The ashworth scale was originally developed in 1964, and modi. The grading was from 0 no increase in tone to 4 limb rigid in flexion and extension. Interrater reliability of a modified ashworth scale of muscle spasticity. Reliability of ashworth and modified ashworth scales in. We are continuing our focus on spasticity for july. Stop using the ashworth scale for the assessment of spasticity. Open access protocol comparing the validity of the modi. Evaluation of spasticity using the ashworth scale with. Interand intrarater reliability of the ashworth scale and the disability assessment scale in patients with upperlimb poststroke spasticity 1. The ashworth scale is a measure of spasticity originally developed to assess the antispastic effects of carisoprodol in multiple sclerosis it has subsequently been adapted for a variety of other diagnoses, including sci. Document the range of movement in the various joints involved in the pattern of spasticity. The ashworth or modified ashworth scale mas is a measure of. A recent study showed that the prevalence of spasticity does not differ between the upper and the lower limbs. Currently, the ashworth scales 45 are the most commonly used measures of spasticity in clinical practice and research.
A modified scale uses scores of 04 and includes additional ratings at the lower end so as to render the scale more discrete. Ashworth scale modified ashworth scale rehabmeasures. Zajicek and coworkers suggested that while ashworth scale is the best available measure of spasticity, it may not be sensitive enough to identify small but clinically significant changes 9. Define and differentiate spasticity from other neurological conditions associated with increased tone. Many studies have been performed on the methodological qualities of the modified ashworth scale but overall these studies seem inconclusive.
Bohannon and smith 1987 revised the original ashworth scale 1964 to render the scale more discrete. The ashworth scale is a measure of spasticity originally developed to assess the. This material is ed and further reproduction or distribution is prohibited. Research article muscle spasticity associated with reduced. The modified ashworth scale mas is an assessment that is often used by clinicians to grade spasticity in the affected limbs of stroke survivors.
The modified ashworth scale mas measures resistance during passive softtissue stretching and is used as a simple measure of spasticity. These base measurements will be useful later in monitoring the re. However, the reliability and validity of these scales has been recently challenged 1016. The modified ashworth scale table 1 is used to grade spasticity. The first abstract, article, and the clinical point of view is provided below. Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the. The study included 38 children with spastic diplegic cp.
Discuss the various presentations and outline functional outcome measures. Spasticity, defined herein as a velocitydependent response of muscle to passive stretching,1,2 may be among the most commonly acknowledged sequelae of centra l nervous system. 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. For each muscle group, reaction to stretch is rated at a specified stretch velocity with 2. 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. These measures have been adopted for measuring spasticity in a variety of other diagnoses, including sci. The mas measures resistance during passive softtissue stretching. The therapeutics and technology assessment subcomittee of the american academy of. 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. Mas 3, though, was observed more frequently in the upper limb muscles 11. Imbalanced signals from the central nervous systems cns. Tardieu scale velocity to stretch v quality of muscle. The modified ashworth scale wrist spasticity was assessed by means of mas.
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 original version is based on a five item scale ranging from 0 to 4. Management of spasticity in children with cerebral palsy ann tilton, md spasticity and other forms of muscle overactivity caused by cerebral palsy may impair function or ease of care or may cause discomfort or poor body image. Modified ashworth scale vs tardieu scale flashcards quizlet. In the only study specific to children with cerebral palsy, the validity and testretest reliability of the tardieu scale were examined. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Assessment of spasticity judith fm fleuren university of. Modified ashworth scale instructions general information derived bohannon and smith, 1987.
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. Spasticity is most often measured by assessing muscle resistance to passive movements using the modified ashworth scale mas. The aim of the present study was to investigate the intrarater reliability of the mmas for the assessment of spasticity in the lower limb. One of the most commonly used assessment for spasticity in the clinic frequently used as the goldstandard to validate other spasticity measures against. 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 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 produces a global assessment of the resistance to passive movement of an extremity, not just stretclex hyperexcitability. What does the ashworth scale really measure and are.
Apr 10, 2008 in the assessment of spasticity, methods that are easily used in practice are. Ashworth scale 15 definition of ashworth scale 15 by. Pdf modified ashworth scale mas model based on clinical data. Ashworth scale mas is the most used scale to determine spasticity.
Ashworth and modified ashworth scale mas spinal cord injury. Grading is always performed at the same time of day, in a constant position of the body for a given limb. Few studies have been performed on the reliability of the mmas. Spasticity is a common and treatable symptom in multiple sclerosis management of spasticity is important to maintain mobility and function and to prevent complications. 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. 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. Does electrical stimulation reduce spasticity after stroke. Pdf spasticity is common symptom presented amongst people with sensorimotor disabilities. Both scales are singleitem measures ranging from 0 to 4. The inter rater reliability of the original and of the modified ashworth scale for the assessment of spasticity in patients with spinal cord injury. The pendulum test involves the appropriate joint, such as the knee, being held in extension and released, with spasticity measured as the rate of decay of oscillation of the limb.
Ashworth 4 employed a scale for the grading of spasticity in the evaluation of ms patients. Interrater reliability of a modified ashworth scale of muscle spasticity physical therapy 1987, 67. The mas is conducted while lying down face up, in order to lower tension in the body as much as possible. The most widely accepted assessment tool is the modified ashworth scale4 table 2. These measures have been adopted for measuring spasticity in a variety of. Research article comparison of modified ashworth scale. Physical therapy and regular exercise and stretching are important components in spasticity management. The severity of spasticity was evaluated by the modified ashworth scoring mas system, and locomotor function was evaluated by the bassobeattiebresnahan bbb scalebasso. Management of spasticity in children with cerebral palsy.
The modified ashworth scale mas is commonly used in clinical practice for grading spasticity. Spasticity involving wrist and finger muscles2 rangeofmotion assessment. Interrater reliability of the modified ashworth scale and. A modified scale uses scores of 04 and includes additional ratings at the lower. You can use this scale in your initial physical examination or subsequent examinations to document response to medical interventions pharmacologic therapy, physical therapy, etc. It is usually associated with other upper motor neuron impairments such as weakness or loss of dexterity. Measuring spasticity using reliable and valid tools is important for the evaluation of treatment efficacy. Modified ashworth scale spasticity peripheral brain. 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 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. Chapter 4 stop using the ashworth scale for the assessment of spasticity. The modified ashworth scale is a scale used to grade the severity of 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 ashworth scale 4, bohannonsmith modified ashworth scale 5, and tardieu scales 69 are currently used to measure spasticity. The aim of the present study was to investigate the intrarater reliability of the mmas. Ashworth scale modified ashworth scale rehabmeasures database. A high degree of paresis and hypoesthesia at stroke onset has. Understand the natural history and progression of spasticity including the various etiologies and sequelae. Pdf 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. It consists of a 5point nominal scale using subjective clinical. The mas is done in supine this will garner the most accurate and the lowest score. In the assessment of spasticity, methods that are easily used in practice are. Is not a measure of spasticity, but scores may by influenced by spasticity 2. Ashworth and modified ashworth scale scire project.
Smith we undertook this investigation to determine the interrater reliability of manual tests of elbow flexor muscle spasticity graded on a modified ashworth scale. Wholelimb blood flow was measured in the femoral and brachial arteries using doppler ultrasound and was normalized to lean limb mass obtained with dualenergy xray absorptiometry. Evaluation of spasticity in children with the authors. The fivepoint ashworth scale was originally proposed by ashworth for use with people with ms. None, but requires clinical judgment and experience with spasticity. One quick and easy way to measure spasticity is the modified ashworth scale mas. 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. Validity of modified ashworth scale as a measure of wrist. Allison and colleages found the scale is less reliable 10. The ashworth scale and mas measure spasticity and are applied manually to. Modified ashworth scale mas interrater reliability of a modified ashworth scale of muscle spasticity richard w. Research article comparison of modified ashworth scale with. The mas better measures muscle hypertonia instead of spasticity. The modified ashworth scale purpose is to grade muscle spasticity.
It was concluded that the ashworth scale is of limited use in the assessment of spasticity in the lower limb of patients with sci. The ashworth and tardieu scales are common clinical measures of spasticity. The modified ashworth scale mas better measures muscle hypertonia instead of spasticity. 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. This week looking into outcome measures for spasticity. The ashworth scale as and modified ashworth scale mas measure spasticity.
Evaluation of spasticity in children with the authors 2010. Comparing the validity of the modified modified ashworth scale. Pdf many studies have been performed on the methodological qualities of the modified ashworth scale but overall these studies seem inconclusive. Ashworth scale with all of its variants remains the standard with which other measures of spasticity are compared. Another study looking at the prevalence of spasticity in cerebral palsy found. Ashworth and modified ashworth scale mas spinal cord.
Bohannon and smith added an additional grading to the ashworth scale and evaluated interrater reliability of the spasticity scores on the elbow. The modified modified ashworth scale mmas is a clinical instrument for measuring spasticity. The focus is on defining and understanding what spasticity is. Mar 23, 2015 the modified ashworth scale is a scale used to grade the severity of spasticity. Tardieu scale this scale quantifies muscle spasticity by assessing the response of the muscle to stretch applied at specified velocities. Start studying modified ashworth scale vs tardieu scale. Stop using the ashworth scale for the assessment of spasticity article pdf available in journal of neurology, neurosurgery, and psychiatry 811. The impact of current or past treatments for spasticity should also be documented. July 2018 spasticity in stroke july 2018 hello members. Spasticity is a movement disorder, defined as a velocity dependent increase in stretch reflexes. Interrater reliability of a modified ashworth scale of. The modified as is also considered more of an abnormality in tone or resistance to passive movements scale rather than a direct spasticity scale. The treatment program for a child with spasticity may include allied health therapy, exercise, casting.
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