Tone Assessment Tool (Modified Ashworth Scale)

Reliable grading for Spasticity in neurological conditions (e.g., Stroke, MS, SCI)

Select the description that matches the resistance felt during **rapid passive movement**:

Grade 0

No increase in muscle tone.

Grade 1

Slight increase in tone, manifested by a catch and release, or by minimal resistance at the **end range** of motion.

Grade 1+

Slight increase in tone, manifested by a catch, followed by minimal resistance throughout **the remainder** (less than half) of the ROM.

Grade 2

More marked increase in tone through most of the ROM, but the part is still easily moved.

Grade 3

Considerable increase in tone, passive movement is difficult.

Grade 4

Limb is rigid in flexion or extension (Severe contracture/rigidity).

Your current selection: --

Assessment Protocol & Clinical Guidance

Patient Position: The patient should be positioned comfortably, typically **supine or seated**, with the head and trunk stable. Test the muscle group in the anti-gravity position (if possible).

Procedure: The examiner should move the limb **RAPIDLY** (quickly, but not so fast as to cause injury) from the position of **maximal muscle stretch** to the end of the available range. The focus is on the resistance felt *during* the quick movement.

Key Difference (Grade 1 vs 1+):
- **Grade 1:** Resistance only felt briefly, then movement is free for the **rest of the range**.
- **Grade 1+:** Resistance starts briefly (the catch), but **minimal resistance persists** through the remainder (less than 50%) of the movement.

References:
1. Ashworth, B. (1964). A new scale for grading spasticity. J Neurol Neurosurg Psychiatry.
2. Bohannon, R. W., & Smith, M. B. (1987). Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther.