Spasticity severity assessment scales

Caucasian senior female patient consulting a middle age african female doctor

Assessment scales for spasticity

Assessment scales are used to evaluate the severity of spasticity and the response to treatment1,2:

  • Severity of spasticity: Ashworth Scale3, Modified Ashworth Scale4 and Tardieu Scale5
  • Disability: Disability Assessment Scale6,7 and Functional Ambulation Classification8
  • Carer Burden Scale9
  • Goal Attainment Scale1

Some of these assessment scales can also be used to quantify the consequences of spasticity on everyday activities2:

  • Disability Assessment Scale: determines the functional impairment associated with spasticity6,7
  • Carer Burden Scale: evaluates the impact of spasticity on physical carer burden9
  • Functional Ambulation Scale: evaluates walking ability8
Mature caucasian adult patient strechtching his arm with the help of a male caucasian physiotherapist

Spasticity scale features

Ashworth Scale1,10

  • Assessment of resistance to stretching when a limb is passively moved
  • Quantitative determination of muscle tone
  • Widely used in patients with spasticity
  • Rates muscle tone using a 5-point scale (0 to 4)

Modified Ashworth Scale1,10

  • A modification of the Ashworth Scale to differentiate mild and moderate spasticity
  • Rates muscle tone using a 6-point scale (0 to 5)

Disability Assessment Scale6,7

The Disability Assessment Scale determines functional impairment, limb position and pain. It consists of four functional domains, each rated by the patient on a 4-point scale (0 to 3):

  • Hygiene
  • Dressing
  • Limb position
  • Pain

To calculate the overall score, the four domain ratings are added, obtaining a final score ranging from 0 to 12.

Functional Ambulation Classification Scale8

This scale examines independence and walking (ambulation) abilities. Patients are rated based on their most independent level of function and ability to ambulate.

Assessed by the physician on a 6-point scale:

  • Level 0 = No functional ambulation
  • Level 1 = Ambulator-dependent for physical assistance, with high dependency
  • Level 2 = Ambulator-dependent for physical assistance, with low dependency
  • Level 3 = Ambulator-dependent for supervision
  • Level 4 = Ambulator-independent (level surfaces only)
  • Level 5 = Ambulator-independent

Carer Burden Scale9

Measures impact of upper limb spasticity on the physical carer burden.

The Carer Burden Scale consists of four items:

  • Cleaning the palm
  • Cutting the fingernails
  • Cleaning the armpit
  • Dressing

Each item is rated by the carer on a 5-point scale, ranging from 0 (no carer burden) to 4 (maximum carer burden), for the most difficult day over the preceding week.

To calculate the overall score, all the item ratings are added and divided by the number of items answered (sum item rating/number of items answered).

The Goal Attainment Scale11

The Goal Attainment Scale (GAS) defines goals that are realistic and measurable

If you are a patient, you and your healthcare team will identify some personal and realistic goals to measure outcomes of treatment on an ongoing basis. The importance and difficulty for each goal are also defined.

At each subsequent visit, physicians rate the GAS score for each goal using a 5-point scale (-2 to +2):

  • -2 = a lot less than expected
  • -1 = a little less than expected
  • 0 = expected level of achievement
  • +1 = a little better than expected
  • +2 = a lot better than expected

Setting up for the future

Once spasticity has been diagnosed and the extent of impairment assessed, treatment that involves many experts can be planned.1,12

To optimise the treatment plan, goals that are set by the patient, the carer and the physician should be decided on. These goals need to be SMART (Specific, Measurable, Achievable, Relevant, and Time-bound) to ensure that the chosen treatment is appropriate and motivation to “stick with the plan” can be maintained. GAS is a good tool for measuring the achievement or otherwise of treatment goals and can be used to indicate whether new or amended goals are needed on an ongoing basis.11

Read more about how to treat spasticity
and its treatment options

For more information about spasticity, check out our other articles.

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References

1Escaldi S, Bianci F, Bavikatte G, Molteni F, Moraleda S, Deltombe T, Francisco G. Module 1: pathophysiology and assessment of spasticity; goal setting. J Int Soc Phys Rehabil Med. 2022 5(Suppl 1):S3-S22. doi: 10.4103/2349-7904.347807.

2Thibaut A, Chatelle C, Ziegler E, Bruno MA, Laureys S, Gosseries O. Spasticity after stroke: physiology, assessment and treatment. Brain Inj. 2013;27(10):1093-105. doi: 10.3109/02699052.2013.804202.

3Ashworth B. Preliminary trial of carisoprodol in multiple sclerosis. Practitioner. 1964 Apr:192:540-2.

4Bohannon RW, Smith MB. Assessment of strength deficits in eight paretic upper extremity muscle groups of stroke patients with hemiplegia. Phys Ther. 1987 Apr;67(4):522-5. doi: 10.1093/ptj/67.4.522.

5Tardieu G, Shentoub S, Delarue R. [Research on a technic for measurement of spasticity]. Rev Neurol (Paris). 1954;91(2):143-4.

6Brashear A, Zafonte R, Corcoran M, Galvez-Jimenez N, Gracies JM, Gordon MF, McAfee A, Ruffing K, Thompson B, Williams M, Lee CH, Turkel C. Inter- and intrarater reliability of the Ashworth Scale and the Disability Assessment Scale in patients with upper-limb poststroke spasticity. Arch Phys Med Rehabil. 2002a Oct;83(10):1349-54. doi: 10.1053/apmr.2002.35474.

7Brashear A, Gordon MF, Elovic E, Kassicieh VD, Marciniak C, Do M, Lee CH, Jenkins S, Turkel C; Botox Post-Stroke Spasticity Study Group. Intramuscular injection of botulinum toxin for the treatment of wrist and finger spasticity after a stroke. N Engl J Med. 2002b Aug 8;347(6):395-400. doi: 10.1056/NEJMoa011892.

8Holden MK, Gill KM, Magliozzi MR, Nathan J, Piehl-Baker L. Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness. Phys Ther. 1984 Jan;64(1):35-40. doi: 10.1093/ptj/64.1.35.

9Bhakta BB, Cozens JA, Chamberlain MA, Bamford JM. Impact of botulinum toxin type A on disability and carer burden due to arm spasticity after stroke: a randomised double blind placebo controlled trial. J Neurol Neurosurg Psychiatry. 2000 Aug;69(2):217-21. doi: 10.1136/jnnp.69.2.217.

10Luo Z, Lo WLA, Bian R, Wong S, Li L. Advanced quantitative estimation methods for spasticity: a literature review. J Int Med Res. 2020 Mar;48(3):300060519888425. doi: 10.1177/0300060519888425.

11Clarkson K, Barnett N. Goal attainment scaling to facilitate person-centred, medicines-related consultations. Eur J Hosp Pharm. 2021 Mar;28(2):106-108. doi: 10.1136/ejhpharm-2019-002040.

12Royal College of Physicians. Spasticity in adults: management using botulinum toxin. National Guidelines. 2018. Available at: https://archive-rcplondon.zedcloud.co.uk/file/12449/download%202018 [accessed September 2025].

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