physioscience 2005; 1(1): 13-18
DOI: 10.1055/s-2005-858096

© Georg Thieme Verlag KG Stuttgart · New York

Kritische Einschätzung der Modifizierten Ashworth-Skala, ihrer Gütekriterien und ihre Anwendung in der klinischen Praxis

Critical Appraisal of the Modified Ashworth Scale, its Psychometric Properties and its Use in Clinical PracticeC. A. Barth
Further Information

Publication History

eingereicht: 10.12.2004

angenommen: 10.1.2005

Publication Date:
26 April 2005 (online)


Die Modifizierte Ashworth-Skala (MAS) ist der Goldstandard aller Assessments für Outcome-Messungen bezüglich Tonus bzw. Spastizität. Die vorliegende Arbeit sichtet Studien, die auf die psychometrischen Eigenschaften dieses Assessments eingehen, und beurteilt die klinische Entscheidungsfindung zu dessen Anwendung. Die betrachteten Publikationen kommen zu inkonsistenten Ergebnissen. Es gibt keine standardisierte Methode einer angemessenen Anwendung der MAS, und die ausschlaggebenden Gütekriterien Validität und Reliabilität sind für die MAS umstritten. Ihre Validität wird durch Unklarheiten hinsichtlich der Begriffe Spastizität und Tonus in Frage gestellt. Ihre Reliabilität erweist sich bei von nur einem Untersucher durchgeführten Tests der Ellenbogenflexoren als am besten. In anderen Fällen ist die Reliabilität nicht immer gegeben. Über die Anwendung der MAS ist jeweils umsichtig und fallspezifisch zu entscheiden.


The Modified Ashworth Scale (MAS) is the gold standard outcome measure for tone and spasticity. This paper reviewed studies looking at the measure’s psychometric properties and appraised clinical decisions about its application. The literature revealed inconsistent findings. The MAS lacks standardisation in terms of appropriate application, and its validity and reliability remain controversial. Validity is challenged by semantic confusion about the terms spasticity and tone. Reliability shows best results when testing elbow flexors and using one examiner. In other situations reliability it not always given. Decisions about application of the MAS should be made judiciously and from case to case.


  • 1 Allison S C, Abraham L D. Correlation of quantitative measures with the modified Ashworth scale in the assessment of plantar flexor spasticity in patients with traumatic brain injury.  J Neurol. 1995;  242 699-706
  • 2 Allison S C, Abraham L D, Petersen C L. Reliability of the Modified Ashworth Scale in the assessment of plantarflexor muscle spasticity in patients with traumatic brain injury.  Int J Rehabil Res. 1996;  19 67-78
  • 3 Allison S C, Abraham L D. Sensitivity of qualitative and quantitative spasticity measures to clinical treatment with cryotherapy.  Int J Rehabil Res. 2001;  24 15-24
  • 4 Ashworth B. Preliminary trial of carisoprodol in multiple sclerosis.  Practitioner. 1964;  192 540-542
  • 5 Bakheit A M, Pittock S, Moore A P. et al . A randomized, double-blind, placebo-controlled study of the efficacy and safety of botulinum toxin type A in upper limb spasticity in patients with stroke.  Eur J Neurol. 2001;  8 559-565
  • 6 Barnes S, Gregson J, Leathley M. et al . Development and inter-rater reliability of an assessment tool for measuring muscle tone in people with hemiplegia after a stroke.  Physiotherapy. 1999;  85 405-409
  • 7 Basmajian J V. Muscle alive, their functions revealed by electromyography. 4th ed. Baltimore; Williams & Wilkins 1978
  • 8 Beattie P. Measurement of health outcomes in the clinical setting: applications to physiotherapy.  Physiotherapy Theory and Practice. 2001;  17 173-185
  • 9 Bhakta B B, Cozens J A, Chamberlain M A. et al . Quantifying associated reactions in the paretic arm in stroke and their relationship to spasticity.  Clin Rehabil. 2001;  15 195-206
  • 10 Blackburn M, van Vliet P, Mockett S P. Reliability of measurements obtained with the Modified Ashworth Scale in the lower extremities of people with stroke.  Phys Ther. 2002;  82 25-34
  • 11 Bohannon R W, Smith M B. Interrater reliability of a modified Ashworth scale of muscle spasticity.  Phys Ther. 1987;  67 206-207
  • 12 Burry H C. Objective measurement of spasticity.  Dev Med Child Neurol. 1972;  14 508-551
  • 13 Carr J H, Shepherd R B, Ada L. Spasticity: Research Findings and Implications for Intervention.  Physiotherapy. 1995;  81 421-428
  • 14 Durward B, Baer G. Physiotherapy and neurology: towards research-based practice.  Physiotherapy. 1995;  81 436-469
  • 15 Fitzpatrick R, Davey C, Buxton M F. et al . Evaluating patient-based outcome measures for use in clinical trials.  Health Technology Assessment. 1998;  2 14
  • 16 Fowler E G, Nwigwe A I, Wong H o T. Sensitivity of the pendulum test for assessing spasticity in persons with cerebral palsy.  Dev Med Child Neurol. 2000;  42 182-189
  • 17 Greenhalgh J, Long A F, Brettle A J. et al . Reviewing and selecting outcome measures for use in routine practice.  J Eval Clin Pract. 1998;  4 339-350
  • 18 Gregson J M, Leathley M, Moore A P. et al . Reliability of the Tone Assessment Scale and the modified Ashworth scale as clinical tools for assessing poststroke spasticity.  Arch Phys Med Rehabil. 1999;  80 1013-1016
  • 19 Gregson J M, Leathley M J, Moore A P. et al . Reliability of measurements of muscle tone and muscle power in stroke patients.  Age Ageing. 2000;  29 223-228
  • 20 Haas B M. Measuring spasticity: a survey of current practice among health-care professionals.  Br J Ther Rehab. 1994;  1 90-95
  • 21 Haas B M, Crow J L. Towards a clinical measurement of spasticity?.  Physiotherapy. 1995;  81 474-479
  • 22 Haas B M, Bergstrom E, Jamous A. et al . The interrater reliability of the original and of the modified Ashworth scale for the assessment of spasticity in patients with spinal cord injury.  Spinal Cord. 1996;  34 560-564
  • 23 Hammond R, ed. Chartered Society of Physiotherapy.  2001; 
  • 24 Katz R T, Rymer W Z. Spastic hypertonia: mechanisms and measurement.  Arch Phys Med Rehabil. 1989;  70 144-155
  • 25 Katz R T, Rovai G P, Brait C. et al . Objective quantification of spastic hypertonia: correlation with clinical findings.  Arch Phys Med Rehabil. 1992;  72 339-347
  • 26 Kerem M, Livanelioglu A, Topcu M. Effects of Johnstone pressure splints combined with neurdevelopmental therapy on spasticity and cutaneous sensory inputs in spastic cerebral palsy.  Dev Med Child Neurol. 2001;  43 307-313
  • 27 Lamontagne A, Malouin F, Richards C L. Locomotor-specific measure of spasticity of plantarflexor muscles after stroke.  Arch Phys Med Rehabil. 2001;  82 1696-1704
  • 28 Lance J W. Symposium synopsis. Feldmann RG, Young RR, Koella WP Spasticity: disordered motor control Chicago; Year Book Medical Publishers 1980
  • 29 Lance J W. What is spasticity?.  Lancet. 1990;  335 606
  • 30 Leonard C T, Stephens J U, Stroppel S L. Assessing the spastic condition of individuals with upper motoneuron involvement: validity of the myonometer.  Arch Phys Med Rehabil. 2001;  82 1416-1420
  • 31 Lin J P. The pathophysiology of spasticity and dystonia. Neville B, Albright AL The Management of Spasticity Associated with the Cerebral Palsies in Children and Adolescents Muskegon; Churchill Communications 2000
  • 32 Lin R M, Sabbahi M. Correlation of spasticity with hyperactive stretch reflexes and motor dysfunction in hemiplegia.  Arch Phys Med Rehabil. 1999;  80 526-530
  • 33 Linder M, Schindler G, Michaelis U. et al . Medium-term functional benefits in children with cerebral palsy treated with botulinum toxin type A: 1-year follow-up using gross motor function measure.  Eur J Neurol. 2001;  8 (Suppl 5) 120-126
  • 34 Love S C, Valentine J P, Blair E M. et al . The effect of botulinum toxin type A on the functional ability of the child with spastic hemiplegia a randomised trial.  Eur J Neurol. 2001;  8 (Suppl 5) 50-58
  • 35 Mayer N H. Clinicophysiologic concepts of spasticity and motor dysfunction in adults with an upper motoneuron lesion.  Muscle Nerve. 1997;  20 (Suppl 6) S1-S13
  • 36 Nordmark E, Anderson G. Wartenberg pendulum test: objective quantification of muscle tone in children with spastic diplegia undergoing selective dorsal rhizotomy.  Dev Med Child Neurol. 2002;  44 26-33
  • 37 Nuyens G, De Weerdt W, Ketelaer P. et al . Inter-rater reliability of the Ashworth scale in multiple sclerosis.  Clin Rehabil. 1994;  8 286-292
  • 38 O’Dwyer N J, Ada L. Reflex hyperexcitability and muscle contracture in relation to spastic hypertonia.  Curr Opin Neurol. 1996;  9 451-455
  • 39 Pandyan A D, Johnson G R, Price C I. et al . A review of the properties and limitations of the Ashworth and modified Ashworth Scales as measures of spasticity.  Clin Rehabil. 1999;  13 373-383
  • 40 Pandyan A D, Price C IM, Rodgers H. et al . Biomechanical examination of a commonly used measure of spasticity.  Clin Biomech. 2001;  16 859-865
  • 41 Pandyan A D, Price C I, Barnes M P. et al . A biomechanical investigation into the validity of the modified Ashworth Scale as a measure of elbow spasticity.  Clinical Rehabilitation. 2003;  17 290-293
  • 42 Peacock W J, Staudt L A. Functional outcomes following selective posterior rhizotomy in children with cerebral palsy.  J Neurosurg. 1991;  74 380-385
  • 43 Pierson S H. Outcome measures in spasticity management.  Muscle Nerve. 1997;  20 36-60
  • 44 Priebe M M, Sherwood A M, Thornby J I. et al . Clinical assessment of spasticity in spinal cord injury: a multidimensional problem.  Arch Phys Med Rehabil. 1996;  77 713-716
  • 45 Richardson D, Sheean G, Werring D. et al . Evaluating the role of botulinum toxin in the management of focal hypertonia in adults.  J Neurol Neurosurg Psychiatry. 2000;  69 499-506
  • 46 Scheinberg A, O’Flaherty S, Chaseling R. et al . Continuous intrathecal baclofen infusion for children with cerebral palsy: a pilot study.  J Paediatr Child Health. 2001;  37 283-288
  • 47 Sehgal N, McGuire J R. Beyond Ashworth. Electrophysiologic quantification of spasticity.  Phys Med Rehabil Clin N Am. 1998;  9 949-979
  • 48 Sherwood A M, Graves D E, Priebe M M. Altered motor control and spasticity after spinal cord injury: subjective and objective assessment.  J Rehabil Res Dev. 2000;  37 41-52
  • 49 Shumway-Cook A, Woollacott M. Motor Control - Theory and Practical Applications. Baltimore; Williams & Wilkins 1995
  • 50 Sköld C, Harms-Ringdahl K, Hultling C. et al . Simultaneous Ashworth measurements and electromyographic recording in tetraplegic patients.  Arch Phys Med Rehabil. 1998;  79 959-965
  • 51 Sköld C, Levi R, Seiger A. Spasticity after traumatic spinal cord injury: nature, severity and location.  Arch Phys Med Rehabil. 1999;  80 1548-1557
  • 52 Sköld C. Spasticity in spinal cord injury: self- and clinically rated intrinsic fluctuations and intervention-induced changes.  Arch Phys Med Rehabil. 2000;  81 144-149
  • 53 Sloan R L, Sinclair E, Thompson J. et al . Inter-rater reliability of the modified Ashworth Scale for spasticity in hemiplegic patients.  Int J Rehabil Res. 1992;  15 158-161
  • 54 Smith A W, Jamshidi M, Lo S K. Clinical measurement of muscle tone using a velocity-corrected modified Ashworth scale.  Am J Phys Med Rehabil. 2002;  81 202-206
  • 55 Thompson A J. Spasticity rehabilitation: a rational approach to clinical management. Sheean GL, Barnes MP Spasticity Rehabilitation Muskegon; Churchill Communications 1998
  • 56 Wade D T. Measurement in neurological rehabilitation. New York; Oxford University Press 1992
  • 57 van Wijck F M, Pandyan A D, Johnson G R. et al . Assessing motor deficits in neurological rehabilitation: patterns of instrument usage.  Neurorehabil Neural Repair. 2001;  15 23-30
  • 58 World Health Organization (WHO) .;; 2004. 

Cornelia A. Barth, MSc

Elektrastr. 13

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