Spasticity Examination Rating Scales and Office Data Form

05 November 2004

• Spasm Frequency Scale¹
  How many spasms has the patient had in the last 24 hours in affected muscles or extremity?
  Definitions of Spasms: (1) Spasm is a jumping or twitching of the muscle or limb without control; (2) A spasm can be a "shooting" of the body part into a position without control; (3) A rapid series of "spasms" without significant pausing/resting is defined as one spasm.
  0=No spasms
  1=One spasm or fewer per day
  2=Between one and five spasms per day
  3=Between five and nine spasms per day
  4=Ten or more spasms per day

• Medical Research Council Scale² (motor testing)
  As far as possible, the action of each muscle should be observed separately.
  0=No contraction
  1=Flicker or trace of contraction
  2=Active movement, with gravity eliminated
  3=Active movement against gravity
  4=Active movement against gravity and resistance
  5=Normal power
  (NOTE: Grades 4-, 4 and 4+ may be used to indicate movement against slight, moderate and strong resistance respectively)

• Modified Ashworth Scale³
  
  0=No increase in muscle tone
  1=Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end range of motion when the part is moved in flexion or extension/abduction or adduction, etc.
  1+=Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM
  2=More marked increase in muscle tone through most of the ROM, but the affected part is easily moved
  3=Considerable increase in muscle tone, passive movement is difficult
  4=Affected part is rigid in flexion or extension (abduction or adduction, etc.)

• Adductor Tone Rating¹
  
  0=No increase in tone
  1=Increased tone, hips easily abducted to 45º by one person
  2=Hips abducted to 45º by one person with mild effort
  3=Hips abducted to 45º by one person with moderate effort
  4=Two people required to abduct the hips to 45º

• Global Pain Scale⁴
  Rate the total amount of pain the patient has had in the last 24 hours.

• References
  
  1. Snow BJ, Tsui JKC, Bhart MH, Varelas M, Hashimoto SA, Calne DB. Treatment of spasticity with botulinum toxin: a double-blind study. Ann Neurol 1990;28:512-515.
  2. Medical Research Council of the UK. Aids to the Investigation of Peripheral Nerve Injuries. Memorandum No. 45. London, Pendragon House, 1976, pp. 6-7.
  3. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1986;67:206-207.
  4. Developed by Brin MF, Albany KA 1991.

Name
Disease/Disorder				DOB		Age
Examiner						Chart#
Date
I	BP/Pulse
II	Examination Position
	supine or sitting	supine sitting	supine sitting		supine sitting		supine sitting
	other
III	Examination Rating (see below for scales)
	Joint/Muscle Group
	right or left	right left	right left		right left		right left
	Spasm Frequency
	Resting Angle (º)
	MRC (0-5)
	Modified Ashworth (0-4)
	Adductor Tone Rating (0-4)
	Global Pain (1-100)
	Range of Motion:       active
	passive
IV	Ambulation Speed
	Time (seconds)
	Distance Traveled
	Assisted	yes no	yes no		yes no		yes no
	Type of Assistance (if required)
V	Treatment Objectives
1.
2.
3.
4.
VI	Comments