- The Ashworth or Modified Ashworth Scale (MAS) is a measure of spasticity developed as a simple clinical classification to assess the anti-spastic effects of carisoprodol in multiple sclerosis. These measures have been adopted for measuring spasticity in a variety of other diagnoses, including SCI.
- 5-point nominal scale using subjective clinical assessments of tone ranging from 0 – ‘no increases in tone’ to 4 – ‘limb rigid in flexion or extension [abduction/adduction]’. An additional grade was added (1+) for the MAS to enhance sensitivity and accommodate hemiparetic patients who typically graded at the lower end of the scale.
Download worksheet from: http://www.rehabmeasures.org/PDF%20Library/Modified%20Ashworth%20Scale%20Instructions.pdf
or from this site: http://www.scireproject.com/sites/default/files/worksheet_ashworth.docx
Body Function – Subcategory: Neuromusculoskeletal & Movement-related Functions and Structures.
Number of Items:
Clinician/Patient may test any number of muscles affected by Spasticity.
Brief Instructions for Administration & Scoring
- Clinician-administered; both tests (Ashworth and MAS) are clinical examinations performed on a relaxed patient in the supine position.
- The muscle is assessed by rating the resistance to passive range of motion (ROM) about a single joint.
- It consists of a 5-point nominal scale using subjective clinical assessments of tone ranging from 0 – ‘No increases in tone’ to 4 – ‘Limb rigid in flexion or extension [abduction/adduction]’. An additional grade is added (1+) for the MAS to indicate resistance in the movement. This enhances sensitivity and accommodates hemi-paretic patients who typically graded at the lower end of the scale.
Not established for SCI; but in stroke, initial change in muscle tone/spasticity in response to botox treatment was approximately a 1-point decrease on the MAS scale, reflecting a clinically significant improvement
(Shaw et al. 2010, n=333, adults with upper limb spasticity due to stroke; >1 month post-stroke)
SEM: not established
MDC: not established for the SCI population but in a stroke population, initial change in muscle tone/spasticity in response to botox treatment was an approximately 1-point decrease on the MAS scale reflecting a clinically significant improvement.
[Shaw et al. 2010, n=333, adults with upper limb spasticity due to stroke >1 month post-injury]
Score Distributions (SD):
Score 0: 25.7%
Score 1: 34.0%
Score 2: 23.7%
Score 3: 16.5%
(Sherwood et al., 2000; N=97, 95 male, 62 cervical SCI; mixed injury types; 0.5-39 years post-SCI)
None specifically indicated, however the observation of resistance is subjective and requires experienced clinical judgment.
- This measure is commonly used in the clinical setting to assess spasticity in people with SCI. However, it should be noted that spasticity is a multi-faceted construct with individual components of spasticity weakly related to each other suggesting that different clinical scales measure unique aspects of spasticity.
- This measure assesses single-joint resistance to passive ROM or a velocity dependent stretch reflex. They do not address spasm frequency or severity, nor do they differentiate between phasic and tonic components of spasticity. Therefore, the overall construct of spasticity is best measured with an appropriate battery of tests including the Ashworth or Modified Ashworth.
- The Ashworth and Modified Ashworth are well-tolerated by patients.
- This measure is easily administered during routine clinic visits and doesn’t require specialized equipment.
Measurement Property Summary
# of studies reporting psychometric properties: 15
- Moderate Inter-rater Reliability (for MAS): ICC = 0.56
(Tederko et al 2007; n=30, 23 males; mixed injury type cervical SCI; inpatient; mean time since injury = 14.1 months)
- Correlation of Ashworth (hip, knee, ankle) with SCATS (clonus, flexion, extension) was Moderate to High.
- Correlation of Ashworth (hip, knee, ankle) with Penn Spasm Frequency Scale (PSFS) was Moderate.
Hip knee ankle
PSFS 0.43 0.43 0.51
Hip - 0.90 0.67
Knee - - 0.77
Clonus 0.56 0.65 0.60
Flexion 0.55 0.47 0.40
Ext 0.98 0.88 0.61
(Benz et al. 2005; n=17; mixed injury types; 24-372 months post-SCI)
- With intrathecal baclofen treatment, Ashworth scores were found to significantly decrease (P<.0001).
[Penn et al. 1989, Gianino et al. 1998, Aydin et al. 2005, Boviatsis et al. 2005]
In a group of MS or SCI patients: with intrathecal baclofen treatment, Ashworth scores were found to significantly decrease. (Boviatsis et al. 2005; n=22, 15 with MS, 7 with SCI; no SCI type data available; 12 males; mean time since injury = 2.71 years)
Dr. Vanessa Noonan, John Zhu, Jeremy Mak, Matthew Querée
Date Last Updated:
Nov 1, 2016
Download the measure
Place the patient in a supine position.
When 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.
When testing a muscle that primarily extends a joint, place the joint in a maximally extended position and move to a position of maximal flexion over one second.
|Score||Modified Ashworth Scale|
|0||No increase in muscle tone|
|1||Slight increase in tone|
|1+||Slight increase in tone, with a catch, followed by minimal resistance|
|2||More marked increase in tone, but affected part(s) easily moved.|
|3||Considerable increase in tone and passive movement difficult.|
|4||Affected part(s) rigid in flexion or extension.|
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