|
Sign In to gain access to subscriptions and/or personal tools.
|
A review of the properties and limitations of the Ashworth and modified Ashworth Scales as measures of spasticity
A D Pandyan
G R Johnson
Centre for Rehabilitation and Engineering Studies (CREST), University of Newcastle upon Tyne, Newcastle upon Tyne, UK
C I M Price
R H Curless
Northumbria Health Care NHS Trust, North Tyneside General Hospital, Tyne & Wear, UK
M P Barnes
Hunters Moor Regional Neurorehabilitation Centre, North Tyneside General Hospital, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
H Rodgers
Department of Medicine (Geriatrics) and Department of Epidemiology and Public Health, North Tyneside General Hospital, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
Background: The Ashworth Scale and the modified Ashworth Scale are the primary clinical measures of spasticity. A prerequisite for using any scale is a knowledge of its characteristics and limitations, as these will play a part in analysing and interpreting the data. Despite the current emphasis on treating spasticity, clinicians rarely measure it.
Objectives: To determine the validity and the reliability of the Ashworth and modified Ashworth Scales.
Study design: A theoretical analysis following a structured literature review (key words: Ashworth; Spasticity; Measurement) of 40 papers selected from the BIDS-EMBASE, First Search and Medline databases.
Conclusions: The application of both scales would suggest that confusion exists on their characteristics and limitations as measures of spasticity. Resistance to passive movement is a complex measure that will be influenced by many factors, only one of which could be spasticity. The Ashworth Scale (AS) can be used as an ordinal level measure of resistance to passive movement, but not spasticity. The modified Ashworth Scale (MAS) will need to be treated as a nominal level measure of resistance to passive movement until the ambiguity between the ‘1’ and ‘1+’ grades is resolved. The reliability of the scales is better in the upper limb. The AS may be more reliable than the MAS. There is a need to standardize methods to apply these scales in clinical practice and research.
Clinical Rehabilitation, Vol. 13, No. 5,
373-383 (1999)
DOI: 10.1191/026921599677595404
 CiteULike  Complore  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter What's this?
This article has been cited by other articles:
|
|
|
|
 
E. Cousins, A. B. Ward, C. Roffe, L. D. Rimington, and A. D. Pandyan
Quantitative Measurement of Poststroke Spasticity and Response to Treatment With Botulinum Toxin: A 2-Patient Case Report
Physical Therapy,
July 1, 2009;
89(7):
688 - 697.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Lidstrom, G. Ahlsten, H. Hirchfeld, and S. Norrlin
Intrarater and Interrater Reliability of Myotonometer Measurements of Muscle Tone in Children
J Child Neurol,
March 1, 2009;
24(3):
267 - 274.
[Abstract]
[PDF]
|
|
|
|
|
|
|
I. O. Sorinola, C. M. White, D. N. Rushton, and D. J. Newham
Electromyographic Response to Manual Passive Stretch of the Hemiplegic Wrist: Accuracy, Reliability, and Correlation With Clinical Spasticity Assessment and Function
Neurorehabil Neural Repair,
March 1, 2009;
23(3):
287 - 294.
[Abstract]
[PDF]
|
|
|
|
|
|
|
S. Mangold, C. Schuster, T. Keller, A. Zimmermann-Schlatter, and T. Ettlin
Motor Training of Upper Extremity With Functional Electrical Stimulation in Early Stroke Rehabilitation
Neurorehabil Neural Repair,
February 1, 2009;
23(2):
184 - 190.
[Abstract]
[PDF]
|
|
|
|
|
|
|
G E Voerman, J F M Fleuren, L A C Kallenberg, J S Rietman, G J Snoek, and H J Hermens
Patient ratings of spasticity during daily activities are only marginally associated with long-term surface electromyography
J. Neurol. Neurosurg. Psychiatry,
February 1, 2009;
80(2):
175 - 181.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Turk, S. V. Notley, R. M. Pickering, D. M. Simpson, P. A. Wright, and J. H. Burridge
Reliability and Sensitivity of a Wrist Rig to Measure Motor Control and Spasticity in Poststroke Hemiplegia
Neurorehabil Neural Repair,
November 1, 2008;
22(6):
684 - 696.
[Abstract]
[PDF]
|
|
|
|
|
|
|
S. R Pierce, M. F Barbe, A. E Barr, P. A Shewokis, and R. T Lauer
Roles of Reflex Activity and Co-contraction During Assessments of Spasticity of the Knee Flexor and Knee Extensor Muscles in Children With Cerebral Palsy and Different Functional Levels
Physical Therapy,
October 1, 2008;
88(10):
1124 - 1134.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. R de Kroon and M. J IJzerman
Electrical stimulation of the upper extremity in stroke: cyclic versus EMG-triggered stimulation
Clinical Rehabilitation,
August 1, 2008;
22(8):
690 - 697.
[Abstract]
[PDF]
|
|
|
|
|
|
|
S. Coote, B. Murphy, W. Harwin, and E. Stokes
The effect of the GENTLE/s robot-mediated therapy system on arm function after stroke
Clinical Rehabilitation,
May 1, 2008;
22(5):
395 - 405.
[Abstract]
[PDF]
|
|
|
|
|
|
|
C. Church, C. Price, A. D. Pandyan, S. Huntley, R. Curless, and H. Rodgers
Response to Letter by Page and Chae
Stroke,
August 1, 2007;
38(8):
e72 - e73.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. E Sullivan and L. D Hedman
Effects of home-based sensory and motor amplitude electrical stimulation on arm dysfunction in chronic stroke
Clinical Rehabilitation,
February 1, 2007;
21(2):
142 - 150.
[Abstract]
[PDF]
|
|
|
|
|
|
|
W. K. L. Yam and M. S. M. Leung
Interrater Reliability of Modified Ashworth Scale and Modified Tardieu Scale in Children With Spastic Cerebral Palsy
J Child Neurol,
December 1, 2006;
21(12):
1031 - 1035.
[Abstract]
[PDF]
|
|
|
|
|
|
|
E. Patrick and L. Ada
The Tardieu Scale differentiates contracture from spasticity whereas the Ashworth Scale is confounded by it
Clinical Rehabilitation,
February 1, 2006;
20(2):
173 - 182.
[Abstract]
[PDF]
|
|
|
|
|
|
|
S. F Tyson, M. Hanley, J. Chillala, A. Selley, and R. C Tallis
Balance Disability After Stroke
Physical Therapy,
January 1, 2006;
86(1):
30 - 38.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Mehrholz, K. Wagner, D. Meissner, K. Grundmann, C. Zange, R. Koch, and M. Pohl
Reliability of the Modified Tardieu Scale and the Modified Ashworth Scale in adult patients with severe brain injury: a comparison study
Clinical Rehabilitation,
July 1, 2005;
19(7):
751 - 759.
[Abstract]
[PDF]
|
|
|
|
|
|
|
A Cooper, I M Musa, R van Deursen, and C M Wiles
Electromyography characterization of stretch responses in hemiparetic stroke patients and their relationship with the Modified Ashworth Scale
Clinical Rehabilitation,
July 1, 2005;
19(7):
760 - 766.
[Abstract]
[PDF]
|
|
|
|
|
|
|
T. Platz, C. Pinkowski, F. van Wijck, I.-H. Kim, P. di Bella, and G. Johnson
Reliability and validity of arm function assessment with standardized guidelines for the Fugl-Meyer Test, Action Research Arm Test and Box and Block Test: a multicentre study
Clinical Rehabilitation,
April 1, 2005;
19(4):
404 - 411.
[Abstract]
[PDF]
|
|
|
|
|
|
|
D. Steenbeek, A. Meester-Delver, J. G Becher, and G. J Lankhorst
The effect of botulinum toxin type A treatment of the lower extremity on the level of functional abilities in children with cerebral palsy: evaluation with goal attainment scaling
Clinical Rehabilitation,
March 1, 2005;
19(3):
274 - 282.
[Abstract]
[PDF]
|
|
|
|
|
|
|
M. Y. C. Pang, J. J. Eng, and A. S. Dawson
Relationship Between Ambulatory Capacity and Cardiorespiratory Fitness in Chronic Stroke: Influence of Stroke-Specific Impairments
Chest,
February 1, 2005;
127(2):
495 - 501.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Mehrholz, Y. Major, D. Meissner, S. Sandi-Gahun, R. Koch, and M. Pohl
The influence of contractures and variation in measurement stretching velocity on the reliability of the Modified Ashworth Scale in patients with severe brain injury
Clinical Rehabilitation,
January 1, 2005;
19(1):
63 - 72.
[Abstract]
[PDF]
|
|
|
|
|
|
|
T. Yan, C. W. Y. Hui-Chan, and L. S. W. Li
Functional Electrical Stimulation Improves Motor Recovery of the Lower Extremity and Walking Ability of Subjects With First Acute Stroke: A Randomized Placebo-Controlled Trial
Stroke,
January 1, 2005;
36(1):
80 - 85.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. D. Aarrestad, M. D. Williams, S. C. Fehrer, E. Mikhailenok, and C. T. Leonard
Intra- and Interrater Reliabilities of the Myotonometer When Assessing the Spastic Condition of Children With Cerebral Palsy
J Child Neurol,
November 1, 2004;
19(11):
894 - 901.
[Abstract]
[PDF]
|
|
|
|
|
|
|
W. B. McKay, H. K. Lim, M. M. Priebe, D. S. Stokic, and A. M. Sherwood
Clinical Neurophysiological Assessment of Residual Motor Control in Post-Spinal Cord Injury Paralysis
Neurorehabil Neural Repair,
September 1, 2004;
18(3):
144 - 153.
[Abstract]
[PDF]
|
|
|
|
|
|
|
A. Crippa, R. Cardini, D. Pellegatta, S. Manzoni, D. Cattaneo, and F. Marazzini
Effects of Sudden, Passive Muscle Shortening According to Grimaldi's Method on Patients Suffering from Multiple Sclerosis: A Randomized Controlled Trial
Neurorehabil Neural Repair,
March 1, 2004;
18(1):
47 - 52.
[Abstract]
[PDF]
|
|
|
|
|
|
|
D. K. Sommerfeld, E. U.-B. Eek, A.-K. Svensson, L. W. Holmqvist, and M. H. von Arbin
Spasticity After Stroke: Its Occurrence and Association With Motor Impairments and Activity Limitations
Stroke,
January 1, 2004;
35(1):
134 - 139.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A M O Bakheit, V A Maynard, J Curnow, N Hudson, and S Kodapala
The relation between Ashworth scale scores and the excitability of the {alpha} motor neurones in patients with post-stroke muscle spasticity
J. Neurol. Neurosurg. Psychiatry,
May 1, 2003;
74(5):
646 - 648.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. P. Barnes, R. M. Kent, J. K. Semlyen, and K. M. McMullen
Spasticity in Multiple Sclerosis
Neurorehabil Neural Repair,
March 1, 2003;
17(1):
66 - 70.
[Abstract]
[PDF]
|
|
|
|
|
|
|
A. D Pandyan, C. I. Price, M. P Barnes, and G. R Johnson
A biomechanical investigation into the validity of the modified Ashworth Scale as a measure of elbow spasticity
Clinical Rehabilitation,
March 1, 2003;
17(3):
290 - 294.
[Abstract]
[PDF]
|
|
|
|
|
|
|
A D Pandyan, M Cameron, J Powell, D J Stott, and M H Granat
Contractures in the post-stroke wrist: a pilot study of its time course of development and its association with upper limb recovery
Clinical Rehabilitation,
January 1, 2003;
17(1):
88 - 95.
[Abstract]
[PDF]
|
|
|
|
|
|
|
A. D Pandyan, P. Vuadens, F. M. van Wijck, S. Stark, G. R Johnson, and M. P Barnes
Are we underestimating the clinical efficacy of botulinum toxin (type A)? Quantifying changes in spasticity, strength and upper limb function after injections of Botox(R) to the elbow flexors in a unilateral stroke population
Clinical Rehabilitation,
June 1, 2002;
16(6):
654 - 660.
[Abstract]
[PDF]
|
|
|
|
|
|
|
L. Turner-Stokes and D. Jackson
Shoulder pain after stroke: a review of the evidence base to inform the development of an integrated care pathway
Clinical Rehabilitation,
March 1, 2002;
16(3):
276 - 298.
[Abstract]
[PDF]
|
|
|
|
|
|
|
J. J. Eng, K. S. Chu, A. S. Dawson, C.M. Kim, and K. E. Hepburn
Functional Walk Tests in Individuals With Stroke: Relation to Perceived Exertion and Myocardial Exertion
Stroke,
March 1, 2002;
33(3):
756 - 761.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Blackburn, P. van Vliet, and S. P Mockett
Reliability of Measurements Obtained With the Modified Ashworth Scale in the Lower Extremities of People With Stroke
Physical Therapy,
January 1, 2002;
82(1):
25 - 34.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M Fritz and R. S Wainner
Examining Diagnostic Tests: An Evidence-Based Perspective
Physical Therapy,
September 1, 2001;
81(9):
1546 - 1564.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J Eng, S. M Levins, A. F Townson, D. Mah-Jones, J. Bremner, and G. Huston
Use of Prolonged Standing for Individuals With Spinal Cord Injuries
Physical Therapy,
August 1, 2001;
81(8):
1392 - 1399.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. B Bhakta, J A. Cozens, M A. Chamberlain, and J. M Bamford
Quantifying associated reactions in the paretic arm in stroke and their relationship to spasticity
Clinical Rehabilitation,
February 1, 2001;
15(2):
195 - 206.
[Abstract]
[PDF]
|
|
|
|
|
|
|
C I. Price and A D Pandyan
Electrical stimulation for preventing and treating post-stroke shoulder pain: a systematic Cochrane review
Clinical Rehabilitation,
January 1, 2001;
15(1):
5 - 19.
[Abstract]
[PDF]
|
|
|
|
|
|
|
F. M.J. van Wijck, A. D. Pandyan, G. R Johnson, and M. P. Barnes
Assessing Motor Deficits in Neurological Rehabilitation: Patterns of Instrument Usage
Neurorehabil Neural Repair,
January 1, 2001;
15(1):
23 - 30.
[Abstract]
[PDF]
|
|
|
|
|
|
|
B. B Bhakta, J A. Cozens, M A. Chamberlain, and J. M Bamford
Impact of botulinum toxin type A on disability and carer burden due to arm spasticity after stroke: a randomised double blind placebo controlled trial
J. Neurol. Neurosurg. Psychiatry,
August 1, 2000;
69(2):
217 - 221.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
