Modified Ashworth Scale
Use the Modified Ashworth Scale to measure the muscle tone of your patients with neurological problems so you can get an idea of how far their spasticity is progressing!
Fact Checked by RJ Gumban.
What is a Modified Ashworth Scale?
The Modified Ashworth Scale (MAS) is a widely used clinical tool to measure spasticity in individuals with neurological conditions. It gauges the increase in muscle tone, ranging from minimal resistance to a considerable rise in passive movement. It is particularly beneficial in evaluating patients with conditions such as spinal cord injury, traumatic brain injury, multiple sclerosis, and cerebral palsy, where muscle spasticity is commonly experienced.
The MAS evaluates the resistance encountered during a quick stretch, with scores indicating everything from a slight increase in muscle tone to a marked increase. Physical therapists and clinicians worldwide employ the scale, and despite some critiques on its reliability, it remains a staple in measuring spasticity and treating upper limb spasticity.
Other scales used in conjunction with the MAS include the Modified Tardieu Scale or the Tardieu Scale, providing a more comprehensive assessment for stroke patients and those with severe brain injuries.
Printable Modified Ashworth Scale
Download this Modified Ashworth Scale and measure the muscle tone of your patients with neurological problems
Printable Modified Ashworth Scale
Download this Modified Ashworth Scale and measure the muscle tone of your patients with neurological problems
How to use the Modified Ashworth Scale
Before conducting this test, ensure you have a flat surface near you, preferably an examination table. This is because the Modified Ashworth Scale instructs you to place your patient in a supine position (lying face up) on a flat surface, so have your patient assume that position first! Help them if needed, especially since this test was designed to monitor spasticity.
Once the patient has assumed a supine position, you will move their limbs to observe muscle tone. There are two types of muscles that you will be monitoring for this test:
- Muscles that primarily flex joints: If you are testing a muscle that especially flexes a joint, you must place a joint in a maximally flexed position and move it to a position of maximal extension in just one second. If you need to measure the second, say “one thousand-one” out loud. Saying that should count as a second.
- Muscles that primarily extend joints: If you are testing a muscle that primarily extends a joint, you must extend a joint in a maximally extended position and then move it to a position of maximal flexion in just one second. Make sure to count one second as you move the limb.
Make sure to take note of your observations because the next thing you need to do is assign a score to all of them. We recommend that as soon as you examine one muscle, you should assign the score for that one before moving to observe another.
Now, let's discuss how this is scored.
How do you score the Modified Ashworth Scale?
The MAS is a six-point scale, with scores ranging from 0 to 4. The scoring system is as follows ((Harb & Kishner, 2023):
- 0 means that there is no increase in muscle tone.
- 1 means that there is a slight increase in muscle tone. This is manifested by a catch-and-release movement or minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or extension.”
- 1+ means a slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the range of motion (ROM).
- 2 means more marked increases in muscle tone through most of the range of motion (ROM), but the affected parts are easily moved.
- 3 means there is a considerable increase in muscle tone and that passive movement is difficult.
- 4 means the affected parts are rigid in flexion or extension.
The MAS is typically used to evaluate spasticity in specific muscle groups, such as the elbow flexors or wrist extensors. The examiner applies a quick, passive stretch to the joint and notes any resistance encountered. The scale can be repeated multiple times for reliability.
Modified Ashworth Scale example
Now that you know what the scale is all about, how to use it, and how to score it, it's time to see what a filled-out Modified Ashworth Scale looks like.
The sample you see here is based on the test instructions that Richard Bohannon, PT, Ph.D., and Melissa Smith, PT, have made for this clinical assessment tool.
If you like what you see and believe this will benefit your work, download a free printable version from our platform! You can print it and fill it out as you examine the patient, or you can go paperless (if that is something you like doing) and jot down your scores on the PDF using the editable fields!
Download this Modified Ashworth Scale Example (Sample) here:
When does one typically use the Modified Ashworth Scale?
Healthcare professionals often use the Modified Ashworth Scale to monitor patients who suffer from neurological disorders as part of a routine evaluation. Such patients usually deal with other ailments caused by these disorders, like spasticity, which this scale measures.
This scale also monitors the effectiveness of treatment plans that patients follow when treating their spasticity. By observing a patient's muscle tone during an examination, they can tell if a particular treatment plan should be maintained or if it's not working and must be tweaked or overhauled. If a patient starts getting lower scores, that means they are improving. If the scores get higher and higher during each evaluation, the spasticity worsens.
About monitoring treatment plans, the scores on the Modified Ashworth Scale should also help determine what goes into a treatment plan based on changes in scores per muscle observed. Should the treatment plan have physical therapy exercises that the patient should follow? Do they need to be injected with muscle relaxants like botulinum toxin injections? You can answer These two questions when monitoring patients using this scale.
Benefits and limitations
The MAS provides an objective measure of muscle tone, allowing for better tracking of progress over time and comparison between different treatment methods (Harb & Kishner, 2023).
It also helps identify specific muscles that may require more targeted interventions. In spinal cord injury and traumatic brain injury patients, the MAS can be used to monitor changes in muscle spasticity over time (Shirley Ryan AbilityLab, n.d.) For patients with multiple sclerosis or cerebral palsy, the MAS assesses the effectiveness of physical therapy interventions.
While widely used, the MAS has received criticism for its reliability and lack of sensitivity. Passive movement may not always accurately reflect functional muscle tone, and variations in scoring between examiners have been reported (Akpinar et al., 2017). In addition, the MAS only captures a limited range of motion and does not account for variability in different muscles within a specific muscle group.
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References
Akpinar, P., Atici, A., Ozkan, F., et al. (2017). Reliability of the Modified Ashworth Scale and Modified Tardieu Scale in patients with spinal cord injuries. Spinal Cord, 55(10), 944–949. https://doi.org/10.1038/sc.2017.48
Harb, A., & Kishner, S. (2023, May 1). Modified Ashworth Scale. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554572/
Shirley Ryan AbilityLab. (n.d.). Modified Ashworth Scale. Rehabilitation Measures Database. https://www.sralab.org/rehabilitation-measures/ashworth-scale-modified-ashworth-scale
Commonly asked questions
The Modified Ashworth scale is a tool used to assess muscle spasticity in patients with neurological conditions such as spinal cord injury, traumatic brain injury, multiple sclerosis, cerebral palsy, and stroke.
The examiner passively moves the patient's limb through its range of motion and grades the resistance felt during this movement. The perceived resistance is then scored according to the Modified Ashworth scale, with a score of 0 representing no increase in muscle tone and a score of 4 indicating that the limb is rigid in flexion or extension.
The Modified Ashworth scale only captures a limited range of motion and does not account for variability in different muscles within a specific muscle group.
