Chapter 4 stop using the ashworth scale for the assessment of spasticity. Difference between spasticity and rigidity difference between. Scale introduction spasticity is one of the positive symptoms of cerebrovascular disease and other upper motor neuron diseases. Finding a case for untreated spasticity in the elderly. Pdf stop using the ashworth scale for the assessment of spasticity. Spasticity mechanisms for the clinician article pdf available in frontiers in neurology 149. Tardieu scale this scale quantifies muscle spasticity by assessing the response of the muscle to stretch applied at specified velocities. Assessment of forearm muscle spasticity with sonoelastography. Removal of the noxious stimuli will often lead to significant reductions in tone. Cannabinoids for reducing spasticity after sci spinal cord. Spasticity is defined as a velocitydependent, increased resistance to passive muscle stretch. Spastic diplegia is one of the most frequently occurring forms of cp, with spasticity confined to the lower extremities. Allison and colleages found the scale is less reliable 10.
Fit to printable area scales small pages up and large pages down to fit the paper. To assess and to compare the reliability of the modified tardieu scale with the modified ashworth scale in patients with severe brain injury and impaired consciousness design. The tardieu scale has been suggested a more appropriate clinical measure of spasticity than the ashworth or modified ashworth scales. This scale grades the muscle tone from 0 normal to 4 severe spasticity. The modified ashworth scale mas better measures muscle hypertonia instead of spasticity. Page 2 of 6 spastic cp is characterized by muscle hypertonicity and impairment in motor skills. Biomechanical measurement of poststroke spasticity age. We undertook this investigation to determine the interrater reliability of manual tests of elbow flexor muscle spasticity graded on a modified ashworth scale. Penn spasm frequency scale psfs spinal cord injury. Interrater reliability of a modified ashworth scale of. An early rehabilitation centre for adults with neurological disorders subjects. Spasticity is isokinetic abnormal but not increased movements, while dystonia and other movement disorders are hyperkinetic abnormal and increased. Patient assessment and history continued ashworth scale score score severity definition 0 none no increase in muscle tone 1 mild slight increase in muscle tone, giving a catch when the limb was moved in.
Spasticity is a longterm complication of spinal cord injuries scis. As a result, many muscles may contract all at once. Elastography can open a new page in early diagnosis of spasticity in ms patients. Some degree of spasticity may be required to support weakened extremities and promote functional mobility. 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. It has the potential to advance outcomes measurement in clinical trials and clinical practice, and provides a new perspective in the clinical evaluation of spasticity.
Spasticity is a condition in which there is an abnormal increase in muscle tone or stiffness of muscle, which might interfere with movement, speech, or be associated with discomfort or pain. The most frequently used clinical methods for estimation of spasticity are the ashworth scale as and the modified ashworth scale mas 19, 20. Fight spasticity with everything youve got does your. Page 1 modified ashworth scale instructions general information derived bohannon and smith, 1987. Spasticity is the presence of overly tight musclesit can affect any muscle. Developed to augment clinical ratings of spasticity and provide a more comprehensive understanding of an individuals spasticity status.
Evaluation of the multiple sclerosis spasticity scale 88. Leeds adult spasticity impact scale lasis stroke engine. This is what fleuren et al 1 have set out to do see page 46. Spasticity evaluation gillette childrens specialty healthcare. Coefficient of repeatability for intrarater variability was between 7. Tardieu is a scale for measuring spasticity that takes into account resistance to passive movement at both slow and fast speed. Per the botox package insert, the maximum cumulative dose of botox should not exceed 400 units in a 3 month interval.
Shrink to printable area resizes only large pages to fit the paper and prints small pages as they are. The most recent versions of the scale use the following criteria. It is also colloquially referred to as an unusual tightness, stiffness, or pull of muscles. Crosssectional observational comparison study setting. Purpose of the measure the composite spasticity index csi provides a clinical measure of spasticity that can be used with patients with hemiparesis following stroke. We each independently graded the elbow flexor muscle spasticity of 30 patients with intracranial lesions. Spasticity is a movement disorder observed in individuals with lesions of the upper motor neurone pathways, for example, in stroke, multiple sclerosis or spinal cord injury. Ankle spasticity and stiffness in neurological disorders the minimum is reached position 3 in figure 5a, time point 3 in figure 5b.
Reliability of the modified tardieu scale and the modified. Total spasticity scores ranged from 22 to 66 mean, 44. Patient characteristics including age, gender, body mass index, time since stroke, stroke aetiology and affected side were noted. Tardieu scale velocity to stretch v quality of muscle. Tardieu scalemodified tardieu scale rehabmeasures database.
The mas better measures muscle hypertonia instead of spasticity. Spasticity mostly occurs in disorders of the central nervous system cns affecting the upper motor neurons in the form of a lesion, such as spastic diplegia, or upper motor neuron syndrome, and can also be present in various types of multiple sclerosis, where it occurs as a symptom of the progressivelyworsening attacks on myelin sheaths and is thus unrelated to the types of spasticity. What causes spasticity is a lack of typical communication between the brain and spinal cord. The australian spasticity assessment scale asas, a five point ordinal scale was done concurrently to measure spasticity for gastrocnemius and hamstrings because of its proven validity and.
Page 1 of 4 do not write in this binding margin princess alexandra hospital spinal injuries unit spasticity assessment form affix identification label here. Place the patient in a supine position if testing a muscle that primarily flexes a joint, place the joint in a maximally flexed position and move to a position of maximal extension over. Usually, sensory messages travel through nerve rootlets to tell the brain how tight the muscles are. Spasticity is usually caused by damage to nerve pathways within the brain or spinal cord that control muscle movement. After a stroke, almost 5% of patients are affected by spasticity within 10 days of the event. The modified ashworth scale mas measures resistance during passive softtissue stretching and is used as a simple measure of spasticity. Pdf the 88item multiple sclerosis spasticity scale. Immediately before performing ultrasound measurements, the degree of spasticity of the wrist and finger flexor muscles was assessed by a single physiatrist ea with mas and tardieu scale determined with the patient in the sitting position. We have studied the ashworth scale s reliability within and among four observers two physicians, an occupational therapist, and a physical therapist in 12 patients with moderate to severe spasticity. Zajicek and coworkers suggested that while ashworth scale is the best available measure of spasticity, it may not be sensitive enough to identify small but clinically significant changes 9. Because spasticity varies so much from person to person, it must be treated on an individual basis and demands a true partnership between the person with ms and his or her healthcare team e.
Spasticity and muscle tightness is commonly treated with medications, physical and occupational therapy. Tardieu scale and modified tardieu scale mts stroke engine. Spasticity in multiple sclerosis ms is common, complex, and disabling with few measures capturing the complexity of this phenomenon. Acrobat can size the pages of a pdf to fit the selected paper size. For each muscle group, reaction to stretch is rated at a specified stretch velocity with 2. Pdf questioning the gold standard of spasticity is almost heresy. This measures the maximum passive range of movement of the target muscle group. Vitamin e 5,000 mg daily plus riluzole had no beneficial effect on spasticity as a secondary outcome measure class iii. Evaluating spasticity page 1 of 3 this telability handout will help you learn more about spasticity and how it is measured what is spasticity. Many scales have been able to document changes after therapeutic intervention.
Purpose of the measure the leeds adult spasticity impact scale lasis is a measure of passive arm function, suitable for patients with spasticity and little or no active movement of the upper extremity. General information derived bohannon and smith, 1987 place the patient in a supine position. Improvement in disability assessment scale after botulinum. The modified tardieu scale identifies the point in the muscles range where spasticity, or a catch, is occurring 2,3. Botox chart documentation for upper limb spasticity elbow. It has been estimated that spasticity affects more than 12 million individuals worldwide, she noted. The only cost involved in the modified tardieu scale is purchase of the goniometers. Spasticity is disruption in muscle movement patterns so that muscles contract all at once. It appears to adhere more closely to lances definition of spasticity as it involves assessment of resistance to passive movement at both slow and fast speeds. Spasticity is classically defined as a motor disorder characterized by a velocitydependent increase in tonic stretch reflexes 36. The tool is a simple, onepage flowchart with three yes or no questions, guiding a brief physical examination, to look for signs of. 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 parts is moved in flexion or. However, the patient was exposed to thc use prior to the placebo control trial which may have introduced significant bias.
Quantitative evaluations of ankle spasticity and stiffness in. Mar 27, 2019 spasticity is a condition in which there is an abnormal increase in muscle tone or stiffness of muscle, which might interfere with movement, speech, or be associated with discomfort or pain. Spasticity impacts a number of mobilityrelated conditions, said lee ann hoffman, ot, msc. No effect on objective assessment of spasticity was.
Page 2 spasticity refers to feelings of stiffness and a wide range of involuntary muscle spasms. To characterise clinical assessment methods for spasticity andor its functional consequences in clinical patient populations at risk to suffer from spasticity. When using the tardieu scale or mts, spasticity is quantified by assessing the muscles response to stretch applied at given velocities. Spasticity either injury to the brain or spinal cord can cause spasticity. The inter rater reliability of the original and of the modified ashworth scale for the assessment of spasticity in patients with spinal cord injury. Spasticity is characterized by spasm, especially the tonic spasm. According to these observations, both time point 2 in the positiontorque curve and time point 3 figure 5b in the velocityangle curve are caused by the sharp increase. Spasticity can also be worsened by noxious stimuli including full bladder, full bowel, pressure sores and pain. Reliability of the australian spasticity assessment scale. Thirty patients with impaired consciousness due to severe cerebral. The therapeutics and technology assessment subcomittee of the american academy of neurology recommends with. Spasticity is motor alteration characterized by muscle hypertonia and hyperreflexia. Spasticity is a velocitydependent increase in muscle tone.
Clinically, spasticity results from the loss of inhibition of motor neurons, causing excessive velocity. You can also add more files, delete or rearrange pages within this tool. Place the patient in a supine position if testing a muscle that primarily flexes a joint, place the joint in a maximally flexed position and move to a position of maximal extension over one second count one thousand one. The authors have no direct financial interest continue reading. Moderate exercise led to a small decline in the ashworth spasticity scale over 3 months, compared to a worsening with no exercise p 0. Muscle movements are normally controlled by a complex system that allows some muscles to contract tighten while others relax. Approximately 20% of all firsttimestroke patients exhibit spasticity 12 weeks, 3 months, and 18 months after the stroke, and spasticity is reported to become more severe over time 1.
It is an important complication of spinal cord injury, traumatic brain injury. The collated evidence can guide our clinical decision about. The commonly accepted definition of spasticity is a motor disorder characterised by a velocitydependent increase in. Developed to augment clinical ratings of spasticity and provide a more comprehensive understanding of an individuals spasticity. Australian spasticity assessment scale asas love sc, gibson n, blair e 0 o catch on rapid passive movement rpm no spasticity. Spasticity can increase fatigue and interfere with functioning at home and at work. Ashworth scale modified ashworth scale rehabmeasures. Spasticity from greek spasmos, meaning drawing, pulling is a feature of altered skeletal muscle performance with a combination of paralysis, increased tendon reflex activity, and hypertonia.
The tardieu scale and modified tardieu scale mts are clinical measures of muscle spasticity for use with patients with neurological conditions. There is no resistance to rpm throughout rest of range. Mmas for the assessment of spasticity in the lower limb. Aug 23, 2018 spasticity is a clinical sign characterized by muscle overactivity and high tone spasms that is associated with several distinct neurological diseases.
Botox chart documentation for upper limb spasticity elbow, wrist, fingers, and thumb continued lines indicate muscle location, and do not point out sites for injection. A further problemparticularly in children with spasticity, which is often secondary to cerebral palsyis the failure of normal muscle growth, resulting in torsion of long bones and consequent joint instability and degeneration. Pdf clinical scales for the assessment of spasticity, associated. Getting the measure of spasticity in multiple sclerosis. The 88item multiple sclerosis spasticity scale msss88 is a reliable and valid, patientbased, intervallevel measure of the impact of spasticity in multiple sclerosis. Damage to nerves in the central nervous system can disrupt the pattern. Spasticity is a condition where a number of muscles suffer continuous contraction, stiffness, and tightness. Separate one page or a whole set for easy conversion into independent pdf files.
Treating spasticity might improve gait and relieve painful spasms. Assessment of spasticity judith fm fleuren university of. In the mmas, spasticity is scored on an ordinal scale from 0 to 4 as follows. The leeds adult spasticity impact scale lasis is a measure of passive arm function that is administered by semistructured interview to the patient or carer. Grading is always performed at the same time of day, in a constant position of the body for a given limb. The gait pattern of those with spastic diplegia includes intoeing steps, toe. It consists of 12 items of low difficulty that evaluate performance of daily functional tasks in the individuals normal environment. The authors have no direct continue reading leeds adult spasticity. The condition develops gradually, reaching its maximum extent long after the initial injury occurs. Scale or resize printed pages in acrobat and reader. Oct 10, 2019 with this diagnostic deficit in mind, hacker worked with david charles, m. Managing spasticity well can go a long way toward seating and wheeled mobility success.179 101 1129 565 1353 272 1024 1063 517 706 9 1596 1467 69 798 843 1534 878 1315 1283 865 1543 968 789 781 299 1308 171 671 280 990 90 1497 33 1568 657 1057 758 46 284 127 538 1274 48 427 192 753