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Continuous state of mild contraction, or a state of

preparedness in the muscle

Dependent on the integrity of peripheral and CNS


mechanisms and the properties of the muscle

Resistance or tension when passively moving the


extremities

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Effective co-activation Ability to move Balance tone
(stabilization) at axial against gravity and between agonist and
and proximal joints resistance antagonistic muscles

Ability to maintain the


Ease of the ability to Ability to use muscles
position of the limb if
shift from stability to in groups or
it is placed passively
mobility and reverse selectively, if
by the examiner and
as needed necessary
then relaxed

Resistance or slight
resistance in
response to passive
movement

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Record the position of the
patient’s because body and
head position influence
cerebral hypertonus.
When testing for muscle tone of
the upper extremity, the patient
is placed in sitting
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Grasp the patient’s limb proximal and distal
to the joint being tested and move the joint
slowly through its range to determine the
free and easy ROM available.
• Note the presence and location of pain.
• If there is no active movement or the extremity feels
heavy, record that the limb is flaccid or “0” in strength.
• If the limb has some active movement and no evidence
of increased tone, the affected muscle or muscle group
may be labeled as “paretic” instead of hypotonic. Then
muscle can then be graded in strength

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Hold the limb on the lateral aspects to avoid
giving tactile stimulation to the muscle belly of
the muscle being tested. Note also if the limb
feels light or heavy.

Clinical assessment of tone involves holding the


patient’s limbs as described and moving it
rapidly through its full range while the patient
is relaxed. Label the tone as “mild”, “moderate”,
or “severe”.

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Record findings for various
muscle groups or movements
• Grade 3 (MAS) spasticity on R elbow
flexors
• Moderate spasticity of R elbow flexors
• Mild to moderate spasticity is evident
in the R elbow flexors

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Ashworth Scale and
Modified Ashworth Scale

Mild-Moderate-Severe
Spasticity Scale

Preston’s Three Step


Hypertonicity Scale

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Mild
• The stretch reflex (palpable catch) occurs at the
muscle’s end range
Moderate
• The stretch reflex (palpable catch) occurs in
midrange
Severe
• The stretch reflex (palpable catch) occurs when
the muscle is in a shortened range
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