Your Source for spasticity Information

 

A variety of scales have been developed to standardize the recording of the findings from the clinical examination of spasticity. The most often used are the Modified Ashworth Scale, and the Tardieu Scale. Other scales are used less frequently, primarily for research purposes. The 6 points of the Modified Ashworth Scale (which includes a 1+ rating) correlate with clinician-determined increasing levels of spasticity during passive range of motion, from no change in or diminished muscle tone (0) to complete inability to move the joint (5). In addition to the degree of spasticity, the Tardieu Scale also includes the angle and velocity of the movement that elicits the response.

Clinical Scale for Spastic Hypertonia (Modified Ashworth Scale):
0 No increase in tone
1 Slight increase in muscle tone, manifested by a catch and release or minimal resistance at the end of the ROM when the affected part(s) is moved in flexion or extension
1+ Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM
2 More marked increase in muscle tone through most of the ROM, but affected part(s) easily moved
3 Considerable increase in muscle tone, passive movement difficult
4 Affected part(s) rigid in flexion or extension

Tardieu Scale:
This test is performed with patient in the supine position, with head in midline. Measurements take place at 3 velocities (V1, V2, and V3). Responses are recorded at each velocity as X/Y, with X indicating the 0 to 5 rating, and Y indicating the degree of angle at which the muscle reaction occurs. By moving the limb at different velocities, the response to stretch can be more easily gauged since the stretch reflex responds differently to velocity.

Velocities:
V1: As slow as possible, slower than the natural drop of the limb segment under gravity
V2: Speed of limb segment falling under gravity
V3: As fast as possible, faster than the rate of the natural drop of the limb segment under gravity

Scoring:
0 No resistance throughout the course of the passive movement
1 Slight resistance throughout the course of passive movement, no clear catch at a precise angle
2 Clear catch at a precise angle, interrupting the passive movement, followed by release
3 Fatigable clonus with less than 10 seconds when maintaining the pressure and appearing at the precise angle
4 Unfatigable clonus with more than 10 seconds when maintaining the pressure and appearing at a precise angle
5 Joint is immovable


Because one of the primary reasons to treat spasticity is its effect on function, the ability to measure change in function is important. Formal measures, such as the Fugl-Meyer Scale, have been developed to measure functioning in patients with spasticity. However, these tools may not be sensitive to changes in spasticity per se and are infrequently used outside of the research setting. Therefore, the clinical assessment becomes more important and is likely to focus on patients' ability to complete a task, the quality of their completion of the task (e.g., ease of movement, normalization of gait), and the length of time that it takes them to complete the task. The clinical assessment should also include and evaluations of the change in level of pain, ease of caregiving or hygiene, or overall quality of life.

Although biomechanical studies, because of the cost and size of the equipment, are typically reserved for use in research studies, they can provide objective measures of spasticity. Two types of studies are the Wartenburg pendulum test, in which an electrogoniometer is used to count the number and record the pattern of the swing when the knee is released from an extended position, and the torque motor test, which measures the amplitude and frequency oscillation during flexion and extension of the wrist.

 

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