Score Ashworth Scale (1964) Modified Ashworth Scale Bohannon & Smith (1987) 0 (0) No increase in tone No increase in muscle tone 1 (1) Slight increase in tone giving a catch when the limb was moved in flexion or extension Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or extension. 1+ (2) Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the reminder (less than half) of the ROM (range of movement). 2 (3) More marked increase in tone but limb easily flexed. More marked increase in muscle tone through most of the ROM, but affected part(s) easily moved. 3 (4) Considerable increase in tone - passive movement difficult. Considerable increase in muscle tone passive, movement difficult. 4 (5) Limb rigid in flexion or extension. Affected part(s) rigid in flexion or extension.
Penn spasm frequency scale Score Spasm frequency score No spasms 0 No spasms Mild spasms at stimulation 1 One or fewer spasms per day Irregular strong spasms less than 1 time/[sol]/h 2 Between 1 and 5 spasms per day Spasms more often than 1 time/[sol]/h 3 Five to less than 10 spasms per day Spasms more than 10 times/[sol]/h 4 Ten or more spasms per day, or continuous contraction
Botulinum toxin (BTX A) injected into the affected muscle blocks the presynaptic release of acetylcholine from the motor endplates of the motorneural junction decreasing tone by limiting muscle contraction
**3-10 percent develop antibodies to the toxin and no longer will receive benefit from the medication
Baclofen given via intrathecal administration achieves much higher CSF concentrations
BLACK BOX WARNING : Don’t abruptly stop medication due to high fever, altered mental status, exaggerated rebound spasticity, and muscle rigidity, which in rare cases has advanced to rhabdomyolysis, multiple organ-system failure, and death
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