Needle electromyography emg and examination under anesthesia can be helpful. Both scales are singleitem measures ranging from 0 to 4, where 0 indicates no. Imbalanced signals from the central nervous systems cns. The assessment of spasticity is important in order to determine effectiveness of treatment on spasticity and to plan medical or surgery applications and also to measure the.
The impact of current or past treatments for spasticity should also be documented. The tardieu scale has been suggested a more appropriate clinical measure of spasticity than the ashworth or modified ashworth scales. Pdf modified ashworth scale mas model based on clinical data. 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. The key to successful management of spasticity is the individual, who needs to be aware of management strategies. 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. The modified ashworth scale mas better measures muscle hypertonia instead of spasticity. Multiple sclerosis ms is an inflammatory disease where many of the patients suffer from spasticity impacting their qualityoflife. Spasticity is one feature of an upper motor neurone syndrome that may affect functionality, limit daily living activities and diminish quality of life in children with spastic cerebral palsy cp 15. Spasticity and clonus result from an upper motor neuron lesion that disinhibits the tendon stretch reflex. Tardieu scalemodified tardieu scale rehabmeasures database. 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.
Spasticity is usually caused by damage to nerve pathways within the brain or spinal cord that control muscle movement. Ashworth and modified ashworth scales as, mas, pdf marketing strategies penn spasm frequency scale psfs, spinal cord assessment tool for spasticity. Spasticity is a component of the upper motor neuron syndrome umns. 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. The ashworth scale as and modified ashworth scale mas measure spasticity. Cannabisderived sativex for msrelated spasticity reported to be effective and safe. Interrater reliability of a modified ashworth scale of muscle spasticity article pdf available in physical therapy 672. The modified ashworth scale is the most universally accepted clinical tool used to measure the increase of muscle tone 1. Mas is an ordinal 6point scale that rates spasticity as follows. Pdf many studies have been performed on the methodological qualities of the modified ashworth scale but overall these studies seem inconclusive. Spasticity is isokinetic abnormal but not increased movements, while dystonia and other movement disorders are hyperkinetic abnormal and increased. Modified ashworth scale for grading spasticity flashcards. Stop using the ashworth scale for the assessment of spasticity article pdf available in journal of neurology, neurosurgery, and psychiatry 811. The aim of this comprehensive scale is to use threshold and suprathreshold resistance measures together to provide an insight into spasticity, scoring the severity of the spasticity so as to make it.
Effectiveness and tolerability of thccbd oromucosal spray for multiple sclerosis spasticity. Spasticity assessment form affix identification label here urn. The modified ashworth scale is a widely used qualitative scale for the assessment of spasticity. Spasticity is defined as a velocitydependent, increased resistance to passive muscle stretch. Whereas spasticity arises as a result of damage to the corticoreticulospinal pyramidal tracts, rigidity is caused by dysfunction of extrapyramidal pathways, most commonly the basal ganglia, but also as a result of lesions of the mesencephalon and spinal cord. The aim of this paper is to understand the effect of spasticity on daily life and identify bedside strategies that enhance patients function and improve comfort.
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 mas measures spasticity in patients with lesions of the central nervous system. Mas 3, though, was observed more frequently in the upper limb muscles 11. Spasticity is a longterm complication of spinal cord injuries scis. Improvement in disability assessment scale after botulinum. Interrater reliability of a modified ashworth scale of. The tardieu scale seems to do this better because it relies on the velocity dependence of spasticity.
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. It is also colloquially referred to as an unusual tightness, stiffness, or pull of muscles. Pdf validity of modified ashworth scale as a measure of. The ashworth scale 4, bohannonsmith modified ashworth scale 5, and tardieu scales 69 are currently used to measure spasticity. The purpose of this paper was to linguistically validate and psychometrically test the multiple sclerosis spasticity scale msss88 in german speaking ms patients. Reliability of ashworth and modified ashworth scales in. Approximately 20% of all firsttimestroke patients exhibit spasticity 12 weeks, 3 months, and 18 months after the stroke, and spasticity is reported to become more severe over time 1. Interrater reliability of a modified ashworth scale of muscle spasticity. 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. Pdf interrater reliability of a modified ashworth scale. During your first visit to the spasticity management program, a medical college of wisconsin physiatrist will conduct a thorough evaluation.
Spasticity is derived from the greek word spasticus, which means to pull. The assessment of spasticity is important in order to determine effectiveness of treatment on spasticity and to plan medical or surgery applications and also to measure the regulation of tonus. Spasticity from greek spasmos, meaning drawing, pulling is a feature of altered skeletal muscle performance with a combination of paralysis, increased tendon reflex activity, and hypertonia. Using this scale, researchers have been able to document substantial reductions in spasticity resulting from surgical and some. Modified ashworth scale instructions abilitylab home. The mas better measures muscle hypertonia instead of spasticity. Spasticity is classically defined as a motor disorder characterized by a velocitydependent increase in tonic stretch reflexes 36. Clinically, spasticity results from the loss of inhibition of motor neurons, causing excessive velocity.
Spasticity is an important impairment in patients with neurological. Spasticity is characterized by abnormally high muscle tone, which often. In the mmas, spasticity is scored on an ordinal scale from 0 to 4 as follows. Spasticity is a condition in which there is an abnormal increase in muscle tone or stiffness of muscle, which might interfere with movement, speech, or be associated with discomfort or pain. It is important to stress to patients that spasticity is a highly manageable symptom and does not necessarily need to lead to disability. A recent study showed that the prevalence of spasticity does not differ between the upper and the lower limbs. Developed to augment clinical ratings of spasticity and provide a more comprehensive understanding of an individuals spasticity status.
Ashworth scale with all of its variants remains the standard with which other measures of spasticity are compared. Chapter 4 stop using the ashworth scale for the assessment of spasticity 75 chapter 5 perception of lower limb spasticity in patients with spinal 95 cord injury chapter 6 patient ratings of spasticity during daily activities are only 111 marginally associated with longterm surface electromyography. Pdf spasticity is common symptom presented amongst people with sensorimotor disabilities. Modified ashworth scale instructions general information derived bohannon and smith, 1987. Ashworth scale modified ashworth scale rehabmeasures. The upper motor neuron syndrome is caused by a lesion proximal to the anterior horn cell. Spasticity can range from relatively mild to quite severe, and treatment is approached in a stepwise fashion rehabilitative pt. Evaluation of spasticity using the ashworth scale with intermediate.
Tardieu is a scale for measuring spasticity that takes into account resistance to passive movement at both slow and fast speed. Both studies measured spasticity with the modified ashworth scale, but the results were not pooled because of. Ms practice spasticity and multiple sclerosis ms 01 contents page 1. The authors conclude, spasticity seems to contribute to motor impairments and activity limitations and may be a severe problem for some patients after stroke, but, given the relatively low numbers of patients with spasticity, they note, our findings support the opinionthat the focus on spasticity in stroke rehabilitation is out of. The modified ashworth scale mas measures resistance during passive softtissue stretching and is used as a simple measure of spasticity. It appears to adhere more closely to lances definition of spasticity as it involves assessment of resistance to passive movement at both slow and fast speeds. You can use this scale in your initial physical examination or. Pdf stop using the ashworth scale for the assessment 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. What does the ashworth scale really measure and are. Stop using the ashworth scale for the assessment of spasticity. The most recent versions of the scale use the following criteria. Treating cerebral palsy symptoms with medical marijuana.
A physiatrist is a physician who treats disabilities from pain, injury, neurological processes or other medical issues, with the goal of optimizing and restoring overall function. The therapeutics and technology assessment subcomittee of the american academy of neurology recommends with. Managing severe spasticity rady childrens hospital. Managing spasticity after sci first, practice healthy behaviors and good selfcare that will help you avoid problems that can increase spasticity, such as urinary tract infections and skin breakdown.
Spasticity can make movement harder to control, so that activities such as feeding yourself may be more dif. A high degree of paresis and hypoesthesia at stroke onset has. Spasticity treatment and symptoms 420evaluationsonline. 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. Sensitivity of the pendulum test for assessing spasticity. Modified ashworth scale spasticity peripheral brain. Scale introduction spasticity is one of the positive symptoms of cerebrovascular disease and other upper motor neuron diseases. Scale tss, to evaluate spasticity in 3 ways, while attempting to avoid the shortcomings of previous scales. 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. Ashworth scales are unreliable for the assessment of muscle spasticity article pdf available in physiotherapy theory and practice 223. A crosssectional study on spasticity in the elbow flexors part 1 and knee. Linguistic and psychometric validation of the msss88.