongst people with sensorimotor disabilities. Modified scale and modified ashworth scale li f, wu y, li x. Interrater reliability of a modified ashworth scale of muscle spasticity. Spasticity was rated at each joint using a score of 0 for no increased tone to a maximum of 4 if the limb was rigid in flexion or extension. There are some controversies about the value of modified ashworth scale mas for assessing spasticity. The modified ashworth scale mas measures resistance during passive softtissue stretching and is used as a simple measure of spasticity. Therapists try to evaluate spasticity by judging changes in movement, improvements in adls or getting a feel for the amount of resistance. Reliability of the modified ashworth scale and modified.
Place the patient in a supine position if testing a muscle that primarily flexes a joint, place the joint in a maximally flexed position and move to a position of maximal extension over. The mas was recorded in patients with poststroke lower limb muscle spasticity and correlated with. The purpose of this study is to compare mas with electrophysiological indices of spasticity. Open access protocol comparing the validity of the modi. Modified ashworth scale reliability for measurement of. The modified modified ashworth scale mmas is a clinical tool used to measure spasticity. In the mmas, spasticity is scored on an ordinal scale from 0 to 4 as follows. For each muscle group, reaction to stretch is rated at a specified stretch velocity with 2. But since there is no measurement theres no way of telling if an intervention is working.
The modified ashworth scale does not comply with the concept of spasticity a velocitydependent increase in muscle tone scholtes, 2007 the modified ashworth scale measures muscle tone intensity at one, unspecified, velocity which can make comparisons difficult scholtes, 2007. The kendalls tau correlation between our grades was. The modified ashworth scale is used by some clinicians because it is a more sensitive measure of mild spasticity. Modified ashworth scale for physical therapyspasticity evaluation. The mas better measures muscle hypertonia instead of spasticity. Interrater reliability of the modified modified ashworth. Modificaa reliability of the 7level functional independence measure fim. Composite spasticity index modified ashworth scale. Assessments of patients are effective in patients management. During mas application, the evaluator performs passive movements on and assigns levels of spasticity to joints of interest according.
Ashworth and modified ashworth scale spinal cord injury. Item score comments item score comments ul assessment as per ot recommendation hand functional assessment, auspinal etc. The most commonly used tools for the assessment of spasticity are the modified ashworth scale and modified tardieu scale, but the results on the reliability of both scales keep equivocal. The modified ashworth scale mas is the most widely used method for assessing muscle spasticity in clinical practice and research.
Pdf interrater reliability of a modified ashworth scale. Lower extremity functional scale modified barthel index motor assessment scale nottingham extended activities of daily life stroke impact scale sunnaas index spasticity these outcome measures assessed changes in muscle tone, stiffness, and contractures. Modified ashworth scale measures resistance to passive stretch commonly used as a primary or secondary outcome measurement in clinical trials the most universally recognized metric easy to perform and has a long history of use tardieu scale actually measures spasticity non. Ngrs numbered graphic rating scale spin scale of pain intensity 1. Interrater reliability of a modified ashworth scale of muscle. However, investigators widely used the scale for evaluation of spasticity, because it is an available and simple clinical measure of tone, 14, 15.
The ashworth scale is a measure of spasticity originally developed to assess the anti spastic effects of carisoprodol in multiple sclerosis it has subsequently. Place the patient in a supine position if testing a muscle that primarily flexes a joint, place the joint in a maximally flexed position and move to a position of maximal extension over one second count one thousand one. Pdf modified ashworth scale mas model based on clinical data. Inpatient rehabilitation clinics at two state hospitals. Grading is always performed at the same time of day, in a constant position of the body for a given limb.
Reliability of the tone assessment scale and the modified ashworth. The ashworth scale as can be used as an ordinal level measure of resistance to passive movement, but not spasticity. The ashworth and tardieu scales are common clinical measures of spasticity. Ashworth scale modified ashworth scale rehabmeasures. The modified ashworth scale mas measures resistance during passive softtissue stretching. The ashworth scale and the modified ashworth scale are most often used clinically in the assessment of adults, however the mts is more commonly used in the assessment of children and has been suggested to be a more accurate clinical measure of spasticity involuntary muscle tightness and stiffness that can occur after a stroke. Pdf whats the risk of using the modified ashworth scale.
This week looking into outcome measures for spasticity. An additional grade summary the ashworth scale is a measure of spasticity originally developed to. Imbalanced signals from the central nervous systems cns. Modified ashworth scale mas remain the primary clinical me. We each independently graded the elbow flexor muscle spasticity of 30 patients with intracranial lesions. Reliability of ashworth and modified ashworth scales in. Intraobserver reliability of modified ashworth scale and. Ashworth and tardieu, links below to access how to perform. Pdf validity of modified ashworth scale as a measure of. Bohannon and smith 1987 revised the original ashworth scale 1964 to render the scale more discrete. Spasticity or exaggerated reflex responses to passive stretch at high velocity appears to be, though that notion has never. Tardieu scale velocity to stretch v quality of muscle. This is considered to allow more accurate recording of the patients condition. Modified ashworth scale reliability for measurement of lower.
The ashworth scale is one of the most widely used methods of measuring spasticity, due in a large part to the simplicity and reproducible method. The modified ashworth scale mas will need to be treated as a nominal level measure of resistance to passive movement until the ambiguity between. Kappa values for the original ashworth and the modified ashworth scales were 0. Sep 29, 2009 the inter rater reliability of the original and of the modified ashworth scale for the assessment of spasticity in patients with spinal cord injury see comment. Possible goals of treatment are improving movement and functions, reducing functionally impairing malposition, improving mobility and independence, reducing spasticity related pain and painful spasms, avoiding longterm complications i.
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