Materials science and engineering, volume 260, conference 1. The interrater and intrarater reliability of the modified. Published under licence by iop publishing ltd iop conference series. This can in turn result in an increase in spindle activity and sensitivity.
Pdf validity of modified ashworth scale as a measure of. Modified ashworth scale mas model based on clinical data measurement towards quantitative evaluation of upper limb spasticity. For this reason, accurate quantification of spasticity has both diagnostic and therapeutic significance. Disorder of movement because spasticity, by definition, is a passive entity. The modified ashworth scale mas is an assessment that is often used by clinicians to grade spasticity in the affected limbs of stroke survivors. Nov 19, 2012 the ashworth scale was originally developed in 1964, and modified by bohannon and smith in 1987. 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 ashworth scale was originally developed in 1964, and modified by bohannon and smith in 1987. Management of spasticity is often achieved with a combination of medications and surgical procedures. 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. Stop using the ashworth scale for the assessment of spasticity.
Spasticity is the uncontrolled tightening or contracting of the muscles that is common in individuals with spinal cord injuries. Reliability of ashworth and modified ashworth scales in children with spastic cerebral palsy article pdf available in bmc musculoskeletal disorders 91. Comparing the validity of the modified modified ashworth. The ashworth or modified ashworth scale mas is a measure of spasticity developed as a simple clinical classification to assess the antispastic effects of carisoprodol in multiple sclerosis. Spasticity can range from relatively mild to quite severe, and treatment is approached in a stepwise fashion rehabilitative pt. The effect of quadriceps femoris muscle strengthening. Translating modified ashworth scale into functional measures. Ashworth scale is the best available measure of spasticity, it may not be sensitive enough to identify small but clinically significant changes 9. The upper motor neuron syndrome is caused by a lesion proximal to the anterior horn cell. The ashworth scale was initially developed in the early 1960s by bryan ashworth, to estimate the efficacy of antispastic drugs in clients with multiple sclerosis. A crosssectional study on spasticity in the elbow flexors part 1 and knee.
Spasticity is defined as velocity dependent resistance to movement. Measuring spasticity using reliable and valid tools is important for the evaluation of treatment efficacy. Johnson proposed that the scale needed to be more accurate 1 and pandyan and coworkers and fleuren suggested that the modified. Ashworth scale modified ashworth scale rehabmeasures. This is what fleuren et al 1 have set out to do see page 46. The purpose of the present study was to investigate the interrater reliability of the mmas during the assessment of elbow flexor spasticit y in adult patients with poststroke hemiplegia. Research article comparison of modified ashworth scale with. The mas better measures muscle hypertonia instead of spasticity. Pdf reliability of ashworth and modified ashworth scales. 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. Spasticity is often defined as a component of the upper motoneuron syndrome, characterised by a velocity dependent increase in tonic stretch. Evaluation of spasticity using the ashworth scale with intermediate. Interrater reliability of the modified ashworth scale for. The relation between ashworth scores and neuromechanical.
The ashworth scale 4, bohannonsmith modified ashworth scale 5, and t ardieu scales 69 are currently used to measure spasticity. Spasticity definition and meaning collins english dictionary. Interrater reliability of a modified ashworth scale of. Questioning the gold standard of spasticity is almost heresy. Pdf comparison of modified ashworth scale and hoffmann. Ashworth and modified ashworth scale mas spinal cord. 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. The ashworth scale as and modified ashworth scale mas measure spasticity. 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. A modified scale uses scores of 04 and includes additional ratings at the lower end so as to render the scale more discrete. A crosssectional study on spasticity in the elbow flexors part 1 and knee extensors part 2 was carried out. Chapter 5 perception of lower limb spasticity in patients with spinal. Aim of this study is to investigate the construct validity and interrater reliability of the ashworth scale as for the assessment of spasticity in upper and lower extremities. The modified ashworth scale mas is the clinically mostused scale to grade degree of spasticity.
Assessment of spasticity judith fm fleuren university of. These measures have been adopted for measuring spasticity in a variety of other diagnoses, including sci. Research article comparison of modified ashworth scale. Modified ashworth scale for grading spasticity flashcards. The most widely used clinical assessment of spasticity is the modified ashworth scale mas, an ordinal scale, but its validity, reliability and sensitivity have often been challenged. The mas is performed in the supine position this will garner the most accurate and the lowest score as any.
This study evaluated whether the mas correlated with electromyographic emg recordings of muscle. Currently, the ashworth scales 45 are the m ost commonly used measures of spasticity in clinical practice. Sep, 2017 rct n241 found that at week 4, abobotulinumtoxina improves muscle tone in children with dynamic equinus modified ashworth scale scores. Modified ashworth scale instructions general information derived bohannon and smith, 1987. Interrater reliability of a modified ashworth scale of muscle spasticity. The tardieu scale seems to do this better because it relies on the velocity dependence of spasticity. Eighteen men and 14 women admitted with acute stroke and still in hospital at the study start date median age, 74 yrs. Comparison of modified ashworth scale and hoffmann reflex in study of spasticity article pdf available in acta medica iranica 483. To establish reliability of the tone assessment scale and modified ashworth scale in acute stroke patients. Ashworth scale modified ashworth scale rehabmeasures database. The modified ashworth scale wrist spasticity was assessed by means of mas.
The modified ashworth scale table 1 is used to grade spasticity. Subsequently, the modified ashworth scale was proposed by bohanon and smith to differentiate more specifically between the lower levels of spasticity by adding a sixth. The tardiue and modified tardieu scales are measured at 3 different velocities v1, v2, and v3. The modified modified ashworth scale mmas is a clinical tool used to measure spasticity. The modified ashworth scale mas is a clinical scale used to assess 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. Interrater reliability of a modified ashworth scale of muscle spasticity article pdf available in physical therapy 672. Evaluation of spasticity using the ashworth scale with. Chapter 4 stop using the ashworth scale for the assessment of 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. Because the severity of spasticity was a potential confounding variable, all subjects with cp were assessed for their degree of right quadriceps femoris muscle spasticity using a modified version of the ashworth scale. The modified ashworth scale mas better measures muscle hypertonia instead of spasticity. The study included 38 children with spastic diplegic cp.
To understand this, spasticity has to be looked at from different perspectives. Interrater reliability of the modified ashworth scale and. Both scales are singleitem measures ranging from 0 to 4, where 0 indicates no. In the mmas, spasticity is scored on an ordinal scale from 0 to 4 as follows. In addition to spasticity these tools include the assessment of active and passive functions, quality of life, and pain. Frigge the university of wisconsinmilwaukee, 2016 under the supervision of professor yingchih wang, phd introduction. Spasticity is a movement disorder observed in individuals with lesions of the upper motor neurone pathways, for example, in stroke, multiple sclerosis or spinal cord injury. Spasticity is classically defined as a motor disorder characterized by a velocitydependent increase in tonic stretch reflexes 36. Ashworth scale mas is the most used scale to determine spasticity.
The mmas is an ordinal level measure of spasticity, which grades the intensity of. Pdf interrater reliability of a modified ashworth scale. Needle electromyography emg and examination under anesthesia can be helpful. Interrater reliability of a modified ashworth scale of muscle. Rating scales like the ashworth scale as and the modified ashworth scale mas are the most commonly used clinical measures of spasticity.
Apr 10, 2008 the ashworth scale and mas measure spasticity and are applied manually to determine the resistance of muscle to passive stretching table i. The spasticity in the lower limbs was assessed using the modified ashworth scale and the pendulum test in seven sci patients grade a on the asia impairment scale before 0, immediately after 0. 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. The modified ashworth scale mas measures resistance during passive softtissue stretching and is used as a simple measure of spasticity. Sensitivity of the pendulum test for assessing spasticity. Many studies have been performed on the methodological qualities of the modified ashworth scale but overall these studies seem inconclusive. The modified ashworth scale is the most universally accepted clinical tool used to measure the increase of muscle tone 1. Stop using the ashworth scale for the assessment of. Jul 15, 2008 spasticity is a common impairment that follows stroke, and it results typically in functional loss. Translating modified ashworth scale into functional. Pdf interrater reliability of a modified ashworth scale of. Ashworth scale, which cannot distinguish spasticity from soft tissue hypertonia. 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.
Commonly used clinical tools for assessment of spasticity muscle tone are the ashworthmodified ashworth scale as mas, tardieu modified tardieu scale tsmts, composite spasticity index csi, etc. The fivepoint ashworth scale was originally proposed by ashworth for use with people with ms. Interand intrarater reliability of the ashworth scale and the disability assessment scale in patients with upperlimb poststroke spasticity 1. Spasticity is a component of the upper motor neuron syndrome umns. The modified ashworth scale mas measures resistance during passive softtissue stretching. Reliability of ashworth and modified ashworth scales in. Ashworth scale and may therefore be a more valid spasticity scale in adults. Spasticity is derived from the greek word spasticus, which means to pull. Modified ashworth scale spasticity peripheral brain.
The ashworth scale 4, bohannonsmith modified ashworth scale 5, and tardieu scales 69 are currently used to measure spasticity. Validity of modified ashworth scale as a measure of wrist. The ashworth scale is a measure of spasticity originally developed to assess the antispastic effects of carisoprodol in multiple sclerosis it has subsequently. Penn spasm frequency scale psfs spinal cord injury.
Allison and colleages found the scale is less reliable 10. Interrater reliability of the modified ashworth scale. The therapeutics and technology assessment subcomittee of the american academy of neurology recommends with. 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. Interrater reliability of the modified modified ashworth.
Reliability of the tone assessment scale and modified ashworth scale as clinical tools for assess ing poststroke spasticity. Spasticity is a motor disorder characterized by a velocitydependent increase in tonic stretch reflexes. Clinically, spasticity is commonly assessed by numerically ranking the resistance to passive joint motion felt by the examiner, using the ashworth scale ashworth 1964, bohannon and smith 1987, peacock and staudt 1991. The ashworth or modified ashworth scales are commonly used to classify the severity of spasticity. Mar 23, 2015 the modified ashworth scale is a scale used to grade the severity of spasticity. Bohannon and smith added an additional grading to the ashworth scale and evaluated interrater reliability of the spasticity scores on the elbow flexors and. While the evidence indicates that the reliability of the mas is better in the upper limb and in certain distal muscle groups, no investigation has compared the effect of limbs and muscle groups on the mas reliability.
Modified ashworth scale mas model based on clinical data. Managing severe spasticity rady childrens hospital. Developed to augment clinical ratings of spasticity and provide a more comprehensive understanding of an individuals spasticity status. 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. Spasticity and muscle overactivity also play a part in muscle shortening. Thurman dj, alverson c, dunn k, guerrero j, sniezek j. You can use this scale in your initial physical examination or subsequent examinations to document response to medical interventions pharmacologic therapy, physical therapy, etc.
The validity of the mas in terms of spasticity assessment is questionable, as it does. Spasticity or exaggerated reflex responses to passive stretch at high velocity appears to be, though that notion has never. 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 table 1. The modified ashworth scale mas progressive gaitways. The modified ashworth scale mas is commonly used in clinical practice for grading spasticity.
A ahmad puzi 1, s n sidek 1, h mat rosly 1, n daud 2 and h md yusof 1. 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 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. Reliability of the tone assessment scale and the modified. Using this scale, researchers have been able to document substantial reductions in spasticity resulting from surgical and some. The modified ashworth scale is a widely used qualitative scale for the assessment of spasticity.