Spasticiteitsschalen

Original Ashworth Scale for grading spasticity (Ashworth 1964)

Grades the resistance encountered in a specific muscle group by means of passively moving a limb through its range of motion at a non-specified velocity.

score	description
0	no increase in muscle tone
1	slight increase in muscle tone giving a catch and release when the limb was moved in flexion or extension
2	more marked increase in muscle tone, but limb moves easily
3	considerable increase in tone, passive movement difficult
4	limb rigid in flexion or extension

 

 

Modified Ashworth Scale – Bohannon scale for grading spasticity (Bohannon 1987)

Grades the resistance encountered in a specific muscle group by means of passively moving a limb through its range of motion at a non-specified velocity.

score	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 ROM when the affected part(s) is (are) moved in flexion or extension
1+	slight increase in muscle tone, manifested by a catch, followed by a 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

 

 

Tardieu Scale or Held Scale (1969)

Spasticity is clinically assessed by passively moving the joint at three specified velocities (V) and rating the intensity and duration of the muscle reaction to stretch (X) and the joint-angle (Y) where this muscle reaction is first felt.

Tardieu scale
Intensity and duration of the reflex (X)		Velocity of stretch (V)
0	no reflex	V1: slow
1	only visible contraction	V2: under gravity
2	contraction with a short catch	V3: rapid
3	contraction lasting a few seconds OR fatigable clonus after a few seconds
4	contraction lasting a few seconds OR infatigable clonus, not even after a few seconds	Angle in ROM (Y)

 

 

Modified Tardieu Scale (Boyd 1999)

Defines the moment of the ‘catch’ (e.g. Tardieu X=3 or X=4 ) in the range of motion (R1) at a fast passive stretch (Tardieu V3)

R1	joint angle at a fast stretch (Tardieu V3)

 

 

Duncan Ely test (Bleck 1987)

Grades buttock elevation in response to rapid passive flexion of the knee while the patient is in prone

+	buttock elevation
-	no buttock elevation

 

Literatuur

• Ashworth B. Preliminary trial of caisoprodal in multiple sclerosis. Practioner 1964;192:540-2.
• Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987;67:206-7.
• Held JP, Pierrot-Deseilligny E. Le Bilan Moteur Central. In: Bailiere JB et Fils, editors. Reeducation motrice des affections neurologiques. Paris; 1969. p. 31-42
• Boyd RN, Graham HK. Objective measurement of clinical findings in the use of botulinum toxin type A for the management of children with cerebral palsy. European Journal of Neurology 1999;6:S23-35.
• Bleck EE. Orthopeadic Management in Cerebral Palsy. London: Mac Keith Press; 1987.