The Ashworth Scale: A Reliable and Reproducible Method of Measuring Spasticity

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Abstract
Spasticity is an important cause of neurological disability, and many new treatments are emerging to treat it. To assess any therapy, a consistent and reproducible method of measuring spasticity is required. The Ashworth Scale, in which each passive movement is graded between 1 (normal) and 5 (immovable), has been used in recent studies, and has the advantage over other methods of being simple to use and applicable over a wide range of arm and leg movements. We have studied the Ashworth Scale's reliability within and among four observers (two physicians, an occupational therapist, and a physical therapist) in 12 patients with moderate to severe spasticity. Total spasticity scores ranged from 22 to 66 (mean, 44.5). Coefficient of repeatability for intrarater variability was between 7.2 and 9.4. Interobserver error measured by Kendall's coefficient of concordance was 0.92. Given that small fluctuations in spasticity occur normally, these results indicate that the Ashworth Scale is a reliable and reproducible method of evaluating spasticity.

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