Summary

What it measures:

Muscle tone/spasticity; 6-category ordinal scale used to grade resistance during passive muscle stretching

Modified Ashworth Scale

0=no increase in tone

1=slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion (ROM) when affected part is moved in flexion or extension

1+=slight increase in muscle tone, manifested by a catch followed by minimal resistance through the remainder of ROM, but affected part is easily moved

2=more marked increase in muscle tone through most of ROM, but affected part is easily moved.

3=considerable increases in muscle tone; passive movement difficult

4=affected part is rigid in flexion or extension

Modified Modified Ashworth Scale (Ansari et al, 2009) 

1+ removed and redefined as a 2; subsequent grades are elevated accordingly

Target Population:

Multiple sclerosis (MS)

The Ms Outcome Measures Taskforce notes limitations including:

• Overall, MAS is limited for people with MS who are high functioning (Paltamaa et al, 2005)
• Upper extremity measurement is more reliable than lower extremity measurement. (Sloan et al, 1992)
• No significant difference in resistance to passive movement between grades 1, 1+, and 2. Not valid at lower grades. Ambiguity exists with the addition of the 1+ grade. (Pandyan et al, 2003)
• No quantification of resistance to the quick stretch in absolute units. Lack of biomechanical definitions regarding ‘catch’ and ‘release.’
• The resistance to passive movement is not significantly influenced by reflex‐mediated neural activity unless the velocity of passive ROM is high. (Pandyan et al, 1999)
• May provide a valid measure of the resistance to passive movement but does not provide an exclusive measure of spasticity. There may be a non‐reflex contribution to resistance to passive movement due to changes in the physical properties of the muscle and connective tissues. Cooper et al, 2005; Pandyan et al, 1999)
• No standardization regarding test position, number of repetitions, testing time (morning/afternoon) or right‐left test order in a case of bilateral involvement. (Kaya et al, 2011)

The Task Force is unable to recommend MAS for use with this population at this time, as there is insufficient information to support a recommendation.