COSMIN database

Clinical scales for the assessment of spasticity, associated phenomena, and function: a systematic review of the literature

Platz, T., Eickhof, C., Nuyens, G., and Vuadens, P.
PURPOSE: To characterise clinical assessment methods for spasticity and/or its functional consequences in clinical patient populations at risk to suffer from spasticity.

METHOD: Systematic literature search and manual-based two-step review process of psychometric properties of clinical assessment scales for spasticity and associated phenomena, as well as of functional scales with an association with spasticity. Reviewed psychometric properties included internal consistency, interrater, intrarater as well as retest reliability, construct validity, ecological validity, and responsiveness.

RESULTS: Until May 2003 electronic database searches established a reference pool of 4151 references of which 90 references contributed to the review objectives. An additional 20 references were identified by an informal reference search. Twenty-four clinical scales that assess spasticity and/or related phenomena as well as 10 scales for 'active function' and three scales for 'passive function' with an association with spasticity could be identified. Some evidence signals that a high interrater reliability of the Ashworth and modified Ashworth scales can be achieved, however not in all circumstances. For many scales, reliability data is, however, missing. This is especially true for test retest reliability. Information about construct validity can promote our understanding of what individual scales are likely to assess. Many scales have been able to document changes after therapeutic intervention.

CONCLUSIONS: The collated evidence can guide our clinical decision about when to use which scale and can promote evidence-based assessment of spasticity and related clinical phenomena.
Disabil Rehabil
0963-8288 (Print)
Publication year:
Biological and physiological variables:
Biological and physiological variables
Functional status:
Physical functioning
Adults (18-65)
Children (0-18)
Seniors (65+)
Diseases of and symptoms related to the nervous system
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
4 - Performance-based tests
6 - Clinical rating scales
7 - Observations
9 - Laboratory tests
Ankle position at rest
AROM - Active Range Of Motion
AS - Ashworth scale
BI - Barthel Index   
Carer burden scale
Clonus score
Disability scale
Extensor toe sign(s)
Finger curl at rest
FMA-UE - Fugl–Meyer Assessment of the upper extremity
Gait analysis
GMFM - Gross Motor Function Measure (Also: GMFM-88 - 88-item version and GMFM-66 - 66-item version)   
Goniometry / Goniometer   
Grip strength
Hygiene score
MAS - Modified Ashworth Scale   
Maximum inter-knee distance
MRC Scale - Medical Research Council Scale   
Muscle tone Scale
NINDS myotatic reflex scale - National Institute of Neurological Disorders and Stroke myotatic reflex scale
PEDI-self-care score - Pediatric Evaluation of Disability Inventory self-care score
Plantar stimulation response
QUEST - Quality of Upper Extremity Skills Test
ROM–visual estimation - Range of Movement-visual estimation
Spasm frequency scale(s)
Spasm score
Spasm severity scale
Spasticité (Bilan moteur)
Spasticity score (hip adductors)
Tendon reflex scale(s)
Tone Assessment Scale
Total spasticity score (ankle)
TS (also MTS) - Tardieu Scale (also: Modified)
VAS for tone (clinical rater)
VAS for tone (patient)
Velocity-corrected MAS - Velocity-corrected Modified Ashworth Scale