Modified Ashworth Scale

The Modified Ashworth Scale (MAS) better measures muscle hypertonia instead of spasticity.

Ashworth Scale for grading Spasticity

Grade Description

• 1) no increase in muscle tone;
• 2) slight increase giving a catch when part is moved in flexion or extension;
• 3) more marked increase in tone but only after part is easily flexed;
• 4) considerable increase in tone; and
• 5) passive movement is difficult and affected part is rigid in flexion or extension.

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.

The MAS better measures muscle hypertonia instead of spasticity.

Modified Ashworth Scale for Grading hypertonia

Grade Description

• 0 -No increase in muscle tone
• 1 -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 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

What is spasticity?

•Diagnostic definition: ‘a motor disorder characterised by a velocity dependent increase in tonic stretch reflexes that results from abnormal intra-spinal processing of primary afferent input’ (Young 1994)

• Functional definition: the abnormal motor control caused by an UMN lesion (as in spastic paraparesis)

Common Causes of spasticity:

• Cerebral palsy
• Brain damage caused by lack of oxygen, as can occur in near drowning or near suffocation
• Brain trauma
• Severe head injury
• Spinal cord injury
• Stroke
• Adrenoleukodystrophy
• Phenylketonuria
• Neurodegenerative illness
• Multiple sclerosis

spasticity is not just about reflexes..

Changes in muscle ultrastructure

• – type I (SO) fibre predominance (Dattola 1993)
• – remodelling of connective tissue (Williams 1984)
• – reduced muscle compliance or thixotropy (Tardieu 1982)
• – loss of sarcomeres (Goldspink 1990)

Changes in motor unit activity

Changes in & around joints (Akeson 1987)

Inter-disciplinary spasticity treatment

Physical measures

• Stretching
• Positioning/Seating
• Splinting & orthoses
• Strengthening exercises
• ‘Movement’ re-education
• Walking aids
• Electrical stimulation?

Medical treatments

‘Psychological’ measures

• Adjustment to disability
• Self-management

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