Bohannon and Smith introduced the Modified Ashworth Scale (MAS) by adding a '1+' grade to the original 5-point Ashworth scale. The study tested whether two experienced, pre-calibrated raters could reliably grade elbow flexor spasticity in 30 patients with CNS lesions. It directly answers the question: is this bedside spasticity test reliable enough to use as an outcome measure?
When you assess spasticity at the bedside, the MAS is the scale you use — and this paper is why it exists.
The original Ashworth scale had no published reliability data and its grade '1' was too coarse for the hemiplegia population, where most patients clustered at the low end. Bohannon and Smith fixed this by adding grade '1+' and then actually tested whether the modified scale was reliable, producing the foundational reliability data the field lacked.
In practice: use the MAS to document spasticity before and after interventions (baclofen, botulinum toxin, electrical stimulation), but be aware that reliability is best established in upper limb testing between calibrated raters. For lower extremity assessment (post-stroke, spinal cord injury, cerebral palsy), reliability is lower. Particularly at the 1/1+ boundary this paper introduced.
The recurring tension in spasticity research traces back to this paper: the 1/1+ distinction that made the scale more sensitive is also the source of its greatest interrater disagreement.
Radiological Assessment of Osteo-Arthrosis.
Mesenchymal Stem Cells.
Traumatic Arthritis of the Hip after Dislocation and Acetabular Fractures: Treatment by Mold Arthroplasty. an End-Result Study Using a New Method of Result Evaluation.
Bone: Formation by Autoinduction.
Treatment of Deep Cartilage Defects in the Knee with Autologous Chondrocyte Transplantation.
Interrater Reliability of a Modified Ashworth Scale of Muscle Spasticity
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Novel Regulators of Bone Formation: Molecular Clones and Activities.
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Femoroacetabular Impingement: a Cause for Osteoarthritis of the Hip.
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Radiological Demarcation of Cemented Sockets in Total Hip Replacement.
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The Operation of the Century: Total Hip Replacement.
Fatty Muscle Degeneration in Cuff Ruptures. Pre- and Postoperative Evaluation by CT Scan.
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The Etiology of Chondromalacia Patellae.
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A System for the Functional Evaluation of Reconstructive Procedures after Surgical Treatment of Tumors of the Musculoskeletal System.
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The Stabilizing System of the Spine. Part I. Function, Dysfunction, Adaptation, and Enhancement.
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The Tension-Stress Effect on the Genesis and Growth of Tissues. Part I. the Influence of Stability of Fixation and Soft-Tissue Preservation.
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Porosity of 3D Biomaterial Scaffolds and Osteogenesis.
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Clinician's Guide to Prevention and Treatment of Osteoporosis.
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Epidemiology of Adult Fractures: a Review.
Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017.
Osteoblastic Cells Regulate the Haematopoietic Stem Cell Niche.
A Joint Coordinate System for the Clinical Description of Three-Dimensional Motions: Application to the Knee.
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Metastasis to Bone: Causes, Consequences and Therapeutic Opportunities.
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Bohannon and Smith introduced the Modified Ashworth Scale (MAS) by adding a '1+' grade to the original 5-point Ashworth scale. The study tested whether two experienced, pre-calibrated raters could reliably grade elbow flexor spasticity in 30 patients with CNS lesions. It directly answers the question: is this bedside spasticity test reliable enough to use as an outcome measure?
When you assess spasticity at the bedside, the MAS is the scale you use — and this paper is why it exists.
The original Ashworth scale had no published reliability data and its grade '1' was too coarse for the hemiplegia population, where most patients clustered at the low end. Bohannon and Smith fixed this by adding grade '1+' and then actually tested whether the modified scale was reliable, producing the foundational reliability data the field lacked.
In practice: use the MAS to document spasticity before and after interventions (baclofen, botulinum toxin, electrical stimulation), but be aware that reliability is best established in upper limb testing between calibrated raters. For lower extremity assessment (post-stroke, spinal cord injury, cerebral palsy), reliability is lower. Particularly at the 1/1+ boundary this paper introduced.
The recurring tension in spasticity research traces back to this paper: the 1/1+ distinction that made the scale more sensitive is also the source of its greatest interrater disagreement.