Tone and Spasticity

tone

resistance of muscle to passive elongation or stretch

hypertonia

increased tone

spasticity

motor disorder characterized by a velocity dependent increase in muscle tone with increased resistance to stretch (UMN- hyperexcitability)

rigidity

a hypertonic state independent of velocity (Stiffness)

dystonia

prolonged involuntary movement disorder characterized by twisting/writhing repetitive movements and increased muscular tone

hypotonia/flaccidity

decreased/low tone

- affects anterior horn cell and peripheral nerve leading to hyperextensibility of joints (LMN)

modified ashworth scale

place the patient in supine position

pt. instructed to relax

if testing muscle that flexes a joint, place the joint in a maximally flexed position and move into extension over one second (opposite for extensors)

0

score of ____ for modified ashworth

- no increase in muscle tone

1

score of ____ for modified ashworth

- slight increase in muscle tone, manifested by a catch or my minimal resistance at the end of the ROM when the affected part is moved in flex/ext

1+

score of _____ for the modified ashworth

- slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than 1/2) of the ROM

2

score of ____ for modified ashworth

- more marked increase in muscle tone through more of the ROM, but affected part is easily moved

3

score of ____ for modified ashworth

- considerable increase in muscle tone, passive movement difficult

4

score of _____ for modified ashworth

- affected part is rigid in flex/ext

9

score of ____ for modified ashworth

- unable to test

tardieu scale

always test at the same time of day and in a consistent position

- UE: sitting

- LE: supine

test at 3 velocities

V1

as slow as possible

V2

speed of limb segment falling with gravity

V3

as fast as possible

R1

angle at catch seen at V2 or V3

R2

full ROM at rest and V1

0

score of ____ for tardieu

- no resistance throughout the passive range

1

score of ____ for tardieu scale

- slight resistance throughout, with no clear catch

2

score of ____ for tardieu scale

- clear catch at a precise angle

3

score of ____ for tardieu scale

- fatigable clonus (<10s)

4

score of ____ for tardieu scale

- un-fatigable clonus (>10s)

0

score of ____ for tardieu scale

- joint immobile