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Modified Ashworth Scale

The Modified Ashworth Scale is considered the primary clinical measure of muscle spasticity in patients with neurological conditions. It was modified by Bohannon & Smith, 1987.

Some publications question its ability to measure spasticity and advocate the Modified Ashworth Scale as a rating scale to measure abnormality in tone or the resistance to passive movements, since there is no clinically direct method for measuring spasticity.

Some clinicians use the Tardien Scale. Both of these scales are more commonly used when assessing neurological conditions and upper motor lesion problems rather than musculoskeletal conditions. A tight muscle may give its own unique end feel. This is similar to normal tissue stretch, but it does not have as great an elastic feel.

See Also: Muscle Injury Treatment & Symptoms

Modified Ashworth Scale for Muscle Tone Measurement

The Modified Ashworth Scale is a 6-point scale. Scores range from 0 to 4, where lower scores represent normal muscle tone and higher scores represent spasticity or increased resistance to passive movement.

  • 0 = Normal tone, no increase in tone
  • 1 = Slight increase in muscle tone, manifested by a catch and release or minimal resistance at the end of the range of motion (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.

Original Ashworth Scale

The Ashworth Scale was published in 1964, it measures the resistance to passive movement. It is a 5-point scale, with a grade score of 0, 1, 2, 3, or 4. The Ashworth Scale is less sensitive than the Modified Ashworth Scale.

ScoreOriginal Ashworth Scale
0No increase in tone
1Slight increase in tone giving a catch when the limb was moved in flexion or extension
2More marked increase in tone but limb easily flexed
3Considerable increase in tone, passive movement difficult
4Limb rigid in flexion or extension

Original Ashworth Scale VS Modified Ashworth Scale

>ScoreAshworth Scale (Ashworth, 1964)Modified Ashworth Scale (Bohannon & Smith, 1987)
0No increase in toneNo increase in muscle tone
1Slight increase in tone giving a catch when the limb was moved in flexion or extensionSlight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion (ROM) when the affected part is moved in flexion or extension
1+N/ASlight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM
2More marked increase in tone but limb easily flexedMore marked increase in muscle tone through most of the ROM, but affected parts easily moved
3Considerable increase in tone, passive movement difficultConsiderable increase in muscle tone, passive movement difficult
4Limb rigid in flexion or extensionAffected part rigid in flexion or extension

References & More

  1. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987 Feb;67(2):206-7. doi: 10.1093/ptj/67.2.206. PMID: 3809245. Pubmed
  2. Pandyan AD, Johnson GR, Price CI, et al. A review of the properties and limitations of the Ashworth and modified Ashworth scales as measures of spasticity. Clin Rehab. 1999;13:373–383. Pubmed
  3. Modified Ashworth Scale – Strokengine
Last Reviewed
December 29, 2023
Contributed by
OrthoFixar

Orthofixar does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice.

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