These modifications resulted in a scale that conforms even more precisely than the ashworth scale to the guidelines of mackenzie and. However, the reliability and validity of these scales has been recently challenged 1016. Reliable and valid tools must be used to assess spasticity in clinical practise and research settings. Ashworth scale with all of its variants remains the standard with which other measures of spasticity are compared. The study included 38 children with spastic diplegic cp. 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 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.
However, the modified ashworth scale, which measures the. The ashworth scale 4, bohannonsmith modified ashworth scale 5, and tardieu scales 69 are currently used to measure spasticity. The modified ashworth scale mas is a clinical scale used to assess muscle spasticity. Many studies have been performed on the methodological qualities of the modified ashworth scale but overall these studies seem inconclusive. The ashworth scale was originally developed in 1964, and modified by bohannon and smith in 1987. 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. You can use this scale in your initial physical examination or subsequent examinations to document response to medical interventions pharmacologic therapy, physical therapy, etc. But since there is no measurement theres no way of telling if an intervention is working. Interrater reliability of the modified ashworth scale. Modified ashworth scale instructions general information derived bohannon and smith, 1987. Research article comparison of modified ashworth scale. Commonly used clinical tools for assessment of spasticity muscle tone are the ashworth modified ashworth scale as mas, tardieu modified tardieu scale tsmts, composite spasticity index csi, etc. The modified ashworth scale mas is commonly used in clinical practice for grading spasticity. For this reason, accurate quantification of spasticity has both diagnostic and therapeutic significance. Management of spasticity is often achieved with a combination of medications and surgical procedures. Ashworth scale modified ashworth scale rehabmeasures. Interrater reliability of the modified modified ashworth.
Multiple sclerosis ms is an inflammatory disease where many of the patients suffer from spasticity impacting their qualityoflife. Validity of modified ashworth scale as a measure of wrist. One quick and easy way to measure spasticity is the modified ashworth scale mas. Spasticity is a motor disorder characterized by a velocitydependent increase in tonic stretch reflexes. Interrater reliability of a modified ashworth scale of.
What does the ashworth scale really measure and are. Spasticity can range from relatively mild to quite severe, and treatment is approached in a stepwise fashion rehabilitative pt. The tardieu scale seems to do this better because it relies on the velocity dependence of spasticity. Evaluation of spasticity using the ashworth scale with. 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. Jul 15, 2008 spasticity is a common impairment that follows stroke, and it results typically in functional loss. The therapeutics and technology assessment subcomittee of the american academy of neurology recommends with.
None, but requires clinical judgment and experience with spasticity. Spasticity can be irritating, inconvenient or even limit your ability to go through your day. These measures have been adopted for measuring spasticity in a variety of. The mas better measures muscle hypertonia instead of spasticity. The relation between ashworth scores and neuromechanical. Interrater reliability of a modified ashworth scale of muscle spasticity article pdf available in physical therapy 672. Mar 23, 2015 the modified ashworth scale is a scale used to grade the severity of spasticity. The ashworth scale and the modified ashworth scale are the. The modified ashworth scale wrist spasticity was assessed by means of mas. The modified ashworth scale mas measures resistance during passive softtissue stretching and is used as a simple measure of spasticity. 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. Comparing the validity of the modified modified ashworth scale. Reliability of ashworth and modified ashworth scales in children.
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. A crosssectional study on spasticity in the elbow flexors part 1 and knee extensors part 2 was carried out. Comparing the validity of the modified modified ashworth. A modified scale uses scores of 04 and includes additional ratings at the lower end so as to render the scale more discrete. These measures have been adopted for measuring spasticity in a variety of other diagnoses, including sci. 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. 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 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. Spasticity and muscle overactivity also play a part in muscle shortening. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The modified ashworth scale mas is an assessment that is often used by clinicians to grade spasticity in the affected limbs of stroke survivors. Ashworth and modified ashworth scale scire project.
This scale grades the muscle tone from 0 normal to 4 severe spasticity. Modified ashworth scale reliability for measurement of lower extremity spasticity among patients with sci. Ashworth and modified ashworth scale mas spinal cord. No study, to date, has been performed to compare the validity of the mmas and the mts.
Apr 10, 2008 in the assessment of spasticity, methods that are easily used in practice are. Currently, the ashworth scales 45 are the most commonly used measures of spasticity in clinical practice and research. Eighteen men and 14 women admitted with acute stroke and still in hospital at the study start date median age, 74 yrs. A crosssectional study on spasticity in the elbow flexors part 1 and knee.
Therapists try to evaluate spasticity by judging changes in movement, improvements in adls or getting a feel for the amount of resistance. The mas is performed in the supine position this will garner the most accurate and the lowest score as any. Modified ashworth scale spasticity visit the post for more. Stop using the ashworth scale for the assessment of. The upper motor neuron syndrome is caused by a lesion proximal to the anterior horn cell.
Resistance to passive movement in children with spastic cerebral palsy was assessed by two raters using the modified ashworth scale and the. 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. Both scales are singleitem measures ranging from 0 to 4, where 0 indicates no. 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.
Stop using the ashworth scale for the assessment of spasticity. Interrater reliability of a modified ashworth scale of muscle spasticity. 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. To determine the nature of passive stretch, electromyographic equipment is needed. Spasticity after stroke is more common in the upper than the lower limbs, and it seems to be more common among younger than older people. The modified ashworth scale mas is the clinically mostused scale to grade degree of spasticity. The validity of the mas in terms of spasticity assessment is questionable, as it does. Ris procite, reference manager, endnote, bibtex, medlars. 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. Sep, 2017 both studies measured spasticity with the modified ashworth scale, but the results were not pooled because of. The fivepoint ashworth scale was originally proposed by ashworth for use with people with ms.
Both studies measured spasticity with the modified ashworth scale, but the results were not pooled because of. The as, mas, tardieu and modified tardieu scales are commonly used in children with cp 20, 21. Nov 19, 2012 the ashworth scale was originally developed in 1964, and modified by bohannon and smith in 1987. Management escalq spasticity in children with cerebral palsy. This can in turn result in an increase in spindle activity and sensitivity. Linguistic and psychometric validation of the msss88.
Reliability of a new scale for measurement of spasticity in. Start studying modified ashworth scale vs tardieu scale. The ashworth or modified ashworth scale mas is a measure of. Spasticity is derived from the greek word spasticus, which means to pull. The modified ashworth scale is a widely used qualitative scale for the assessment of spasticity. Interrater reliability of modified ashworth scale and modified. In the assessment of spasticity, methods that are easily used in practice are. Local intramuscular injection of botulinum toxin bt is an established, welltolerated treatment in the pharmacological management of focal spasticity. Modified ashworth scale vs tardieu scale flashcards quizlet. The ashworth scale and mas measure spasticity and are applied. The modified ashworth scale is a scale used to grade the severity of spasticity. The ashworth or modified ashworth scales are commonly used to classify the severity of spasticity. Pdf interrater reliability of a modified ashworth scale.
The ashworth scale is a measure of spasticity originally developed to assess the. 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. This study evaluated whether the mas correlated with electromyographic emg recordings of muscle. Later, modified ashworth scale mas has been developed with some additions to. Pdf interrater reliability of a modified ashworth scale of muscle. To establish reliability of the tone assessment scale and modified ashworth scale in acute stroke patients.
Ashworth scale modified ashworth scale rehabmeasures database. The inter rater reliability of the original and of the modified ashworth scale for the assessment of spasticity in patients with spinal cord injury. 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. 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. Modified ashworth scale mas model based on clinical data measurement towards quantitative evaluation of upper limb spasticity. Over 10 million scientific documents at your fingertips. Interrater reliability of the modified ashworth scale and. 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 purpose of this paper was to linguistically validate and psychometrically test the multiple sclerosis spasticity scale msss88 in german speaking ms patients.
There is a strong body of level i evidence for its effectiveness in the management of upper and lower limb spasticity. The modified ashworth scale mas measures resistance during passive softtissue stretching. Translating modified ashworth scale into functional. The modified ashworth scale purpose is to grade muscle spasticity. 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. 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. Ashworth scale is the best available measure of spasticity, it may not be sensitive enough to identify small but clinically significant changes 9. 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.
Pdf we undertook this investigation to determine the interrater reliability of manual tests of elbow flexor muscle spasticity graded on a modified. Another study looking at the prevalence of spasticity in cerebral palsy found. The modified ashworth scale table 1 is used to grade spasticity. Pdf validity of modified ashworth scale as a measure of. Modified ashworth scale for grading spasticity flashcards. Spasticity and spinal cord injury page 2 of 3 constipation or large hemorrhoids. Ashworth scale 15 definition of ashworth scale 15 by. The modified ashworth scale mas better measures muscle hypertonia instead of spasticity. Ashworth scale mas is the most used scale to determine spasticity. Spasticity is a common impairment that follows stroke, and it results typically in functional loss. Disorder of movement because spasticity, by definition, is a passive entity.
Johnson proposed that the scale needed to be more accurate 1 and pandyan and coworkers and fleuren suggested that the modified. 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. Interand intrarater reliability of the ashworth scale and the disability assessment scale in patients with upperlimb poststroke spasticity 1. Measuring spasticity using reliable and valid tools is important for the evaluation of treatment efficacy. The ashworth scale as and modified ashworth scale mas measure spasticity. The interrater and intrarater reliability of the modified. Reliability of the tone assessment scale and the modified. Spasticity is defined as velocity dependent resistance to movement.
Pdf modified ashworth scale mas model based on clinical data. Needle electromyography emg and examination under anesthesia can be helpful. Frigge the university of wisconsinmilwaukee, 2016 under the supervision of professor yingchih wang, phd introduction. Research article comparison of modified ashworth scale with. There is a paucity of literature regarding the validity of the modified modified ashworth scale mmas and the modified tardieu scale mts.
The modified modified ashworth scale mmas is a clinical tool used to measure spasticity. The ashworth scale and mas measure spasticity and are applied manually to. Mental health occupational therapy occupational therapy assistant occupational therapy activities physical therapy ot therapy therapy tools therapy ideas nbcot exam prep acute care. 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. Pdf interrater reliability of a modified ashworth scale of. Ashworth scale, which cannot distinguish spasticity from soft tissue hypertonia. 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.
Fracture or other injury to the muscles, tendons or bone below the level of spinal cord injury. 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. Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the. Spasticity is a component of the upper motor neuron syndrome umns. Translating modified ashworth scale into functional measures. Interrater reliability of a modified ashworth scale of muscle. Modified ashworth scale spasticity peripheral brain.
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