General
- Developed to document the extent of spasticity and functional limitation.
- In addition, documentation of range of movement, muscle power, quality of life, function, and gait (if relevant) are required
- These assessments should be performed ahead of any planned intervention so the effects of the intervention can be evaluated. For children with cerebral palsy, measures such as the Gross
Extent of spasticity
- Modified Ashworth Scale
- Most commonly used tool
- Use for one single joint PassiveROM (Video)
- When assessing for spasticity in a particular muscle, begin in a position in which that muscle is maximally shortened. (eg From a flexed elbow to test for biceps spasticity)
- Over 1 second (or faster), manually stretch that muscle by moving the joint through the opposite movement.
- E.g., to assess bicep brachii spasticity, begin in maximal elbow flexion, and rapidly move the elbow through EXT passively.
- Clinical use
- Generally patients with an Ashworth score of 3 are candidates for intrathecal baclofen,
- Although those with less severe spasticity may also benefit depending on the clinical context.
- During ITB test dose (25-50 μg in children) for spasticity an improvement of one point or greater is considered positive.
Modified Ashworth scale | Description | Tone |
0 | Moves freely at any velocity | Normal |
1 | Catch and release/minimal resistance at the end of ROM | Slight increase |
1+ | Catch and release/minimal resistance <50% of ROM | Slight increase |
2 | Resistance present throughout the ROM Joint can be easily moved still | Increased |
3 | Very difficult passive movement | Marked increased |
4 | Cannot move joint at all | Complete rigid |
Child’s functional capabilities
Gross Motor Function Classification System (GMFCS)
- Between 6ᵗʰ and 12ᵗʰ birthday
Level 1
- Children walk at home, school, outdoors and in the community. They can climb stairs without the use of a railing. Children perform gross motor skills such as running and jumping, but speed, balance and coordination are limited.
Level 2
- Children walk in most settings and climb stairs holding onto a railing. They may experience difficulty walking long distances and balancing on uneven terrain, inclines, in crowded areas or confined spaces. Children may walk with physical assistance, a hand-held mobility device or used wheeled mobility over long distances. Children have only minimal ability to perform gross motor skills such as running and jumping.
Level 3
- Children walk using a hand-held mobility device in most indoor settings. They may climb stairs holding onto a railing with supervision or assistance. Children use wheeled mobility when traveling long distances and may self-propel for shorter distances.
Level 4
- Children use methods of mobility that require physical assistance or powered mobility in most settings. They may walk for short distances at home with physical assistance or use powered mobility or a body support walker when positioned. At school, outdoors and in the community children are transported in a manual wheelchair or use powered mobility.
Level 5
- Children are transported in a manual wheelchair in all settings. Children are limited in their ability to maintain antigravity head and trunk postures and control leg and arm movements.
Gross Motor Function Measure (GMFM)
- The GMFM is a standardized observational instrument that has been designed and validated to measure change over time, helping to summarize this with a single score that can then be compared to chart their progress.
- Versions: GMFM-88 with 88 items or GMFM-66
- Evaluates specific gross motor skills across five dimensions:
- Lying/rolling
- Sitting
- Crawling/kneeling
- Standing
- Walking/running/jumping.
- Uses a 0-3 scoring scale per item to quantify ability and detect changes, making it ideal for tracking intervention outcomes or development.
- Scores are reliable (ICC >0.98) and responsive to clinically important differences (e.g., 1.58 points for GMFM-66).