The modified ashworth scale mas measures resistance during passive softtissue stretching and is used as a simple measure of spasticity. An additional grade summary the ashworth scale is a measure of spasticity originally developed to. Ashworth and modified ashworth scale mas assessment overview assessment area icf domain. The effect of quadriceps femoris muscle strengthening.
The ashworth scale was originally developed in 1964, and modified by bohannon and smith in 1987. Intensive therapy it programs for children with neurological dis. 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. 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. Published under licence by iop publishing ltd iop conference series. The aim of this study was to investigate the construct validity and interrater reliability of the ashworth scale as for the assessment of spasticity in the upper and lower extremities. Research article comparison of modified ashworth scale with. The severity of spasticity was evaluated by the modified ashworth scoring mas system, and locomotor function was evaluated by the bassobeattiebresnahan bbb scalebasso mouse score bms. Objective examination by the same neurologist was done.
Because the severity of spasticity was a potential confounding variable, all subjects with cp were assessed for their degree of right quadriceps femoris muscle spastic ity using a modified version of the ashworth scale. Frigge the university of wisconsinmilwaukee, 2016 under the supervision of professor yingchih wang, phd introduction. Botox is recommended as an option for focal spasticity in adults the therapeutics and technology assessment subcomittee of the american academy of neurology recommends with level a evidence that botox should be used as a treatment option for adult focal spasticity. What does the ashworth scale really measure and are. However, some publications question its ability to measure spasticity and advocate the modified ashworth scale as a rating scale to measure abnormality in tone or the resistance to passive movements, since there is no clinically direct method for measuring.
No study, to date, has been performed to compare the validity of the mmas and the mts. Nov 19, 2012 the ashworth scale was originally developed in 1964, and modified by bohannon and smith in 1987. Materials science and engineering, volume 260, conference 1. Interrater reliability of a modified ashworth scale of muscle spasticity. Interrater reliability of modified ashworth scale and modified tardieu scale in children with spastic cerebral palsy. Modified ashworth scale spasticity peripheral brain. This scale grades the muscle tone from 0 normal to 4 severe spasticity. N, naghdi s, 2012 comparing the validity of the modified modified ashworth scale mmas and the modified tardieu scale mts in the assessment of wrist flexor spasticity in patients with stroke. The study included 38 children with spastic diplegic cp. This sixfold scale range from 0 no spasticity to 4 fixed muscle contracture based on the amount of muscle resistance perceived by the examiner in response to passive stretch of particular joint see. The mmas is an ordinal level measure of spasticity, which grades the intensity of.
The presence of pain during shoulder abduction or contracture of the shoulder adductors had no influence on the reliability of the mmas. Open access protocol comparing the validity of the modi. The inter rater reliability of the original and of the modified ashworth scale for the assessment of spasticity in patients with spinal cord injury. Evaluation of spasticity using the ashworth scale with. Ashworth scale modified ashworth scale rehabmeasures database. Needle electromyography emg and examination under anesthesia can be helpful. Interrater reliability of the modified ashworth scale. Sixteen people, living in the community three years after their stroke main measures. Ashworth scale modified ashworth scale rehabmeasures.
It is a quick and easy measure that can help assess the efficacy of treatment. About 65%78% of the sci population have some amount of spasticity, and it is more common in cervical neck than thoracic chest and lumbar lower back injuries. You can use this scale in your initial physical examination or subsequent examinations to document response to medical interventions pharmacologic therapy, physical therapy, etc. Testretest reliability and interrater reliability of the modified tardieu scale and the modified ashworth scale in hemiplegic patients with stroke. Stop using the ashworth scale for the assessment of spasticity. The aim of this study was to investigate the interrater reliability of mas and modified mas mmas for the assessment of poststroke elbow flexor spasticity. 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. The modified ashworth scale mas is commonly used in clinical practice for grading spasticity. 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 mas better measures muscle hypertonia instead of spasticity.
Interrater reliability of a modified ashworth scale of. Later, modified ashworth scale mas has been developed with some additions to the ashworth scale table 4. We each independently graded the elbow flexor muscle spasticity of 30 patients with intracranial lesions. The most commonly used ones are the modified ashworth scale mas and the modified tardieu scale. Reliability of ashworth and modified ashworth scales in.
The safety evaluation showed that stimulation with either 1hz or 5hz. The ashworth or modified ashworth scales are commonly used to classify the severity of spasticity. To assess and to compare the reliability of the modified tardieu scale with the modified ashworth scale in patients with severe brain injury and impaired consciousness design. The modified ashworth scale mas is the most used scale to determine spasticity.
The mas is a function of the angle at which the clinician perceives a resistance to stretch andor a catch during a passive joint rotation. Allison and colleages found the scale is less reliable 10. Modified ashworth scale mas model based on clinical data measurement towards quantitative evaluation of upper limb spasticity. The scale measures the resistance and spasticity or catch in the joint during passive movement. The modified ashworth scale wrist spasticity was assessed by means of mas. Key messages reliable and valid tools must be used to assess spasticity accurately in clinical and research settings. Translating modified ashworth scale into functional. The modified ashworth scale table 1 is used to grade spasticity. We undertook this investigation to determine the interrater reliability of manual tests of elbow flexor muscle spasticity graded on a modified ashworth scale. Spasticity is a motor disorder characterized by a velocitydependent increase in tonic stretch reflexes. Ashworth score and hamstring stiffness were inversely relat. Start studying modified ashworth scale vs tardieu scale. Ashworth and tardieu, links below to access how to perform. Johnson proposed that the scale needed to be more accurate 1 and pandyan and coworkers and fleuren suggested that the modified.
The testretest reliability of the modified ashworth scale was moderate to good k 0. The ashworth scale as and modified ashworth scale mas measure spasticity. Spasticity only requires intervention if it is bothersome to the patient, interferes with function or results in unwanted limb contractures assessment is commonly completed using either tardieu or modified ashworth scale these scales provide a guide to compare treatment regimes and the impact of these. The mas is performed in the supine position this will garner the most accurate and the lowest score as any. Spasticity can range from relatively mild to quite severe, and treatment is approached in a stepwise fashion rehabilitative pt.
The ashworth scale and tardieu scale as well as laboratory measures of spasticity stretchinduced electromyographic emg activity and. Interrater reliability of a modified ashworth scale of muscle. Validity of modified ashworth scale as a measure of wrist. Modified ashworth scale the modified ashworth scale mas measures resistance during passive softtissue stretching. 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. The section of the tone assessment scale relating to response to passive movement is reliable at various joints, except the ankle. The modified ashworth scale is considered the primary clinical measure of muscle spasticity in patients with neurological conditions. The recently developed clinical measurement for the measurement of spasticity is the modified modified ashworth scale mmas purpose of study the purpose of this study is to determine the inter. The clinical import of the ashworth scale has not been well established and is, in part, enmeshed in the controversy as to whether spasticity has a signi. The authors have no direct financial interest continue reading. Sep, 2017 rct n241 found that at week 4, abobotulinumtoxina improves muscle tone in children with dynamic equinus modified ashworth scale scores.
Evaluation of spasticity after stroke by using ultrasound to measure the muscle architecture parameters. 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. Tardieu scale velocity to stretch v quality of muscle. One quick and easy way to measure spasticity is the modified ashworth scale mas. Modified ashworth scale reliability for measurement of.
Apr 10, 2008 a prospective crosssectional observational study was planned to determine the reliability of the ashworth scale as and the modified ashworth scale mas in children with spastic cerebral palsy cp. Pandyan et al 1987 presented in table 1, was first developed by ashworth in 1964 as a 5point scale, with the purpose of creating a simple clinical tool to test the efficiency of an antispastic drug in patients with multiple sclerosis. 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. Purpose of the measure the composite spasticity index csi provides a clinical measure of spasticity that can be used with patients with hemiparesis following stroke.
Evaluation of spasticity after stroke by using ultrasound. Reprinted with the express permission of rachel scott, pt, dpt background and purpose. These modifications resulted in a scale that conforms even more precisely than the ashworth scale to the guidelines of mackenzie and. The more famously used tool found in the practice is the ashworth scale or the modified ashworth scale, 15.
Modified ashworth scale mas was applied in both groups for assessing muscle tone of lower limbs no influence, contralateral. Comparing the validity of the modified modified ashworth. The original version is based on a five item scale ranging from 0 to 4. Intrarater reliability of the modified modified ashworth. Ashworth scale with all of its variants remains the standard with which other measures of spasticity are compared. Modified ashworth scale vs tardieu scale flashcards quizlet. To assess the reliability of the modified ashworth scale mas and modified tardieu scale mts in patients with spinal cord injuries scis. Modified ashworth scale instructions general information derived bohannon and smith, 1987. Many studies have been performed on the methodological qualities of the modified ashworth scale but overall these studies seem inconclusive. One of the most commonly used assessment for spasticity in the clinic frequently used as the goldstandard to validate other spasticity measures against. The modified ashworth scale mas better measures muscle hypertonia instead of spasticity. There is a paucity of literature regarding the validity of the modified modified ashworth scale mmas and the modified tardieu scale mts. The other methods are neuroimaging techniques and electrophysiological studies, but they are not practical in daily routine for spasticity assessment.
This week looking into outcome measures for spasticity. Apr 10, 2008 in the assessment of spasticity, methods that are easily used in practice are. Modified ashworth scale mas bohannon and smith 1987 grade description 0 no increase in muscle tone 1 slight increase in muscle tone, manifested by a catch and release or by. Interrater reliability of a modified ashworth scale of muscle spasticity article pdf available in physical therapy 672. Modified scale and modified ashworth scale li f, wu y, li x. A ahmad puzi 1, s n sidek 1, h mat rosly 1, n daud 2 and h md yusof 1. Spasticity involving wrist and finger muscles2 rangeofmotion assessment.
Crosssectional observational comparison study setting. Ashworth scale is the best available measure of spasticity, it may not be sensitive enough to identify small but clinically significant changes 9. The mmas had very good intrarater reliability in the assessment of upper limb spasticity in patients with hemiparesis. The severity of spasticity was evaluated by the modified ashworth scoring mas system, and locomotor function was evaluated by the bassobeattiebresnahan bbb scale basso mouse score bms.
The ashworth scale and mas measure spasticity and are applied manually to. The tardieu scale seems to do this better because it relies on the velocity dependence of spasticity. To compare the tardieu scale as a clinical measure of spasticity after stroke with the ashworth scale design. An early rehabilitation centre for adults with neurological disorders subjects. For each muscle group, reaction to stretch is rated at a specified stretch velocity with 2.
Pdf comparing the validity of the modified modified. Management of spasticity is often achieved with a combination of medications and surgical procedures. Modified ashworth scale for grading spasticity score description 0 no increase in muscle tone 1 slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion when theaffected parts is moved in flexion or extension. Therapists try to evaluate spasticity by judging changes in movement, improvements in adls or getting a feel for the amount of resistance. 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. The modified ashworth scale 1 ranges from 0 no increase in muscle tone to 4, in which affected parts are rigid in flexion or extension. Modified ashworth scale mas model based on clinical data. Is not a measure of spasticity, but scores may by influenced by spasticity 2. The modified as is also considered more of an abnormality in tone or resistance to passive movements scale rather than a direct spasticity scale. Reliability of the tone assessment scale and the modified.
Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion. Spasticity is the uncontrolled tightening or contracting of the muscles that is common in individuals with spinal cord injuries. Comparing the validity of the modified modified ashworth scale mmas and the modified tardieu scale mts in the assessment of wrist flexor spasticity in patients with strokeprotocol for a neurophysiological study. Thirty patients with impaired consciousness due to severe cerebral. Ashworth spasticity scale and modified version springerlink. Grading is always performed at the same time of day, in a constant position of the body for a given limb. The most wellknown and commonly used scale is ashworth scale as table 3. But since there is no measurement theres no way of telling if an intervention is working. Mar 23, 2015 the modified ashworth scale is a scale used to grade the severity of spasticity.
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