Johnson proposed that the scale needed to be more accurate 1 and pandyan and coworkers and fleuren suggested that the modified. Pdf interrater reliability of a modified ashworth scale of. 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 safety evaluation showed that stimulation with either 1hz or 5hz. 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 section of the tone assessment scale relating to response to passive movement is reliable at various joints, except the ankle.
Management of spasticity is often achieved with a combination of medications and surgical procedures. The modified as is also considered more of an abnormality in tone or resistance to passive movements scale rather than a direct spasticity scale. 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. 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.
The tardieu scale seems to do this better because it relies on the velocity dependence of spasticity. The mmas had very good intrarater reliability in the assessment of upper limb spasticity in patients with hemiparesis. Materials science and engineering, volume 260, conference 1. 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. Apr 10, 2008 in the assessment of spasticity, methods that are easily used in practice are. 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. Key messages reliable and valid tools must be used to assess spasticity accurately in clinical and research settings. It may assist in studies on the prevalence of spasticity after stroke and the relationship between tone and function. 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. We undertook this investigation to determine the interrater reliability of manual tests of elbow flexor muscle spasticity graded on a modified ashworth scale. 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.
Spasticity is the uncontrolled tightening or contracting of the muscles that is common in individuals with spinal cord injuries. There is a paucity of literature regarding the validity of the modified modified ashworth scale mmas and the modified tardieu scale mts. Ashworth and modified ashworth scale mas assessment overview assessment area icf domain. 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. Published under licence by iop publishing ltd iop conference series. Comparing the validity of the modified modified ashworth. Modified ashworth scale spasticity peripheral brain.
Modified ashworth scale vs tardieu scale flashcards quizlet. Examplesofmisapplicationofthe ashworth and modified ashworth scales three studies exemplify the prevailing misunderstanding of the lack of validity of the mas as a spasticity measure. The effect of quadriceps femoris muscle strengthening. Spasticity involving wrist and finger muscles2 rangeofmotion assessment. 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. Reprinted with the express permission of rachel scott, pt, dpt background and purpose. The mas better measures muscle hypertonia instead of spasticity.
Ashworth scale is the best available measure of spasticity, it may not be sensitive enough to identify small but clinically significant changes 9. These modifications resulted in a scale that conforms even more precisely than the ashworth scale to the guidelines of mackenzie and. You can use this scale in your initial physical examination or subsequent examinations to document response to medical interventions pharmacologic therapy, physical therapy, etc. One quick and easy way to measure spasticity is the modified ashworth scale mas. 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. Start studying modified ashworth scale vs tardieu scale. In the mmas, spasticity is scored on an ordinal scale from 0 to 4 as follows.
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. The study included 38 children with spastic diplegic cp. 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. Modified ashworth scale the modified ashworth scale mas measures resistance during passive softtissue stretching. Ashworth scale modified ashworth scale rehabmeasures database. Interrater reliability of a modified ashworth scale of muscle. 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. The modified ashworth scale mas is an assessment that is often used by clinicians to grade spasticity in the affected limbs of stroke survivors. Learn vocabulary, terms, and more with flashcards, games, and other study tools. 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. Thirty patients with impaired consciousness due to severe cerebral. The modified ashworth scale mas is commonly used in clinical practice for grading spasticity. Research article comparison of modified ashworth scale with.
Pdf interrater reliability of a modified ashworth scale. The modified ashworth scale mas better measures muscle hypertonia instead of spasticity. The inter rater reliability of the original and of the modified ashworth scale for the assessment of spasticity in patients with spinal cord injury. Modified ashworth scale mas was applied in both groups for assessing muscle tone of lower limbs no influence, contralateral. For each muscle group, reaction to stretch is rated at a specified stretch velocity with 2. 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. Mar 23, 2015 the modified ashworth scale is a scale used to grade the severity of spasticity. 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. 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. An early rehabilitation centre for adults with neurological disorders subjects. Sixteen people, living in the community three years after their stroke main measures. The other methods are neuroimaging techniques and electrophysiological studies, but they are not practical in daily routine for spasticity assessment.
Grading is always performed at the same time of day, in a constant position of the body for a given limb. Many studies have been performed on the methodological qualities of the modified ashworth scale but overall these studies seem inconclusive. We each independently graded the elbow flexor muscle spasticity of 30 patients with intracranial lesions. Evaluation of spasticity after stroke by using ultrasound. The modified ashworth scale mas measures resistance during passive softtissue stretching and is used as a simple measure of spasticity. The ashworth scale as and modified ashworth scale mas measure spasticity. 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.
A ahmad puzi 1, s n sidek 1, h mat rosly 1, n daud 2 and h md yusof 1. The modified ashworth scale table 1 is used to grade 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. 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. The ashworth scale was originally developed in 1964, and modified by bohannon and smith in 1987. Needle electromyography emg and examination under anesthesia can be helpful. The original version is based on a five item scale ranging from 0 to 4.
Reliability of the modified tardieu scale and the modified. 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. What does the ashworth scale really measure and are. Modified ashworth scale reliability for measurement of. Interrater reliability of a modified ashworth scale of muscle spasticity article pdf available in physical therapy 672. 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. Objective examination by the same neurologist was done. Validity of modified ashworth scale as a measure of wrist. Ashworth spasticity scale and modified version springerlink. Frigge the university of wisconsinmilwaukee, 2016 under the supervision of professor yingchih wang, phd introduction. 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 1 ranges from 0 no increase in muscle tone to 4, in which affected parts are rigid 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. Interrater reliability of a modified ashworth scale of muscle spasticity. 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 ashworth scale and mas measure spasticity and are applied manually to. 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. Tardieu scale velocity to stretch v quality of muscle. 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. Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion. Interrater reliability of the modified ashworth scale.
Tardieu scale this scale quantifies muscle spasticity by assessing the response of the muscle to stretch applied at specified velocities. 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. But since there is no measurement theres no way of telling if an intervention is working. The ashworth scale and tardieu scale as well as laboratory measures of spasticity stretchinduced electromyographic emg activity and. The authors have no direct financial interest continue reading. Introduction reliable and valid tools must be used to assess spasticity in clinical practise and research settings. Sep, 2017 rct n241 found that at week 4, abobotulinumtoxina improves muscle tone in children with dynamic equinus modified ashworth scale scores. The ashworth or modified ashworth scales are commonly used to classify the severity of spasticity. Allison and colleages found the scale is less reliable 10. Ashworth score and hamstring stiffness were inversely relat. An additional grade summary the ashworth scale is a measure of spasticity originally developed to.
The scale measures the resistance and spasticity or catch in the joint during passive movement. Intensive therapy it programs for children with neurological dis. Modified ashworth scale mas model based on clinical data measurement towards quantitative evaluation of upper limb spasticity. Spasticity can range from relatively mild to quite severe, and treatment is approached in a stepwise fashion rehabilitative pt. Crosssectional observational comparison study setting. Spasticity is a motor disorder characterized by a velocitydependent increase in tonic stretch reflexes. Modified ashworth scale mas model based on clinical data. Open access protocol comparing the validity of the modi. Nov 19, 2012 the ashworth scale was originally developed in 1964, and modified by bohannon and smith in 1987. Reliability of ashworth and modified ashworth scales in. Interrater reliability of modified ashworth scale and modified tardieu scale in children with spastic cerebral palsy. Pdf comparing the validity of the modified modified.
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. Translating modified ashworth scale into functional. Evaluation of spasticity using the ashworth scale with. Ashworth scale with all of its variants remains the standard with which other measures of spasticity are compared. To assess the reliability of the modified ashworth scale mas and modified tardieu scale mts in patients with spinal cord injuries scis.
The modified ashworth scale mas is the most used scale to determine spasticity. Stop using the ashworth scale for the assessment of spasticity. Is not a measure of spasticity, but scores may by influenced by spasticity 2. Ashworth and tardieu, links below to access how to perform. This week looking into outcome measures for spasticity. Ashworth scale modified ashworth scale rehabmeasures. This scale grades the muscle tone from 0 normal to 4 severe spasticity. The mmas is an ordinal level measure of spasticity, which grades the intensity of. The modified ashworth scale wrist spasticity was assessed by means of mas. Intrarater reliability of the modified modified ashworth. No study, to date, has been performed to compare the validity of the mmas and the mts. The presence of pain during shoulder abduction or contracture of the shoulder adductors had no influence on the reliability of the mmas.
The most commonly used ones are the modified ashworth scale mas and the modified tardieu scale. 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. Testretest reliability and interrater reliability of the modified tardieu scale and the modified ashworth scale in hemiplegic patients with stroke. 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 testretest reliability of the modified ashworth scale was moderate to good k 0. To compare the tardieu scale as a clinical measure of spasticity after stroke with the ashworth scale design. It is a quick and easy measure that can help assess the efficacy of treatment.
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