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改良Ashworth和Tardieu量表

目录
Modified Ashworth Scale .......................................................................................................... 2 Purpose of the measure ............................................................................................................ 2 Available versions ...................................................................................................................... 2 Features of the measure ........................................................................................................... 3 Alternative forms of the Modified Ashworth Scale................................................................... 7 Client suitability ......................................................................................................................... 8 Modified Tardieu Scale (MTS) ................................................................................................. 10 Purpose of the measure .......................................................................................................... 10 Available versions .................................................................................................................... 11 Features of the measure ......................................................................................................... 12 Scoring and Score Interpretation ............................................................................................ 15 Alternative forms of the Modified Tardieu Scale .................................................................... 17 Client suitability ....................................................................................................................... 19

Modified Ashworth Scale
Purpose of the measure
The Modified Ashworth Scale is considered the primary clinical measure of muscle spasticity in patients with neurological conditions. However, some publications question its ability to measure spasticity and advocate the Modified Ashworth Scale as a rating scale to measure abnormality in tone or the resistance to passive movements, since there is no clinically direct method for measuring spasticity (Gregson, Leathley, Moore, Sharma, Smith & Watkins, 1999; Pandyan, Johnson, Price, Curless, Barnes & Rodgers, 1999).
改良 Ashworth 是神经系统疾患肌肉痉挛的主要临床测量手段。然而，许多研究质疑它在测量痉挛的能力，并提倡将其作为测量张力异常或被动运动受阻的评定量表。因为临床尚无直接方法测量痉挛。(Gregson, Leathley, Moore, Sharma, Smith & Watkins, 1999; Pandyan, Johnson, Price, Curless, Barnes & Rodgers, 1999).
Available versions
The Ashworth Scale was initially developed in the early 1960s by Bryan Ashworth, to estimate the efficacy of anti-spastic drugs in clients with Multiple Sclerosis. It is a 5-point scale, with a grade score of 0, 1, 2, 3, or 4 (Ashworth, 1964). In 1987, Bohannon and Smith added the grade "1+" and

proposed slight changes on the definitions of each score in order to increase the sensitivity of the measure and facilitate scoring. The new measure was then called the Modified Ashworth Scale and is considered by many as the gold standard for measuring spasticity (Bohannon & Smith, 1987).
Features of the measure
Items:评定条目 Although there are no standardized guidelines for its use, the Modified Ashworth Scale can be applied to muscles of both the upper or lower body. The rater should extend the client's limb from a position of maximal flexion to maximal extension until the first soft resistance is felt. Moving a client's limb through its full range of motion should be done within one second by counting "one thousand and one" (Bohannon and Smith, 1987).
尽管没有使用的标准指南，但改良 Ashworth 量表可以用于上下肢的肌肉评定。测量者应将患者肢体从最大屈曲位伸直到最大伸直位，直到感觉到软组织抵抗。全关节范围内移动患者肢体时，应在 1s 内完成，即数"one thousand and one"(Bohannon and Smith, 1987).
Mehlroz, Wagner, Meibner, Grundmann and Zange (2005) suggest testing of the upper limbs should take place while the client is lying supine, with the upper limbs parallel to the trunk, elbows extended, wrists in a neutral

position, and the lower limbs positioned parallel to one another. Exceptions are made for the shoulder extensors, where the arm should be moved from extension to 90 degrees of flexion, and for the shoulder internal rotators, where the arm should be moved from neutral to a maximum external rotation.
Mehlroz, Wagner, Meibner, Grundmann and Zange (2005)建议测量上肢应在仰卧位进行，上肢平行于躯干放置，肘关节伸直，腕关节处于中立位，双下肢平行放置，但肩关节伸肌和内旋肌测量时不同。伸肌测量时，手臂应从伸直位移动到屈曲 90°，内旋肌测量时，手臂应从中立位移动到最大外旋位。
For the lower limbs, Blackburn, van Vliet, and Mockett (2002) recommend that the client should be side lying. Specifically for testing the soleus muscle, the hips and knees should be positioned in 45 degrees of flexion and the ankle is moved from maximum plantar flexion to maximum dorsiflexion. For the gastrocnemius muscle, hips should be in 45 degrees of flexion with the knees in maximum extension and the ankle is moved from maximum plantar flexion to maximum dorsiflexion. For the quadriceps femoris muscle, knees and hips should be in maximal extension and the knee is moved from maximum extension to maximum flexion.
Blackburn, van Vliet, and Mockett (2002)推荐患者侧卧。对下肢来说，尤其是测量比目鱼肌时，双髋和膝应在 45°屈曲位，踝关节从最大跖屈位移动到最大背伸位。对腓肠肌来说，双髋 45°屈曲，双膝最大伸直位，踝关节从最大跖屈位移动到最大背伸位。对股四头肌来说，双膝髋都应在最大伸直位，膝关节从最大伸直位移动到最大屈曲位。

Throughout testing the client should be instructed to remain calm and relaxed, and when repeated testing is undertaken, testing should be initiated at the same time of the day to minimize possible changes in spasticity levels due to medication interaction (Bohannon and Smith, 1987). 整个测试中，应教育患者保持冷静放松。若需要重复测试，应在同一天进行以最大程度减少因药物作用而导致的痉挛程度的变化(Bohannon and Smith, 1987)。
Scoring: The Modified Ashworth Scale is a 6-point scale. Scores range from 0 to 4, where lower scores represent normal muscle tone and higher scores represent spasticity or increased resistance to passive movement.
改良 Ashworth 是 6 等级的量表。计分从 0-4 分不等，分数越低，代表肌张力正常；分数越高，代表痉挛或者被动运动阻力增加。 Specific score definitions for the Ashworth Scale and for the Modified Ashworth Scale are as follows:
Ashworth 及改良 Ashworth 的具体评分标准见下：
Ashworth Scale Score (Ashworth, 1964)
0 1 No increase in tone Slight increase in tone giving a catch when the limb was moved in flexion or extension
Modified Ashworth Scale (Bohannon & Smith, 1987)
No increase in muscle tone 无肌张力增高 Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion (ROM) when the affected part is moved in flexion or extension

当受累部分做屈伸时，有轻微肌张力增高，表现为卡住-释放或者关节活动度末端较小的阻力。 1+ N/A Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM 肌张力轻度增加，表现为卡住，继而在剩余（不到一半）的活动范围内有轻度的阻力。 2 More marked increase in tone but limb easily flexed More marked increase in muscle tone through most of the ROM, but affected parts easily moved 多数关节活动范围内感觉到更多明显的肌张力增高，但受累部位还可以轻易被移动。 3 Considerable increase in tone, passive movement difficult Limb rigid in flexion or extension Considerable increase in muscle tone, passive movement difficult 肌张力显著增高，被动运动困难。 4 Affected part rigid in flexion or extension 受累部位僵直于屈曲或伸直位。
Time: 时间：未报道，但随被测肌肉数目而改变。 Not reported, but it will vary with the numbers of muscles being tested.
Subscales: 子量表：无 None
Equipment: 机器：治疗垫、纸
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Therapy mat Paper
Training：培训：无经典报道。 None typically reported.

Alternative forms of the Modified Ashworth Scale 其他可供选择的量表
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Ashworth Scale:
Published in 1964, the Ashworth Scale was the original measure for resistance to passive movement. It is a 5-point scale, with a grade score of 0, 1, 2, 3, or 4. The Ashworth Scale is less sensitive than the Modified Ashworth Scale (Brashear, Zafonte, Corcoran, Galvez-Jimenez, Gracies, Gordon et al., 2002).
Ashworth 量表： 1964 年发表， Ashworth 量表是测量被动运动阻力的最原始的测量方法。分制， 5 Ashworth 量表不如改良版敏感。 (Brashear, Zafonte, Corcoran, 分别为 0,1,2,3,4。 Galvez-Jimenez, Gracies, Gordon et al., 2002).
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Modified Modified Ashworth Scale: Published in 2006, the Modified Modified Ashworth Scale aims to improve the reliability of the Modified Ashworth Scale. It is a 5-point scale, where the authors omitted the grade "1+" from the Modified Ashworth Scale and slightly redefined the grade "2" (Ansari, Naghdi, Younesian, & Shayeghan, 2008). The definition for each grade is as follows:
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改良改良 Ashworth 量表

发表于 2006 年，改良改良 Ashworth 量表致力于改进改良 Ashworth 量表的可靠性。也是 5 分制的量表，作者删去了改良 Ashworth 的“1+”级，并稍稍重新定义了“2”级(Ansari, Naghdi, Younesian, & Shayeghan, 2008)。每级的定义如下：
Modified Modified Ashworth Scale (Ansari, Naghdi, Moammeri, Score Jalaie, 2006)
0 1 No increase in muscle tone 无肌张力增加 Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion (ROM) when the affected part is moved in flexion or extension 轻度肌张力增加，表现为有卡住-释放或者受累部分屈曲或伸直时关节活动终末有较小阻力。 Marked increase in muscle tone, manifested by a catch in the middle ROM, but affected part easily moved 明显的肌张力增加，表现为活动范围中间卡住，但受累部分可以轻易活动。 Considerable increase in muscle tone, passive movement difficult 显著的肌张力增高，被动活动困难。 Affected part rigid in flexion or extension 受累部分屈/伸僵直.
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3 4
Client suitability
患者适用类型
Can be used with:
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Clients with stroke. 脑卒中 Clients with other neurological impairment such as multiple sclerosis, traumatic brain injury, spinal cord injury.其他神经系统障碍如多发硬化、脑外伤、脊髓损伤。

Should not be used in: To date, there is no information on restrictions for using the Modified Ashworth Scale. 不适用于：目前尚无具体限制信息。

Modified Tardieu Scale (MTS)
Purpose of the measure
测量目的
The Modified Tardieu Scale (MTS) is a clinical measure of muscle spasticity in patients with neurological conditions. When using the MTS, spasticity is quantified by assessing the muscle's response to stretch applied at given velocities. The quality of the muscle reaction at specified velocities and the angle at which the muscle reaction occurs are incorporated into the measurement of spasticity using the MTS (Morris, 2002).
改良 Tardieu 量表（MTS）是临床神经系统疾患患者肌肉痉挛的一种测量方式。使用 MTS 时，痉挛根据肌肉在特定速度下牵伸的反应进行定量评估。特定速度的肌肉反应品质以及肌反应时所处的关节角度，在使用 MTS 时都会综合考虑到痉挛的测量中去(Morris, 2002)。
The Ashworth Scale and the Modified Ashworth Scale are most often used clinically in the assessment of adults, however the MTS is more commonly used in the assessment of children and has been suggested to be a more accurate clinical measure of spasticity (Morris, 2002).
Ashworth 量表及改良 Ashworth 量表长用于临床成年人的评估，但 MTS 则常用于儿童的评估，且被认为在痉挛临床测量方面更加准确(Morris, 2002)。

The ability of the Ashworth Scales to measure spasticity has been questioned and some publications suggest that they measure abnormal tone or resistance to passive stretch rather than spasticity because they do not take into account the velocity-dependent component of spasticity. The MTS compares the muscle's resistance to passive stretch at both slow and fast speeds in order to account for the velocity-dependent characteristic of spasticity (Paulis, Horemans, Brouwer & Stam, 2011).
Ashworth 量表测量痉挛的能力曾被质疑，且有些文章认为，他们测量的是异常肌张力或者被动牵伸时的阻力，而不是痉挛程度，因为他们并未曾考虑到痉挛时 MTS 对比了慢速和快速两种情况下被动牵伸时的肌肉阻力，速度依赖性的成分。以对痉挛的速度依赖性作一个很好的解释(Paulis, Horemans, Brouwer & Stam, 2011)。
Available versions
可用的版本
Tardieu et al. (1954) first suggested the technique of spasticity measurement used in the Tardieu Scale. Held and Pierrot-Deseilligny (1969) later developed the quantifiable Tardieu Scale that was then translated into English by Gracies et al. (2000). Boyd and Graham (1999) further modified the scale as the Modified Tardieu Scale (MTS).
Tardieu 等人 Held （1954）年第一次建议使用 Tardieu 量表作为痉挛测量的技术。 and Pierrot-Deseilligny (1969)继而发展了定量的 Tardieu 量表，并由 Gracies 等

(2000)翻译为英文。Boyd and Graham (1999)进一步改良了量表，即“Modified Tardieu Scale”
Features of the measure
测量的特性
Items:条目 There are no actual items to the MTS. 尚未有现行的关于 MTS 的条目。
Description of tasks 任务描述 There are no actual items to the MTS. 尚未有现行 MTS 的条目。
The examiner evaluates the muscle group's reaction to stretch at a specified velocity with 2 parameters: X (quality of muscle reaction) and Y (angle of muscle reaction).
测量者通过两个参数来评估特定速度下肌群对牵张的反应：X（肌肉反应的品质 /性质）、Y（肌肉反应时所处的角度）。
Velocity of stretch:
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V1: As slow as possible (minimizing stretch reflex) V2: Speed of the limb segment falling under gravity V3: As fast as possible (faster than the rate of the natural drop of the limb segment under gravity)

牵张速度： V1：尽可能慢（缓和牵张反射）
V2：肢体抗重力下落的速度
V3：尽可能快（快于肢体自由落体的速率）
The resulting joint angles are defined as:
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R1 (the angle of catch following a fast velocity stretch - during either V2 or V3); and
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R2 (passive range of motion following a slow velocity stretch - V1) (Mackey, Watt, Lobb & Stott, 2004).
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As V1 is used to measure the passive range of motion (PROM), only V2 and V3 are used to rate spasticity. 相对应的关节角度定义如下： R1 是快速牵张时出现卡住的角度，也就是在 V2 或者 V3 的速度下；
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R2 是在一个相对较慢的速度下，被动活动关节时，感受到阻碍或卡住时的角度，也就是在 V1 的速度下(Mackey, Watt, Lobb & Stott, 2004).
通常 V1 用来测量被动关节活动度，而 V2 和 V3 常用来量化痉挛。
Grading should always be performed at the same time of the day, and the limb being test should be placed in the same position for repeat testing. The MTS specifies limb placement positions for consistency (Boy & Graham, 1999;

Morris 2002). Other joints, in particular the neck, must also remain in a constant position for the duration of the test and on subsequent testing. 痉挛评估分级应在每天同一时刻进行，并且重复测量时被测肢体要摆在相同的位 TMS 为保持结果的一致性，置。也定义了肢体的摆放位置(Boy & Graham, 1999; Morris 2002)。其他关节，尤其是颈部，务必在整个检查以及后续检查中保持在同一位置。 Angle of muscle reaction (Y): Measured relative to the position of minimal stretch of the muscle (corresponding to angle) for all joints except hip, where is it relative to the resting anatomical position (Gracies, Marosszeky, Renton, Sandanam, Gandevia & Burke, 2000).
肌肉反应时所处的角度（Y）：除髋关节外，其他角度测量时均相对于肌肉牵伸反射最小的位置（相对应的角度）；髋关节相对于检查时的解剖位(Gracies, Marosszeky, Renton, Sandanam, Gandevia & Burke, 2000)。
What to consider before beginning 检查前的准备
Test positions:
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Upper limb - To be tested in a sitting position. Lower limb - To be tested in supine position.
检查体位: 上肢：坐位检查。下肢：仰卧位检查。

For further details on testing positions, please visit Morris (2002): 其他检查体位详见： https://www.wendangku.net/doc/b47733417.html,/content/maney/ptr/2002/00000007/00000001/ art00006
Scoring and Score Interpretation
Although not described in the original Tardieu Scale, Boyd and Graham (1999) describe R1 and R2 when evaluating the reaction of the muscle. R1 is used to denote the angle at which a "catch" resulting from an overactive stretch reflex is present, and R2 denotes the angle of muscle length at rest. In the development of the MTS, Boyd and Graham suggested that the relationship between R1 and R2 is of greater importance than the individual measures of R1 and R2. 记分和分数解读：尽管原始 Tardieu 量表没有描述，但 Boyd and Graham (1999)描述了评估肌肉反应时 R1 和 R2 的意义。R1 表示牵伸反射过度兴奋时，肌肉出现“卡住”所处 R2 的角度，表示肌肉静息长度时出现反应时所处的角度。在 MTS 后续发展过程中，Boyd and Graham 认为 R1 和 R2 之间的关系比单纯测量 R1 和 R2 更重要。
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A large difference between R1 and R2 suggests a large dynamic component with a greater capacity for change or improvement.
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A small difference between R1 and R2 suggests a predominantly fixed contracture in the muscle with a poorer capacity for change.

R1 和 R2 相差很大说明动态成分比重大，有较大的改变或改善空间。
R1 和 R2 没有很大差距说明肌肉存在既定挛缩，改变的空间较小。
Therefore, the relationship between R1 and R2 can be used to estimate the role of neural mechanisms (spasticity) and mechanical restraint of the soft tissue when the muscle reacts to passive stretch.
R1 因此，和 R2 之间的关系可用来评估被动牵张时的肌肉反应的神经机制和软组织机械限制在痉挛中所占比例。 Time: Not reported, but it will vary with the numbers of muscles being tested. 时间：尚未报道，但会随肌肉检查的数量而改变。 Training requirements
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None typically reported, however, the experience of the rater has considerable influence on results (Ansari et al., 2008; Singh et al., 2011)
培训要求：未见特定报道，但测量者的经验势必会影响结果(Ansari et al., 2008; Singh et al., 2011)。
Subscales None. 子量表：无

Equipment:
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Pencil or pen Goniometer Mat, plinth or bed 器材：铅笔或圆珠笔；量角器；治疗垫、辅具或床。
Alternative forms of the Modified Tardieu Scale
Tardieu Scale: First developed in 1954, the Tardieu Scale has been suggested as a reliable alternative to the Ashworth Scales, as it compares the muscle's resistance to passive stretch at both slow and fast speeds in order to account for the velocity-dependent characteristic of spasticity.
改良 Tardieu 量表的其他形式
Tardieu 量表：1954 年首现，Tardieu 量表曾被认为可作为 Ashworth 量表替代选择，因为它考虑到痉挛速度依赖性的特点，对比了慢速和快速被动牵伸时肌肉阻力的情况， Modified Tardieu Scale: Published in 1999, the MTS uses the same grading scale outlined in the original Tardieu Scale, however the modifications aim to standardize the testing procedure. Specific limb placement, alignment positions and procedures are described. Measures of passive range of motion are described as R2; the angle of muscle reaction ('catch') is described as R1;

and the difference between the two measures (R2-R1) are used to help differentiate spasticity and soft-tissue restrictions (Boyd and Graham, 1999).
改良 Tardieu 量表：1999 年发表，MTS 使用同原版 Tardieu 量表相同的评分量表，但改良的目的在于规范化检查流程。特定的肢体摆放、对线以及流程都有所描述。测量被动关节活动范围时，描述见 R2；测量肌肉反射（出现“卡住”）时，描述见 R1；两次测量（R2-R1）的差异可以用来辅助鉴别痉挛和软组织限制（(Boyd and Graham, 1999)。
Score definitions for the Tardieu Scale and the MTS are provided below. Score definitions between the two measures are consistent.
Tardieu 量表和 MTS 的分数定义见下。两种测量方式的分数定义是一致的。 Quality of muscle reaction (X): 肌肉反应的品质性质（X）
Grade Description 描述 0 No resistance throughout the course of the passive movement. 整个被动活动中无阻力。 1 Slight resistance throughout the course of the passive movement, with no clear catch at a precise angle. 被动活动中感到轻微阻力，但没有在特定角度出现明显的卡住感。 2 Clear catch at a precise angle, interrupting the passive movement, followed by a release. 特定角度出现明显卡住，被动运动受阻，后会有释放感。 3 Fatigable clonus (<10 seconds when maintaining pressure) occurring at a precise angle. 特定角度出现 fatigable 的阵挛（持续给予压力时小于 10s）

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Infatigable clonus (>>10 seconds when maintaining pressure) occurring at a precise angle. 特定角度出现 fatigable 的阵挛（持续给予压力时远大于 10s）
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Joint is immoveable. 关节僵直，不可动。
Client suitability
Can be used with:
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Clients with stroke. Clients with other neurological impairment such as cerebral palsy (Boyd & Graham, 1999) and traumatic brain injury (Mehrholz et al., 2005).
Should not be used in: To date, there is no information on restrictions for using the Tardieu Scale or the MTS. 临床适应症：可以用于：脑卒中、其他神经系统障碍如脑瘫(Boyd & Graham, 1999)、脑外伤 (Mehrholz et al., 2005)。
禁忌：目前为止尚无关于使用 Tardieu 量比或 MTS 受限的信息。