Modified Tardieu Scale

Spasticity is a common condition in children and adults with cerebral palsy. It causes a person’s muscles to become stiff. It can reduce their range of movement and cause pain and difficulty when they try to complete daily activities1.

The purpose of the Modified Tardieu Scale is to measure if there is spasticity present in a person’s muscle and its response to movement. The results can be used to inform which therapeutic interventions will be considered to help reduce this condition. Later on, they can also be used to measure how much an intervention has reduced their spasticity2.

The Modified Tardieu Scale can be used for any child or adult with cerebral palsy who has muscle spasticity.

The Modified Tardieu Scale is carried out by an occupational therapist, physiotherapist, neurologist or rehabilitation medicine specialist.

There are two parts to the assessment that are applied to each muscle group that is examined. In the first part of the assessment, the health professional slowly moves the person’s limb to observe the full range of their available movement. In the second part of the assessment, the same limb is moved quickly.

For example, a therapist may slowly move a person’s arm from a position where the elbow is fully bent to a position where it is as straight as possible. They would then repeat the action quickly. They would then measure the elbow angles that are achieved with a device called a goniometer.

The amount of time it takes to complete this assessment will vary from five minutes to half an hour or more. It will depend on the number of the person’s muscle groups that need measuring and how easy it is to take the measurements.

You can ask your health care provider about how the Modified Tardieu Scale will be included within your fees for ongoing assessment and intervention. The cost will vary depending on the service provider. You should also check with your provider to confirm if there will be additional costs to develop a home program, travel to the sessions or prepare reports.

You can ask your health care provider if you are eligible for funding to assist with the assessment fees. People with disability living in Australia may also be eligible for a health care rebate through Medicare or funding from the National Disability Insurance Scheme.

Training

This assessment should be conducted by a qualified health professional with experience carrying out the Modified Tardieu Scale and knowledge of standard testing protocol.

Cost

The only cost involved in the modified Tardieu Scale is purchase of the goniometers.

Method

The Modified Tardieu Scale identifies the point in the muscle’s range where spasticity, or a “catch”, is occurring2,3.

  • First measure: This measures the maximum passive range of movement of the target muscle group. It is generally referred to as R2.
  • Second measure: This measure is then made by moving the muscle group from its shortest to longest position using a rapid velocity stretch. Known as R1, it measures the angle at which muscle resistance or “catch” is felt in response to this rapid stretch.

A “catch” early in the available range indicates more significant spasticity than a catch that is toward the end of the Range of Movement (RoM). The relationship between R1 and R2, calculated as R2 minus R1, indicates the ‘dynamic’ component of spasticity. A large R2 - R1 difference suggests that there is potential to successfully treat a person’s spasticity.

Things to note

  • The Modified Tardieu Scale is an adaption of the original, more complex and time consuming assessment called the Tardieu Scale
  • The resistance of muscles to passive movement can have neural and biomechanical reasons (like joint integrity, muscle stiffness, soft tissue compliance)4-6. This assessment can help a health professional differentiate between the neural and biomechanical components. This is important as treatments for each are different.

Psychometric properties reviewed

Validity - Insufficient research has been completed to confirm if this scale is a valid measure of spasticity4,6. It is, however, the only existing clinical assessment to measure the point in the muscle’s range where spasticity is occurring and is considered to be consistent with the established definition of spasticity.

Reliability - It is generally understood that there is a large variability in the magnitude of the angles measured6. Studies evaluating aspects of reliability report a range of results for different muscle groups and for intra-rater, inter-rater and test retest reliabilities. Therefore, there is insufficient consistency across studies, muscle groups and GMFCS levels to draw conclusions about the reliability of the Modified Tardieu Scale1-6,11.

It is considered that a reliable measure can be best achieved by an experienced clinician with sufficient training and practice1,7. Other ways to obtain the most reliable measures include having a single rater completing the measurements in a standardised test environment. This includes the position of the person being tested and the starting position of each muscle group12.

Responsiveness - Researchers1 have reported that repeated measures over time for hip adductors and hamstrings with different raters can vary by 10-18°, and with the same rater by 4-19°. No research was found which specifically addressed responsiveness to change following interventions.

NOTE: Assessments should have strong psychometric properties. These properties refer mainly to i) validity – whether the tool measures what it is meant to measure, ii) reliability – whether the results of the tool are stable under different conditions and, for tools which measure outcome iii) responsiveness – whether the test is responsive to change.

Date of literature searches: November 2016

  1. Fosang, A. L., Galea, M. P., McCoy, A. T., Reddihough, D. S., & Story, I. (2003). Measures of muscle and joint performance in the lower limb of children with cerebral palsy. Developmental Medicine & Child Neurology, 45(10), 664-670.
  2. Wallen, M., Ziviani, J., Naylor, O., Evans, R., Novak, I., & Herbert, R. D. (2011). Modified constraint-induced therapy for children with hemiplegic cerebral palsy: a randomized trial. Developmental Medicine & Child Neurology, 53(12), 1091-1099. doi:10.1111/j.1469-8749.2011.04086.x.
  3. Boyd, R., & Graham, H. K. (1999). 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(Supp 4), S23-35. See abstract
  4. Alhusaini, A. A., Dean, C. M., Crosbie, J., Shepherd, R. B., & Lewis, J. (2010). Evaluation of spasticity in children with cerebral palsy using Ashworth and Tardieu Scales compared with laboratory measures. Journal of Child Neurology, 25(10), 1242-1247. See abstract
  5. Bar-On, L., Van Campenhout, A., Desloovere, K., Aertbeliën, E., Huenaerts, C., Vandendoorent, B., Molenaers, G. (2014). Is an instrumented spasticity assessment an improvement over clinical spasticity scales in assessing and predicting the response to integrated botulinum toxin type a treatment in children with cerebral palsy?. Archives of Physical Medicine & Rehabilitation, 95(3), 515-523. doi:10.1016/j.apmr.2013.08.010.
  6. Haugh, A. B., Pandyan, A. D., & Johnson, G. R. (2006). A systematic review of the Tardieu Scale for the measurement of spasticity. Disability and Rehabilitation, 28(15), 899-907. doi:10.1080/09638280500404305. See abstract
  7. Gracies, J. M., Burke, K., Clegg, N. J., Browne, R., Rushing, C., Fehlings, D., Delgado, M. R. (2010). Reliability of the Tardieu Scale for assessing spasticity in children with cerebral palsy. Archives of Physical Medicine & Rehabilitation, 91(3), 421-428.
  8. Kelly, B., MacKay-Lyons, M. J., Berryman, S., Hyndman, J., & Wood, E. (2008). Assessment protocol for serial casting after botulinum toxin A injections to treat equinus gait. Pediatric Physical Therapy, 20(3), 233-241. See abstract
  9. Mackey, A. H., Walt, S. E., Lobb, G., & Stott, N. S. (2004). Intraobserver reliability of the modified Tardieu scale in the upper limb of children with hemiplegia. Developmental Medicine & Child Neurology, 46(4), 267-272.
  10. Numanoglu, A., & Gunel, M. K. (2012). Intraobserver reliability of modified Ashworth scale and modified Tardieu scale in the assessment of spasticity in children with cerebral palsy. Acta Orthopaedica et Traumatologica Turcica, 46(3), 196-200. See abstract
  11. Yam, W. K., & 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. See abstract
  12. Scholtes, V. A. B., Becher, J. G., Beelen, A., & Lankhorst, G. J. (2006). Clinical assessment of spasticity in children with cerebral palsy: a critical review of available instruments. Developmental Medicine & Child Neurology, 48(1), 64-73.
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The information on this page was developed using the best research evidence combined with the expertise of clinicians and people with cerebral palsy and their families. It is provided to help people with cerebral palsy, their families and caregivers, clinicians and service providers make decisions about suitable interventions. This information is intended to support, but not replace, information exchanged, and decisions made, between people with cerebral palsy, their families and health professionals.