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Subject of the scale: Impairment: spasticity |
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The Tardieu scale is a generic clinical scale, the objective of which is to assess the spasticity symptom component in a situation of limited articulation in a patient suffering from a lesion of the central nervous system with spastic paresis. The Tardieu scale was developed starting with the clinical examination method developed by Guy Tardieu in 1950-60 [1,2,3]. The central and innovative idea of this clinical method was the measurement of the angle of projection, which characterises each spastic muscle at a given time when one stretches it sufficiently quickly.
A first attempt to transform the Tardieu clinical method into a simplified and accessible clinical scale was made by Held and Pierrot-Deseilligny [4] who developed a scale where each muscle was marked in 2 positions, at 3 speeds, by angle of projection and degree of muscular response, i.e. a marking with 12 figures per muscle.
Gracies then developed the scale which he named the Tardieu Scale [5,6,7], where each muscle is described by two numbers: one is the angle of spasticity, corresponding to the difference between its length obtained at slow speed (V1) and the angle of projection obtained at rapid speed (V3) the other is the degree of spasticity which represents an ordinal numeration of 0 to 4 describing the type of muscular reaction (with or without clonus, whether tiring or not).
This is a simple scale, easy to use, which assesses real spasticity in accordance with its definition and not the muscular tone (Ashworth) because it includes the notion of speed as a parameter contributing to the assessment [8].
Initially it is therefore useful to determine the angle of maximal articular mobilisation obtained at the slowest possible speed (to best eliminate the stretching reflex, at speed V1). Secondly, one mobilises the articulation at the fastest possible speed for the examiner and one notes the angle which appears, if there is one (speed V3). The angle of spasticity is the difference between the angle at V1 and the angle at V3. Finally the intensity of the response is graded from 0 to 4.
ATTENTION:
1) The scale retains the benchmark Tardieu position, where 0° is the articular range where the muscle is the shortest. For example, for the ankle, the 90° for the Tardieu assessment corresponds to the 0° of the ankle [tibio-talienne] in anatomical position; the 110° in the Tardieu grading corresponds to 20° of dorsal flexion according to anatomical references.
2) A preliminary version of the scale, where the angle of spasticity does not appear, is erroneously called the Modified Tardieu Scale and has also been tested [16-23].
> Access to the scale is free
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Validity |
Face validity |
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Content validity |
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Criterion validity
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Concurrent validity
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Predictive validity |
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Construct validity
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Convergent validity
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[10] [11] [13] [14] |
Divergent validity
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Discriminant validity
(sensitivity and distinctiveness) |
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Reliability |
Intra-rater reliability |
[7] [9] [18] [22] [23] |
Inter-rater reliability |
[7] [16] [17] [19] [20] [21] [23] |
Test-retest |
[7] [11] [15] |
Internal consistency (alpha) |
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Responsiveness
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General comment on reliability:
The scale has been evaluated in all languages since language does not affect its use. The assessments have often concerned children with infantile paresis but also the other pathologies of the central nervous system in adults. It has often been tested in specific muscle groups.
Reference update:
To notify us of a missing reference, please use:
contact@scale-library.com
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For more details of the scale, the comments or the psychometric properties presented here, please contact
Dr. Jean-Michel GRACIES : jean-michel.gracies@hmn.aphp.fr |
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Inaugural references: [1] Tardieu G, Shentoub S, Delarue R.[Research on a technic for measurement of spasticity]. Rev Neurol (Paris). 1954;91(2):143-4. French. No abstract available.
[2] Tardieu G. Evaluation et caractères distinctifs des diverses raideurs d’origine cérébrale. Chapitre VB1b Les feuillets de l’infirmité motrice cérébrale. Paris: Association Nationale des IMC Ed; 1966. p 1-28.
[3] Tardieu G, Lacert P. Le tonus et ses troubles en clinique. Encyclopédie médico-chirurgicale. Neurologie. Paris: 1977. p 17007 A 20.
[4] Held J, Pierrot-Deseilligny E, Rééducation motrice des affections neurologiques. Paris : Baillère ; 1969 :32-42.
[5] Gracies JM, Marosszeky JE, Renton R, Sandanam J, Gandevia SC, Burke D. Short-term effects of dynamic Lycra splints on upper limb in hemiplegic patients. Arch Phys Med Rehabil 2000;81:1547-1555.
[6] Gracies JM. Evaluation de la spasticité - apport de l'échelle de Tardieu. Motricité Cérébrale. 2001 ;22 :1-16.
[7] Gracies JM, Burke K, Clegg NJ, Browne R, Rushing C, Fehlings D, Matthews D, Tilton A, Delgado MR. Reliability of the Tardieu Scale for assessing spasticity in children with cerebral palsy. Arch Phys Med Rehabil. 2010;91(3):421-8.
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Psychometric references: [9] Scholtes VA, Becher JG, Beelen A, Lankhorst GJ. Clinical assessment of spasticity in children with cerebral palsy: a critical review of available instruments. Dev Med Child Neurol 2006;48(1):64-73.
[10] Patrick E, Ada L. The Tardieu Scale differentiates contracture from spasticity whereas the Ashworth Scale is confounded by it. Clin Rehabil. 2006;20(2):173-82.
[11] Haugh AB, Pandyan AD, Johnson GR. A systematic review of the Tardieu Scale for the measurement of spasticity. Disabil Rehabil. 2006;28(15):899-907.
[12] Sheean G, McGuire JR. Spastic hypertonia and movement disorders: pathophysiology, clinical presentation, and quantification. PMR. 2009;1(9):827-33.
[13] Alhusaini AA, Dean CM, Crosbie J, Shepherd RB, Lewis J. Evaluation of spasticity in children with cerebral palsy using Ashworth and Tardieu Scales compared with laboratory measures. J Child Neurol. 2010;25(10):1242-7.
[14] Paulis WD, Horemans HL, Brouwer BS, Stam HJ. Excellent test-retest and inter-rater reliability for Tardieu Scale measurements with inertial sensors in elbow flexors of stroke patients. Gait Posture. 2011;33(2):185-9.
[15] Williams G, Olver J, de Graaff S, Singer BJ. The use of botulinum toxin type A in the management of adult-onset focal spasticity: a survey of Australian allied health professionals. Aust Occup Ther J. 2012;59(4):257-64.
[16] 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.
[17] 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.
[18] Mackey AH, Walt SE, Lobb G, Stott NS. Intraobserver reliability of the modified Tardieu scale in the upper limb of children with hemiplegia. Dev Med Child Neurol. 2004 Apr;46(4):267-72.
[19] 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.
[20] 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.
[21] Ansari NN, Naghdi S, Hasson S, Azarsa MH, Azarnia S. The Modified Tardieu Scale for the measurement of elbow flexor spasticity in adult patients with hemiplegia. Brain Inj. 2008 Dec;22(13-14):1007-12. doi: 10.1080/02699050802530557.
[22] Singh P, Joshua AM, Ganeshan S, Suresh S. Intra-rater reliability of the modified Tardieu scale to quantify spasticity in elbow flexors and ankle plantar flexors in adult stroke subjects. Ann Indian Acad Neurol. 2011 Jan;14(1):23-6. doi: 10.4103/0972-2327.78045.
[23] 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.
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