From the Guidelines
The Modified Ashworth Scale is the recommended tool for quantifying spasticity in patients with neurological conditions, as it provides a reliable and efficient way to measure resistance to passive movement on a scale from 0 to 4. This scale is particularly useful in the context of stroke rehabilitation, as it helps healthcare providers monitor changes in spasticity over time and evaluate the effectiveness of interventions such as medications, physical therapy, or surgical procedures 1. The scale's simplicity and ease of use make it practical for routine clinical use, with an approximate administration time of 10 minutes 1.
When using the Modified Ashworth Scale, clinicians should move the patient's limb through its range of motion at a moderate speed and rate the resistance felt, allowing for a more precise assessment of mild to moderate spasticity. The scale is also useful for conditions like multiple sclerosis, cerebral palsy, and spinal cord injuries. However, it's essential to note that the scale's subjective nature means that consistency in assessment technique is crucial for reliable measurements 1.
Recent guidelines support the use of botulinum toxin for patients with focal spasticity, depending on patient characteristics and preferences, and the Modified Ashworth Scale can be used to assess the effectiveness of this treatment 1. A study comparing the efficacy of botulinum toxin and oral baclofen found that botulinum toxin was effective in reducing spasticity, with a significant difference in ankle spasticity as measured by the Modified Ashworth Scale 1.
Key points to consider when using the Modified Ashworth Scale include:
- The scale measures resistance to passive movement on a scale from 0 to 4
- The scale is useful for monitoring changes in spasticity over time and evaluating the effectiveness of interventions
- The scale is simple and easy to use, with an approximate administration time of 10 minutes
- Consistency in assessment technique is essential for reliable measurements
- The scale can be used to assess the effectiveness of treatments such as botulinum toxin for focal spasticity 1.
From the Research
Modified Ashworth Scale
The Modified Ashworth Scale (MAS) is a measure used to assess spasticity, which is a velocity-dependent increase in muscle tone and uncontrolled, repetitive, involuntary contractions of skeletal muscles 2. The scale is used to evaluate the severity of spasticity in patients with neurological disorders such as stroke, spinal cord injury, and multiple sclerosis.
Characteristics and Limitations
The MAS is an ordinal level measure of resistance to passive movement, but not spasticity itself 2. The scale has limitations, including ambiguity between the '1' and '1+' grades, which can affect its reliability 2. The reliability of the MAS is better in the upper limb, and it may be more reliable than the Ashworth Scale (AS) 2.
Clinical Use
The MAS is used in clinical practice and research to evaluate the effectiveness of treatments for spasticity, such as botulinum toxin type A 3. The scale is also used to assess the severity of spasticity and to monitor changes in spasticity over time 4.
Treatment Options
Treatment options for spasticity include oral medications such as baclofen, tizanidine, and dantrolene, as well as interventional procedures such as focal injections of botulinum toxin and intrathecal baclofen pump 5, 3, 6, 4. The choice of treatment depends on the severity and location of the spasticity, as well as the patient's overall health and medical history.
Key Points
- The Modified Ashworth Scale is a measure of resistance to passive movement, not spasticity itself 2.
- The scale has limitations, including ambiguity between grades and variable reliability 2.
- The MAS is used in clinical practice and research to evaluate the effectiveness of treatments for spasticity 3, 4.
- Treatment options for spasticity include oral medications, interventional procedures, and surgical interventions 5, 3, 6, 4.