Alternative to Modified Ashworth Scale for Spasticity

The Modified Ashworth Scale (or the original version) are the most popular and common way used by therapists and physicians to measure spasticity. This ordinal scale is a simple clinical way to measure resistance to passive stretch. However, it is limited by the measurer’s subjective experience and is considered to have poor inter-rater reliability.

Instead, the Tardieu Scale is considered to be a better alternative to the Ashworth/Modified Ashworth scale because is an interval scale. The Tardieu also considers the velocity for spasticity. The Tardieu is a good alternative for occupational therapists to use as it measures the spasticity angle — between the end of passive ROM at slow stretch and the angle of catch at fast stretch.

Measurement

According to physiopedia

A standard goniometer will be utilized to measure R2 and R1. The patient will be in testing position according to the muscle to be tested. The stretching velocity of V1 and V3 will be applied to measure R2 and R1, respectively. The quality of muscle reaction will be graded at the stretching velocity of V3 as well. The difference between R2 and R1 will be the measure of the dynamic component of spasticity.

Scoring the Tardieu Scale

Quality of Muscle Reaction

0 No resistance throughout passive movement
1 Slight resistance throughout,with no clear catch at a precise angle
2 Clear catch at a precise angle followed by release
3 Fatiguable Clonus (< 10 secs) occurring at a precise angleFatiguable Clonus (< 10 secs) occurring at a precise angle
4 Unfatiguable Clonus (> 10 secs) occurring at a precise angle
5 Joint immobile

 

Velocity to Stretch

V1 As slow as possible
V2 Speed of the limb segment falling (freefall against gravity)
V3 At a fast rate (>gravitational pull)

 

Spasticity Angle

 

Video


Sources

  1. Alibiglou L, Rymer WZ, Harvey RL, Mirbagheri MM. The relation between Ashworth scores and neuromechanical measurements of spasticity following stroke.J Neuroengineer Rehabil20085:18.
  2. Blackburn M, van Vliet P, Mockett SP. Reliability of measurements obtained with the modified Ashworth scale in the lower extremities of people with stroke.Phys Ther200282:25–34.
  3. Pandyan AD, Johnson GR, Price CI, Curless RH, Barnes MP, Rodgers H. A review of the properties and limitations of the Ashworth and modified Ashworth Scales as measures of spasticity.Clin Rehabil199913:373–383.
  4. https://www.physio-pedia.com/Tardieu_Scale
  5. Morris S. Ashworth and Tardieu Scales: Their clinical relevance for measuring spasticity in adult and paediatric neurological populations. Physical Therapy Reviews. 2002 Mar 1;7(1):53-62.