The MTS assesses the muscle's response to stretch at given velocities.
Dependent on number of joints being tested.
Dependent on the number of joints being tested.
Initially reviewed by Christopher Newman, PT, MPT, NCS, Jennifer H. Kahn, PT, DPT, NCS, and the SCI EDGE task force of the Neurology Section of the APTA in 8/2012.
Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.
For detailed information about how recommendations were made, please visit: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations
|
Abbreviations: |
|
|
HR |
Highly Recommend |
|
R |
Recommend |
|
LS / UR |
Reasonable to use, but limited study in target group / Unable to Recommend |
|
NR |
Not Recommended |
Recommendations for use based on acuity level of the patient:
|
|
Acute (CVA < 2 months post) (SCI < 1 month post) (Vestibular < 6 weeks post) |
Subacute (CVA 2 to 6 months) (SCI 3 to 6 months) |
Chronic (> 6 months) |
|
SCI EDGE |
LS |
LS |
LS |
|
StrokEDGE |
R |
R |
R |
Recommendations based on level of care in which the assessment is taken:
|
|
Acute Care |
Inpatient Rehabilitation |
Skilled Nursing Facility |
Outpatient Rehabilitation |
Home Health |
|
MS EDGE |
UR |
UR |
UR |
UR |
UR |
|
StrokEDGE |
R |
R |
R |
R |
R |
Recommendations based on SCI AIS Classification:
|
|
AIS A/B |
AIS C/D |
|
SCI EDGE |
LS |
LS |
Recommendations based on EDSS Classification:
|
|
EDSS 0.0 – 3.5 |
EDSS 4.0 – 5.5 |
EDSS 6.0 – 7.5 |
EDSS 8.0 – 9.5 |
|
MS EDGE |
UR |
UR |
UR |
UR |
Recommendations for entry-level physical therapy education and use in research:
|
|
Students should learn to administer this tool? (Y/N) |
Students should be exposed to tool? (Y/N) |
Appropriate for use in intervention research studies? (Y/N) |
Is additional research warranted for this tool (Y/N) |
|
MS EDGE |
No |
No |
No |
Yes |
|
SCI EDGE |
No |
No |
No |
Not reported |
|
StrokEDGE |
Yes |
Yes |
Yes |
Not reported |
Stroke: (Paulis et al., 2011; n = 13 subjects living in a nursing home; mean age = 70.2 (12.30) years; compared test-retest and interrater reliability of Tardieu of elbow flexors measured with goniometry vs. inertial sensors (IS))
Tardieu (R2-R1) SEM Goni = 6.19, IS = 8.81
Passive ROM (R2) SEM Goni= 5.04, IS= 6.80
Angle of Catch (R1) SEM Goni = 4.47, IS= 5.72
Stroke: (Paulis et al., 2011)
Smallest Detectable Difference (SDD) calculated from above referenced SEM data and test retest data:
Tardieu (R2-R1) SEM Goni = 17.16, IS = 24.41
Passive ROM (R2) SEM Goni= 13.98, IS= 18.85
Angle of Catch (R1) SEM Goni = 12.39, IS= 15.85
Stroke: (Paulis et al., 2011)
Test-retest reliability of Tardieu performed with goniometer and with inertial sensors (IS) of elbow flexors:
|
R2-R1 |
ICC |
|
Goniometric |
Excellent 0.86 |
|
IS |
Excellent 0.76 |
|
PROM, R2 |
ICC |
|
Goniometric |
Excellent 0.87 |
|
IS |
Excellent 0.86 |
|
AoC (R1)* |
ICC |
|
Goniometric |
Excellent 0.91 |
|
IS |
Excellent 0.82 |
*AoC = Area of Catch
Stroke: (Ansari et al., 2008; n = 30 individuals with hemiplegia > 1 month post stroke)
Interrater reliability for MTS used to assess elbow flexor spasticity:
Adequate interrater reliability for R2-R1 (ICC = 0.72)
Adequate interater reliability for MTS quality (ICC = 0.74) and R1 (ICC = 0.74) and R2 (ICC = 0.56)
Stroke: (Paulis et al., 2011)
|
R2-R1 |
ICC |
|
Goniometric |
Adequate 0.66 |
|
IS |
Excellent 0.84 |
|
PROM, R2 |
ICC |
|
Goniometric |
Excellent 0.89 |
|
IS |
Excellent 0.89 |
|
AoC* (R1) |
ICC |
|
Goniometric |
Adequate 0.60 |
|
IS |
Excellent 0.87 |
*AoC: Angle of Catch
Stroke: (Singh et al., 2011; n = 91 people with acute stroke; mean age = 64 (SD = 11.1) years)
|
ICCs |
elbow flexors |
ankle plantar flexors |
|
R1 |
Excellent 0.998 |
Excellent 0.990 |
|
R2 |
Excellent 0.978 |
Excellent 0.995 |
|
R2-R1 |
Excellent 0.991 |
Excellent 0.907 |
|
MTS scores |
Excellent 0.847 |
Excellent 0.863 |
p < 0.0001 for all of the above
Stroke: (Patrick & Ada, 2006; n = 16, chronic stroke living in the community, comparing MAS, MTS, and clinical measure of spasticity in laboratory - EMG)
PEA (Percentage of Exact Agreement) of Tardieu and laboratory measure of spasticity, 100% for elbow flexors and plantar flexors
Excellent Convergent Validity (r = 0.86 for elbow flexors; 0.62 for ankle)
PFPEA of Tardieu and laboratory measures of contracture was 94% for elbow flexors and plantar flexors
Excellent Convergent Validity (r = 0.89 for elbow flexors; 0.84 for plantar flexors)
Severe Brain Injury: (Mehrholz et al., 2005; n = 30, patients with impaired consciousness due to severe cerebral damage of various etiologies; mean age = 63.9(12.9) years)
|
SEM for Intra-rater Reliability |
|
|
Domain |
SEM |
|
Shoulder flexion |
0.05 |
|
Shoulder external rotation |
0.05 |
|
Elbow flexion |
0.04 |
|
Elbow extension |
0.04 |
|
Wrist flexion |
0.02 |
|
Wrist extension |
0.04 |
|
Hip flexion |
0.02 |
|
Hip extension |
0.04 |
|
Knee flexion |
0.05 |
|
Knee extension |
0.03 |
|
Ankle extension (knee joint flexed) |
0.02 |
|
Ankle extension (knee joint fully extended) |
0.04 |
|
SEM for Inter-rater Reliability |
|
|
Domain |
SEM |
|
Shoulder flexion |
0.05 |
|
Shoulder external rotation |
0.05 |
|
Elbow flexion |
0.03 |
|
Elbow extension |
0.03 |
|
Wrist flexion |
0.07 |
|
Wrist extension |
0.03 |
|
Hip flexion |
0.04 |
|
Hip extension |
0.03 |
|
Knee flexion |
0.04 |
|
Knee extension |
0.03 |
|
Ankle extension (knee joint flexed) |
0.03 |
|
Ankle extension (knee joint fully extended) |
0.04 |
Severe Brain Injury: (Mehrholz et al., 2005)
Patient Characteristics
|
Characteristic |
Patients, n = 30 |
|
Age (years)a |
63.9 (±12.9) |
|
Sex (female/male) |
9/21 |
|
Diagnosis |
|
|
Ischemic Stroke |
7 |
|
Intracerebral Hemorrhage |
11 |
|
Traumatic brain injury |
5 |
|
Cerebral hypoxia |
7 |
|
Duration of illness (days)a |
78 (±93) |
|
Antispastic therapy |
|
|
Local (botulinum toxin) |
0 |
|
Systemic (baclofen or tizanidine) |
2 |
|
Implanted intrathecal baclofen pump system |
0 |
|
Glasgow Coma Scale scorea |
6.9 (±2.3) |
|
Coma Remission Scale scorea |
8.0 (±4.5) |
|
Body mass index (kg/m^2)a |
24.1 (±3.8) |
aMean ± standard deviation.
Severe Brain Injury: (Mehrholz et al., 2005)
Adequate Intrarater reliability: k = 0.65-0.87 for muscle groups tested; except shoulder ER: k = 0.53
Angle of muscle reaction: joint (ICC = elbow flexors, 0.73 (Adequate); knee flexors, 0.72 (Adequate); ankle PF with knee flexed, 0.70 (Adequate); ankle PF with knee extended, 0.65 (Adequate))
Severe Brain Injury: (Mehrholz et al., 2005)
Intrarater reliability
|
Domain |
Cohen’s kappa |
Standards for use |
|
Shoulder flexion |
0.65 |
Poor |
|
Shoulder external rotation |
0.53 |
Poor |
|
Elbow flexion |
0.78 |
Adequate |
|
Elbow extension |
0.75 |
Adequate |
|
Wrist flexion |
0.87 |
Excellent |
|
Wrist extension |
0.71 |
Adequate |
|
Hip flexion |
0.76 |
Adequate |
|
Hip extension |
0.72 |
Adequate |
|
Knee flexion |
0.67 |
Poor |
|
Knee extension |
0.81 |
Excellent |
|
Ankle extension (knee joint flexed) |
0.82 |
Excellent |
|
Ankle extension (knee joint fully extended) |
0.72 |
Adequate |
Interrater reliability
|
Domain |
Cohen’s kappa |
Standards for use |
|
Shoulder flexion |
0.44 |
Poor |
|
Shoulder external rotation |
0.39 |
Poor |
|
Elbow flexion |
0.48 |
Poor |
|
Elbow extension |
0.51 |
Poor |
|
Wrist flexion |
0.33 |
Poor |
|
Wrist extension |
0.38 |
Poor |
|
Hip flexion |
0.42 |
Poor |
|
Hip extension |
0.37 |
Poor |
|
Knee flexion |
0.53 |
Poor |
|
Knee extension |
0.44 |
Poor |
|
Ankle extension (knee joint flexed) |
0.47 |
Poor |
|
Ankle extension (knee joint fully extended) |
0.29 |
Poor |
Children with CP: (Fosang et al., 2003; n = 18, ages 2-10 yrs old, determine reliability and magnitude of error for MAS, PROM, and Tardieu Scale)
Adequate to Excellent Correlation for MTS at Hamstrings (ICC = 0.68-0.90)
Poor to Excellent Coorelation of MTS at Gastroc (ICC = 0.38-0.90)
Adequate to Excellent Correlation MTS at Hip Add (ICC = 0.61-0.93)
Children with CP: (Yam & Leung, 2006; n = 17 children with CP; mean age = 7yr 9mo)
Interrater reliability between MAS and MTS, 4 joints in LE tested:
Poor to Adequate: Modified Tardieu (ICC = 0.22-0.71)
Poor to Adequate: R1 (ICC = 0.37-0.71); R2 (ICC = 0.17-0.74; R2-R1 (ICC = 0.40-0.69)
Children with CP: (Fosang et al., 2003)
Adequate interrater reliability (ICC = 0.58-0.72)
Ansari, N. N., Naghdi, S., et al. (2008). "The Modified Tardieu Scale for the measurement of elbow flexor spasticity in adult patients with hemiplegia." Brain Injury 22(13-14): 1007-1012. Find it on PubMed
Boyd, R. N. and Graham, H. K. (2007). "Objective measurement of clinical findings in the use of botulinum toxin type A for the management of children with cerebral palsy." European Journal of Neurology 6(S4): s23-s35.
Fosang, A. L., Galea, M. P., et al. (2003). "Measures of muscle and joint performance in the lower limb of children with cerebral palsy." Developmental Medicine and Child Neurology 45(10): 664-670. Find it on PubMed
Haugh, A. B., Pandyan, A. D., et al. (2006). "A systematic review of the Tardieu Scale for the measurement of spasticity." Disability and Rehabilitation 28(15): 899-907. Find it on PubMed
Mehrholz, J., Wagner, K., et al. (2005). "Reliability of the Modified Tardieu Scale and the Modified Ashworth Scale in adult patients with severe brain injury: a comparison study." Clinical Rehabilitation 19(7): 751-759. Find it on PubMed
Patrick, E. and Ada, L. (2006). "The Tardieu Scale differentiates contracture from spasticity whereas the Ashworth Scale is confounded by it." Clinical Rehabilitation 20(2): 173-182. Find it on PubMed
Paulis, W. D., Horemans, H. L., et al. (2011). "Excellent test-retest and inter-rater reliability for Tardieu Scale measurements with inertial sensors in elbow flexors of stroke patients." Gait and Posture 33(2): 185-189. Find it on PubMed
Singh, P., Joshua, A. M., et al. (2011). "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 14(1): 23-26. Find it on PubMed
Yam, W. K. and Leung, M. S. (2006). "Interrater reliability of Modified Ashworth Scale and Modified Tardieu Scale in children with spastic cerebral palsy." Journal of Child Neurology 21(12): 1031-1035. Find it on PubMed
We have reviewed more than 500 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others.