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Subject of the scale: Impairment: spasticity

Modified Ashworth Scale (MAS)


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The modified Ashworth scale is a generic clinical scale. It analyses the hypertonic component (spasticity) of a limitation in range of motion in patients with central nervous system lesions.

It is used in clinical practice for all types of central nervous system lesions and is the international gold standard for the evaluation of spasticity, particularly in publications.

The scale was originally developed in English by Ashworth [1], and was later modified by Bohannon and Smith [2].

The scale is simple, easy and quick to use.

> Access to the scale is free

Psychometric properties:


Psychometric properties



Face validity


Content validity


Criterion validity

Concurrent validity


Predictive validity


Construct validity

Convergent validity


Divergent validity


Discriminant validity
(sensitivity and distinctiveness)



Intra-rater reliability

[4] [5] [6] [9] [10] [11]

Inter-rater reliability

[2] [3] [4] [5] [6] [7] [8] [9] [10] [11]


[7] [9] [11]

Internal consistency (alpha)




General comment on reliability:

The scale has been evaluated in all languages since language does not affect its use. However, it has mostly been evaluated in children with cerebral palsy and other pathologies of the central nervous system. It has often been tested in specific muscle groups.

Reference update:

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More information:

For more details of the scale, the comments or the psychometric properties presented here, please contact Dr. François GENET :


Inaugural references:

[1] Ashworth B. Preliminary trial of carisoprodol in multiple sclerosis. Practitioner. 1964 Apr;192:540-2. No abstract available.

[2] Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987 Feb;67(2):206-7.

Psychometric references:

[3] Boyd RN, Barwood SA, Ballieu CE, Graham HK. Validity of a clinical measure of spasticity in children with cerebral palsy in a double-blind randomized controlled clinical trial. Developmental Medicine & Child Neurology 1998;40(suppl 78):7.

[4] Gregson JM, Leathley M, Moore AP, Sharma AK, Smith TL, Watkins CL. Reliability of the Tone Assessment Scale and the modified Ashworth scale as clinical tools for assessing poststroke spasticity. Arch Phys Med Rehabil. 1999 Sep;80(9):1013-6.

[5] Fosang AL, Galea MP, McCoy AT, Reddihough DS, Story I. Measures of muscle and joint performance in the lower limb of children with cerebral palsy. Dev Med Child Neurol. 2003 Oct;45(10):664-70.

[6] Clopton N, Dutton J, Featherston T, Grigsby A, Mobley J, Melvin J. Interrater and intrarater reliability of the Modified Ashworth Scale in children with hypertonia. Pediatr Phys Ther. 2005 Winter;17(4):268-74.

[7] Mehrholz J, Wagner K, Meissner D, Grundmann K, Zange C, Koch R, Pohl M. Reliability of the Modified Tardieu Scale and the Modified Ashworth Scale in adult patients with severe brain injury: a comparison study. Clin Rehabil. 2005 Oct;19(7):751-9.

[8] Yam WK, Leung MS. Interrater reliability of Modified Ashworth Scale and Modified Tardieu Scale in children with spastic cerebral palsy. J Child Neurol. 2006 Dec;21(12):1031-5.

[9] Mutlu A, Livanelioglu A, Gunel MK. Reliability of Ashworth and Modified Ashworth scales in children with spastic cerebral palsy. BMC Musculoskelet Disord. 2008 Apr 10;9:44. doi: 10.1186/1471-2474-9-44.

[10] Ansari NN, Naghdi S, Arab TK, Jalaie S.The interrater and intrarater reliability of the Modified Ashworth Scale in the assessment of muscle spasticity: limb and muscle group effect. NeuroRehabilitation. 2008;23(3):231-7.

[11] Waninge A, Rook RA, Dijkhuizen A, Gielen E, van der Schans CP. Feasibility, test-retest reliability, and interrater reliability of the Modified Ashworth Scale and Modified Tardieu Scale in persons with profound intellectual and multiple disabilities. Res Dev Disabil. 2011 Mar-Apr;32(2):613-20. doi: 10.1016/j.ridd.2010.12.013. Epub 2011 Jan 12.

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