ASSESSMENT FORM: MUSCLE TONE
ASHWORTH SCALE
(From Motor Control: Shumway & Cook 2012)
MILD MODERATE SEVERE SCALE
SEVERITY OF HYPER-TONICITY MILD MODERATE SEVERE SCALE OF HYPERTONICITY
Slight S Slight resistance during passive movement.
Moderate S+ Moderate resistance during passive movement.
Severe S++ Severe resistance during passive movement.
Rigidity R Resistance in all directions of movement during
movement.
Hypotonia H Uncontrolled weight of limb during movement.
Normal N
Fluctuating F (as for example seen in Athetosis)
Extensor reflex arch ERB
Crossed extensor GER
Flexor reflex arch FRB
Asymmetrical tonic neck reflex ATNR
Symmetrical tonic neck reflex STNR
Tonic labyrinth neck reflex TLR
Associated reactions GR
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Positive support reflex PSR
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ASSESSMENT OF ACTIVE MOVEMENT
1 = Occupational therapist can passively perform required movement with
patient without there being abnormal resistance to or assistance with
movement. Patient can then possibly maintain position but not actively
perform movement.
2 = Patient can actively perform required movement but in an abnormal
manner. DESCRIBE ABNORMAL MANNER.
3 = Patient can perform required movement in a normal active manner.
UPPER LIMB
1/2/3
SHOULDER AND ELBOW COMMENTS
Flexion of shoulder, arm in extension,
external rotation wrist joint in extension and
supination fingers and thumb extension and
abduction.
Flex arm as above in internal rotation.
Return arm back to begin position along the
side.
Abduct extended arm and back to begin
position along the side.
Move arm over body and touch opposite
shoulder:
- with forearm in pronation
- with forearm in supination
Touch top of head:
- with forearm in pronation
- with forearm in supination
Fold both hands behind the head.
Supinate forearm (without lateral flexion
of trunk to affected side):
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- elbow flexed
- elbow extended
Pronation of forearm (without adduction of
arm at shoulder).
External rotation of extended arm:
- in horizontal abduction
- back to begin position along the side
- with flexion of shoulder
Touch shoulder on the same side:
- with shoulder in flexion
- with shoulder in abduction
WRISTS AND FINGERS
Place flat hand in front of him, fingers in
extension.
Place flat hand alongside him, fingers in
extension.
Open hand for grip:
- wrist in flexion
- wrist in extension
- forearm in supination
- forearm in pronation
- fingers and thumb abduction
- fingers and thumb adduction
Perform grip but open fingers again:
- forearm in pronation
- forearm in supination
- elbow in flexion
- elbow in extension
Move fingers individually:
- thumb
- index finger
- little finger
- third and fourth fingers
Opposition:
- thumb with index finger
- thumb with third and fourth fingers
- thumb with little finger
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LOWER LIMB
1/2/3
SUPINE REMARK
Flex knee without flexing hip.
Rotate leg:
- in internal rotation
- in eksternal rotation
Whilst knee is flexed, ankle:
- dorsiflexion
- plantar flexion
LYING
Flex knee
Lift pelvis with both legs flexed and feet flat on
base of support (bridging).
Supine, leg in extension:
- ankle in dorsiflexion
- ankle in plantar flexion
SITTING IN A CHAIR
Foot flat on the floor, hip abducted and
adducted.
Lift affected leg and place over other leg.
Move foot under chair without lifting foot.
STANDING
Stand with unaffected foot in front of other
foot (step position).
Feet touching each other parallel.
One leg stand on affected leg.
Staan in step position with weight on affected
leg.
In step position with weight on unaffected leg
and then lift affected leg.
Shift weight from affected leg to unaffected leg
so that you make a step.
Vice versa.
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SUMMARY
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