Modified Ashworth Scale of Spasticity

Modified Ashworth Scale of Spasticity is a common scale to use for measuring spasticity in those with cerebral palsy, stroke, and other neurological disorders. The Modified Ashworth Scale is a scale that is used to quantify the amount of spasticity or stiffness in a patient.

The Modified Ashworth Scale has five different symptom severity levels ranging from 0 to 4. The Modified Ashworth Scale is commonly used to measure spasticity in those with cerebral palsy, stroke, and other neurological disorders.

Used of to the scale :

• It is used to assess the spasticity.

Purpose of the scale :

• It is considered the primary clinical measure of muscle spasticity in patients with neurological conditions.
• It is also a rating scale that measures the abnormality of the tone & the resistance of the passive movements.

In which condition Modified Ashworth Scale of Spasticity is used?

This scale is used in many neurological conditions:

• Stroke
• Spinal cord injury
• Multiple sclerosis
• Cerebral palsy
• Traumatic brain injury
• Pediatric hypertonia
• Central nervous system lesions.

Which is Method Use in this scale?

• Starting position is supine .
• This scale is performed by to the extension of the patients limb .
• First from to the a position of the maximal possible flexion to the maximal possible extension.
• Into Afterwards, this scale is assessed while the move of to the extension to flexion.

What is Equipment need for this scale :

• Training
• Therapy mat
• None typically reported
• Paper

Scoring of Modified Ashworth Scale of Spasticity:

NO	Description
O	Slightly increase into the muscle tone which is giving to a catch when the slightly increase into the muscle tone, which is manifested by the limb, limb is moved into the flexion or extension.
1	Slightly increase into the muscle tone, which is manifested by the catch followed by the minimal resistance of the throughout (ROM ).
1+	More marked increase to in muscle tone through to most of the limb but easily for to the flexed .
2	More marked increase to in muscle tone through to most of to the limb but easily for to the flexed .
3	Considerable increase into the tone & passive movement is to the difficult
4	Limb is rigid into the flexion or extension

Clinical Considerations of this scale :

• This scale is commonly used in the clinical setting which is to the assess the spasticity into the people with to the SCI.
• It is note to the spasticity in the multi-facet & construct with to the individual components of to the spasticity weakly which is related to the each other , it is suggest to the different clinical scales measure to the unique aspects of spasticity.
• It is also measure to the assesses of to the single-joint resistance / passive ROM & velocity dependent stretch reflex.
• It is do not address the spasm frequency or severity .
• It is not to do the differentiate between to the phasic & tonic components of the spasticity.
• So that the overall construct of the spasticity which is the best measured with to the appropriate battery of the tests including this scale .
• This Ashworth or Modified Ashworth both are well-tolerated by the patients.
• This scale is measure easily administered into the during routine clinic visits & does not require the specialized equipment.

Versions of the scale

• This Scale is initially developed in the early 1960s by the Bryan Ashworth.
• In this scale include to the 5-point scale with a grade score of to the 0, 1, 2, 3, or 4 .

• Into the 1987
• Bohannon & Smith are added to the grade – 1 .
• Proposed to the slight changes on to the definitions of to the each score into the order to the increase of the sensitivity to the measure & facilitate the scoring.
• It is called The new measurement of the Modified Ashworth Scale .
• It is considered by the many as the gold standard for to the measuring the spasticity .

Evidence of this scale :

NO .	Reference	Year	Study details	Relevant results
1	Bohannon & Smith	1987	Inter-rater reliability of to this scale . Tested of muscle : elbow flexors of to the impaired arm. Ns – 30 – include in to the condition of the patient in NS is MS (1), HI (5), CVA (24) . Na – 2 = physiotherapist . Assessors are independently assessed to the each subject of the once.	86.7% of the agreement between to the assessors means in Kendall’s t = 0.847 & p <0.001 Cohen’s is calculated to the = 0.826a
2	Bodin and Morris	1991	inter-rater reliability of this scale . tested of muscle : elbow flexors & extensors with the knee flexors. Measurements are take to the bilaterally. Ns = 34 – include in to the condition of the patient in Ns is hemiplegia – 34 . Na – 4 = physiotherapist -2 & doctor – 2 . assessors are serially assessed to the each subject .	76% of to the agreement between to the assessors means in Kendall’s t = 0.857 Cohen’s is calculated to the = 0.745a
3	Sloan et al.	1992	inter-rater reliability of to this scale . tested of muscle : elbow flexors & extensors with the knee flexors. Measurements are take to the bilaterally. Ns = 34 – include in to the condition of the patient in Ns is hemiplegia – 34 . Na – 4 = physiotherapist -2 & doctor – 2 . assessors are serially assessed to the each subject .	Spearman’s is calculated varied from to the 0.56 & 0.90 at to the elbow & between to the 0.26 & 0.62 at to the knee.
4	Allison et al.	1996	Inter & Intra-rater reliability of this scale . Tested of muscle : ankle plantar flexors. Measurements are take to the bilaterally. Day-1 of to the testing = Ns = 30 – include in to the condition of the patient in Ns is HI ; Na – 2 = physiotherapist . Both test are assessed all to the subjects independently. Day-2 of to the testing = Tester 1 ia onle assessed & Ns = 21 subjects.	for to the Day-1 = Inter-rater reliability tester 1 & tester 2 – 55% agreement Include = 0.727; t = 0.647 other is Intra-rater reliability of to the tester 1 is 53% agreement include = 0.741; t = 0.674; Intra-rater reliability of to the tester 2 = 48% agreement include = 0.550; t = 0.478 for to the Day-2 = it is a Intra-rater reliability of to the tester 1: 58% agreement include = 0.821; t = 0.739

Reliability of this scale :

• Interrater / Intrarater of the Reliability :

• Use of the muscle tested = Elbow flexor & extensor with to the knee flexor into the Hemiplegia patients.
• Measurements are take to the bilaterally.

• Ns = 34 – include in to the condition of the patient in Ns is hemiplegia = 34
• Na – 4 physiotherapist -2 & doctor – 2.
• The assessors are to the serially assessed to the each subject.

• Spearman’s are calculated to the varied from 0.56 & 0.90 at to the elbow or between to the 0.26 & 0.62 at to the knee .

• Into the daily practice this scale is used to the procedure is to the quick & easy.
• It is a common tool in to the measurement of to the spasticity.
• It is also used as to the in the research, like as to the In different patient groups of to the stroke,multiple sclerosis & spinal cord injury.

• The scale is found to the moderate to good intra-rater reliability & poor to moderate inter-rater reliability .

Validity of this scale :

Criterion Validity :

• in to the 35 patient s see the good correlations between the modified Ashworth scores & EMG parameters which is derived from the simultaneous surface & EMG is recordings to the muscles tested.

• It is not to the possible to the draw unequivocal support of to this scale & being a valid & ordinal measure of to the spasticity due to the one key of the methodological inconsistency.
• Into The actual time of to the grade spasticity is reported to the between 0.25 & 0.33 s but however, many of the derived to the EMG parameters are poorly referenced to the time window.

Construct Validity:

• 13 modified of to the original scale by to the adding an to the additional category,=
• A- 1+ falling is between to the 1 & 2 with to the aim of this increasing the sensitivity.
• Both scales are since been used to the measures of to the spasticity for to the clinical & research purposes.
• Clinical rating of the spasticity on this scale is made after the assessor tests of to the resistance which is provide to the passive movement about the joint.
• Both scales are describe the resistance perceived while the moving a joint through to the full range of movement = except into the grade 4

Content Validity:

• This scale is initially to the developed as to the simple clinical tool to the test which is the efficacy of an to the anti-spastic drug into the patients with to the multiple sclerosis.

Alternative form of this Scale :

Ashworth Scale:

• It is Published into the 1964 .
• This Scale is to the original measurement for to the resistance of the passive movement.
• It is a 5-point of to the scale .
• Which is used with the grade score of the 0, 1, 2, 3, or 4.
• This scale is less sensitive than the Modified Ashworth Scale .

Ashworth Scale Scoring :

NO	Description
0	No increase into the muscle tone .
1	Sightly increase in tone give a catch when the limb was move in flexion / extension .
2	More marked to the increase in tone but limb is easily to flex .
3	Considerable increase to the tone so that passive movement is difficult .
4	Limb is rigid into the flexion / extension .