Disability and Rehabilitation, August 2006; 28(15): 899 – 907

REVIEW PAPER

A systematic review of the Tardieu Scale for the measurement of

spasticity

A. B. HAUGH1,2, A. D. PANDYAN3, & G. R. JOHNSON1

1
Centre for Rehabilitation and Engineering Studies (CREST), University of Newcastle upon Tyne, 2Regional Neurological
Rehabilitation Centre, Hunters Moor, Newcastle upon Tyne, and 3Institute of Life Course Studies and School of Health &
Rehabilitation, Keele University, Sheffield, UK

Accepted October 2005

Abstract
Background. The Tardieu Scale has been suggested a more appropriate clinical measure of spasticity than the Ashworth or
modified Ashworth Scales. It appears to adhere more closely to Lance’s definition of spasticity as it involves assessment of
resistance to passive movement at both slow and fast speeds.
Objective. To review the available literature in which the Tardieu Scale has been used or discussed as a measure of
spasticity, with a view to determining its validity and reliability.
Study design. A systematic review of all literature found related to the Tardieu Scale (keywords: Tardieu scale, spasticity)
from Pubmed and Ovid databases, including medline, CINAHL, EMBASE, Journals at Ovid full text, EBM reviews and
Cochrane database of systematic reviews. Hand searching was also used to track the source literature.
Conclusions. In theory, we can acknowledge that the Tardieu Scale does, in fact, adhere more closely to Lance’s definition
of spasticity. However, there is a dearth of literature investigating validity and reliability of the scale. Some studies have
identified the Tardieu Scale to be more sensitive than other measures, to change following treatment with botulinum toxin.
Further studies need to be undertaken to clarify the validity and reliability of the scale for a variety of muscle groups in adult
neurological patients.

Keywords: Tardieu scale, spasticity, validity, reliability, systematic review

felt is not solely due to the neural component of

Introduction
Spasticity is a phenomenon, which affects patients
with a variety of neurological conditions [1]. One of
the most widely accepted definitions of spasticity is
that of Lance (1980), who described spasticity as
‘‘one component of the upper motor neurone
syndrome’’, which is ‘‘characterised by a velocity-
dependent increase in the tonic stretch reflexes
(muscle tone) with exaggerated tendon jerks, result-
ing from the hyperexcitability of the stretch reflex’’
[2]. In 1954, Tardieu and his colleagues originally
introduced the concept of a ‘‘spastic reaction’’, as a
muscle reaction produced by the passive stretching
of a limb segment, depending upon the speed/
acceleration of the passive stretch [3].
Clinicians identify spasticity by evaluating the level
of resistance on passive movement. The resistance
spasticity but also to biomechanical factors (such as
soft tissue compliance and joint integrity) [4].
Differentiation between the neural component of
resistance (spasticity) and soft tissue changes is
necessary, as they respond to different types of
treatment [1]. It is important to be able to measure
spasticity to evaluate the impact of specific treat-
ments and to choose the most efficient and cost-
effective management option for each individual
patient.
The most commonly used clinical scales for the
measurement of spasticity are the Ashworth and
Modified Ashworth Scales [5]. However, their
validity in terms of spasticity measurement has
recently been questioned, as they do not address
the velocity-dependent aspect of the phenomenon as
described by Lance and they have been described

Correspondence: Mrs Alex Haugh, c/o Dr A. D. Pandyan, School of Health & Rehabilitation, Mackay Building, Keele University, Keele, ST5 5NA, Sheffield,
UK. E-mail: a.d.pandyan@keele.ac.uk
ISSN 0963-8288 print/ISSN 1464-5165 online ª 2006 Informa UK Ltd.
DOI: 10.1080/09638280500404305
900 A. B. Haugh et al.
as simply measuring resistance to passive movement
[6,7]. This view was endorsed by Vattanasilp et al.
[8] who described the Ashworth Scale as a grading of
muscle stiffness, which is unable to ‘‘differentiate’’
between ‘‘the neural and peripheral contributions’’.
The Tardieu Scale has been suggested as a more
suitable alternative to the Ashworth Scale for
measuring spasticity [7,8], as it assesses and com-
pares the response of the muscle to passive movement
at both slow and fast speeds. In a case study reported
in 1954, Tardieu et al. [3] used EMG to determine
the reflex activity when the elbow was passively
extended from 60 – 1108 at a variety of speeds. They
concluded that a stretch reflex was elicited at a
specific speed (or faster) for the respective patient
and postulated that this speed would vary with
different subjects. They also described comparing
the observed angle of movement at ‘‘relaxation’’ and
on ‘‘brusque stretching’’ and suggested that differ-
ences between the two angles could determine the
presence of soft tissue changes.
According to Gracies [7], Tardieu himself made
several modifications to his original work and
concluded that three speeds were necessary in the
assessment of spasticity: One slow velocity, below
that which would trigger the stretch reflex and two
fast speeds above the threshold necessary to trigger
the stretch reflex. He stated the importance of
maintaining a constant position of the limb segment
proximal to the muscle group being assessed. Gracies
also states that Tardieu developed a qualitative scale
describing the muscle reaction, (referenced to
Tardieu [1966] Tardieu & Lacert [1977]).
Held and Pierrot-Deseilligny further developed
Tardieu’s work, publishing a scale in 1969 [9]. They
discuss the assessment of spasticity and state three
factors are required to rate its intensity [9]:
1. The strength and duration of the stretch
reflex;
2. The angle at which the stretch reflex is
activated;
3. The speed necessary to trigger the stretch
reflex.
They describe the procedure as a passive mobiliza-
tion of the limb, starting with the limb placed where
the muscle to be tested is in its least stretched
position. They improve upon Tardieu’s definitions
of speed: low, medium ‘‘which corresponds to the
passive fall of the limb segment under the influence
of weight’’ and high; and record the quality/strength
of the reaction at each of the speeds. They also
add further criteria stating assessment should take
place at ‘‘the same time of day, with the same body
position and a constant position of other limb
segments’’.
In 1999 Boyd and Graham [10] further standar-
dized the ‘‘conditions for limb placement and
alignment’’ with upper limb tests performed with
the patient in sitting and lower limb tests in supine.
They attempt to regulate the velocity used by
stating the initial speed to be as slow as possible
and describe the high speed as fast as possible, but
‘‘faster than the drop of the limb segment under
gravity’’.
In this recent version of the scale, only two speeds,
one ‘slow’ and one ‘fast’ are used per muscle group
tested. The slow speed is used in all cases, with either
the gravity-drop or the fast passive speed being
chosen appropriate to the muscle group being tested
[11,12]. Gracies [7] advocates the use of the speed of
the limb segment falling due to gravity where
possible, as it is reproducible for subsequent
examinations and between raters.
The aim of this report is to review the literature
regarding the Tardieu Scale to determine its validity
and reliability as a clinical measure of spasticity, as
defined by Lance [2]. [Validity and reliability are
complex concepts and for the purposes of this review
we have defined validity as ‘‘operationalization that
accurately reflects a theoretical construct’’ (i.e., the
measure quantifies whatever it is purported to mea-
sure), and reliability as ‘‘consistency or repeatability of
measurement’’. A detailed description of these
terms are described in Trochim, William M. The
Research Methods Knowledge Base, 2nd ed. URL:
http://trochim.human.cornell.edu/kb/index.htm (ver-
sion current as of 16 August 2004).]
Method
A systematic review was undertaken of all literature
concerning the Tardieu Scale. The keywords:
Tardieu Scale and spasticity were entered into
Pubmed and Ovid databases, which included med-
line, CINAHL, EMBASE, Journals at Ovid full text,
EBM reviews – database of abstracts or reviews of
effectiveness and Cochrane database of systematic
reviews. Hand searching was used to track the source
literature. The lead author independently reviewed
all identified full journal papers. The second author
independently verified these reviews. Although,
abstracts were included these were not fully reviewed
due to paucity in data.
Results
A total of 31 publications were found which used,
discussed or simply mentioned the Tardieu Scale. A
surprisingly small number considering the scale
began its development in 1954. Twenty-three of
the references found were full journal articles, six
were abstracts and two were book chapters. Those
 Review of the Tardieu Scale for the measurement of spasticity
published in abstract format only were excluded
from this review as they present insufficient informa-
tion. Book chapters and review articles were also
excluded. A total of 10 full journal articles remained
for review.
The only validation study has been published in the
form of an abstract [13] and hence was not reviewed.
In this validity study the authors compared the
Tardieu Scale against the modified Ashworth Scale,
which has been previously shown to be a measure of
resistance to imposed passive movement but not
spasticity [4 – 6]. Therefore, it would appear that the
study did not truly investigate whether the Tardieu
Scale could be used as a valid measure of spasticity.
There are only two full journal article studies
attempting to determine the reliability of the scale
[14,15]. Both involved children with CP and
investigated the ‘range of movement’ (ROM) aspect
of the Tardieu Scale (i.e., they measured the full
passive ROM at a slow speed and then the ROM to
the angle at which a muscle reaction is elicited on
passive movement at a fast speed and calculated the
difference between the two values). The subjective
part of the scale, to rate the quality of the muscle
reaction, was not considered. In each case, the
reliability of the Tardieu Scale was compared against
the modified Ashworth Scale. Mackey et al. [15]
looked at intrarater reliability only, assessing both
intrasession and intersession variability of the biceps
brachii, whereas Fosang et al. [14] assessed both
intra and interrater reliability of the hamstrings,
gastrocnemius and hip adductor muscle groups
(see Table I). Statistical interpretation of the data
presented is difficult as neither Fosang et al. nor
Mackey et al. state the model or form of ICC used.
Eight studies were found which report using an
aspect of the Tardieu Scale within their research to
measure spasticity or dynamic range [16 – 23]. As
they do not involve investigation of the validity or
reliability of the scale they must presume these
parameters to be adequate. Of these, three studies
[16,19,20] describe measuring ‘dynamic range of
movement’/‘dynamic muscle range’ but do not use
the subjective scale to assess the quality of muscle
reaction elicited on the fast passive stretch (Table II).
All three involve paediatric subjects with CP under-
going treatment for spasticity with botulinum toxin A
and concurrently used the Modified Ashworth Scale
as a measure of ‘spasticity’.
The five remaining papers used both the subjective
scale as well as the range of movement aspect of the
Tardieu Scale [17,18,21 – 23]. These five papers
considered a variety of age groups and neurological
conditions as well as having used different spasticity-
reducing treatments (Table III).
There are a further 13 publications which mention
the Tardieu Scale. Of these the major publications,
901
which review and discuss the scale are Ward [24],
Boyd and Ada [12], Gracies [7], Morris [11] and
Hodgkinson [25]. Excepting the investigations by
Tardieu et al., none of the studies found used
concurrent EMG to verify the presence or absence of
the stretch reflex.
Discussion
In this review we attempted to appraise the literature
to gain a better understanding of the properties of the
Tardieu Scale. However, with regard to validity no
conclusion can be drawn, as there is no literature to
draw on. As already stated, the quality of the ICC
used by Fosang et al. [14] and Mackey et al. [15]
cannot be assessed. Rankin and Stokes [26] suggest
that the ICC is prone to inflating reliability if
intrasubject variability is high and evidence pre-
sented in the paper would suggest this was the case
(see next paragraph).
Fosang et al. [14] and Mackey et al. [15] report
large variability in the magnitude of angular measure-
ments and in the difference between the slow and
fast measure between measurement sessions. For
interrater reliability Fosang et al. [14] reports a
discrepancy in measurement of 10 – 158 for the slow
passive range of motion and 10 – 188 for the fast range
of motion. They confirm a disparity of 6 – 188 for the
slow angular velocity and 4 – 198 on the fast passive
movement for test-retest results. Mackey et al. [15]
obtained measurements at three velocities V1, V2, V3
(see appendix) and stated that for intrasessional
repeatability ‘‘90% of the measurement differences
were below 12 degrees for the three velocities’’. For
intersessional repeatability they report ‘‘90% of
measurement differences were below 17 degrees at
the slow velocity, 16 degrees at the gravity velocity
and 25 degrees at the fast velocity’’. Therefore Fosang
et al. [14] deduced that interrater reliability was greater
than intrarater reliability, whereas Mackey et al. [15]
concluded that the Tardieu Scale has ‘‘limited ability
to assess spasticity in children with CP’’.
Each of the three experimental papers, considering
only the range of movement aspect of the scale,
assessed lower limb muscle groups. None discuss the
validity of the scale. Love et al. [19] comment on
reliability of the MAS being better than that of the
‘‘dynamic range’’ based on the Tardieu scale. Booth
et al. [20] simply comment failure to establish
reliability of their goniometric measurements as a
limitation of their study. Results from the study by
Boyd et al. [16] demonstrated that the range of
movement aspect of the Tardieu Scale was deemed
most sensitive to change at 3 weeks post botulinum
toxin A injection.
The studies using both the range of movement
aspect and the scale to rate the quality of the muscle
 902

Table I. Summary of publications assessing reliability of the Tardieu Scale.

Reference Study details Results

A. B. Haugh et al.

Fosang et al. Design: Repeated measures design Interrater reliability:

(2003) [14] Subjects: 18 children with CP (aged 2 – 10 years) Poor for MAS
Exclusion criteria: Severe fixed contractures, orthopaedic surgery 12 months prior ‘‘Acceptable reliability’’ for PROM and MTS at hamstrings and gastrocnemius
to study entry, lower limb botulinum toxin A injections, and/or inhibitory plasters muscles on second session of testing.
6 months before study entry, and pharmacological management for spasticity MTS – hamstrings 0.72; gastrocnemius 0.71; hip adductors 0.58
Assessors: 6 physiotherapists with 4 – 21 years clinical paediatric physiotherapy Test-retest reliability demonstrates ‘‘wide variability among raters’’
experience Range of ICC results for all 6 raters:
Data collected over 6 days MTS: hamstrings 0.68 – 0.90;
Muscle groups tested: hamstrings, gastrocnemius, hip adductors gastrocnemius 0.38 – 0.90;
Outcome measures: MAS; PROM; MTS hip adductors 0.61 – 0.93
Statistics: ICC; SEM; ANOVA
Mackey et al. Design: Blinded repeated measures design Velocity:
(2004) [15] Subjects: 10 children with Hemiplegic CP (aged 5 – 16 years) A significant difference occurred between the mean values of all three velocities
Exclusion criteria: Non-hemiplegic CP, progressive spasticity, casting or botulinum Elbow joint angle:
toxin injections within the last 12 months, previous upper limb surgery, elbow Intrasession repeatability:
flexion contracture greater than 208, and cognitive/learning disabilities reducing No significant difference in intrarater reliability of median values
the child’s ability to participate Intersession repeatability:
Assessor: one experienced paediatric physical therapist Considerable variability occurred from one week to the next
Muscle groups tested: biceps brachii
Outcome measures: MTS using 3 velocities V1, V2 and V3; three-dimensional
kinematics; MAS
Statistics: paired t-tests and ANOVA for data with normal distribution;
non-parametric tests including Mann-Whitney U and Kruskal Wallis for small
data sets

MAS, modified Ashworth Scale; MTS, modified Tardieu Scale; PROM, passive range of movement; ICC, Intraclass correlation coefficients; SEM, Standard error of measurement scores; ANOVA,
Analysis of Variance; CP, Cerebral Palsy.
 Table II. Summary of publications utilising the range of movement aspect only of the Tardieu Scale.

Study Design Subjects and treatment Outcome measures Conclusion summary

Boyd et al. Prospective before 25 children (aged 4 – 9 yrs)
(2000) [16] and after trial Muscle group involved: gastroc-soleus
Treatment: All subjects received
botulinum toxin A; 10 subjects also
required serial casting (for between 1
and 3 weeks duration)
Love et al. Matched-pair design 12 matched-pairs (aged 3 – 13 yrs)
(2001) [19] Muscle group involved: calf
Experimental group: treated with
botulinum toxin A injections
Control group: no placebo
Booth et al. Retrospective study 30 children (aged 2 – 18 yrs) were
(2003) [20] allocated to two groups of 15.
Muscle group involved: calf
One group underwent casting only; the
second group received botulinum toxin
A prior to serial casting
Goniometry: PROM (R2); Ankle kinetics showed improvements at
dynamic ROM (R1) 12 and 24 weeks post botulinum toxin
Muscle tone (MAS) A injection, indicating improvements in
SMC gait pattern. A significant increase in
Kinematics & kinetics dynamic ROM occurred at 3 weeks
post injection, suggesting R1 is a
sensitive measure to change at this stage
following treatment with botulinum
toxin A.
Static muscle length (R2) Functional progress in the experimental
Dynamic muscle range (R1) group lasted longer than the expected
MAS time-course of the botulinum toxin A,
GMFM suggesting a reduction in spasticity
VAS enables more permanent improvements
in function.
Muscle tone (MAS*) Treatment with botulinum toxin A and
Goniometry: ROM R1 (MTS); maximal serial casting achieves target ranges of
ROM R2 movement more quickly than serial
casting alone.

(P)ROM, (passive) range of motion; MAS, modified Ashworth Scale; MAS*, modified by authors of the study; SMC, ‘‘new test of selective motor control’’; PRS, Physicians rating scale; 3DGA, three-
dimensional gait analysis; GMFM, Gross Motor Function Measure; VAS, visual analogue scale; COPM, Canadian Occupational Performance Measure; MTS, modified Tardieu Scale.
Review of the Tardieu Scale for the measurement of spasticity
903
 904

Table III. Summary of experimental studies using both the subjective scale and the range of movement aspect of the Tardieu Scale.

Study Design Subjects and treatment Outcome measures Results/conclusions

Decq et al. Prospective, 46 patients (aged 8 – 79 yrs) with stroke, MAS According to the outcome measures used
(2000) [17] non-randomized, cerebral trauma, ‘Little disease’ and MS Tardieu Scale spasticity was eliminated in 44 of the 46
non-controlled study Treatment: Soleus neurotomy PROM patients, the remaining two, though
Kinematic parameters of gait improved, had some residual clonus.
The authors highlight the importance of
treating the soleus muscle when spasticity
occurs in the calf.
A. B. Haugh et al.

Gracies et al. Crossover trial 16 patients (aged 36 – 85 yrs) at least Limb circumference The lycra splints significantly reduced
(2000) [18] 3 weeks post stroke Resting angular position spasticity in the wrist and finger flexors,
Treatment: Dynamic lycra splint for the Tardieu Scale (spasticity) where plastic boning was incorporated into
upper limb, worn for a 3-hour period Goniometer: AROM; PROM the splint, creating greater stretch forces. A
Proprioception – McCloskey method small reduction in limb swelling occurred.
Visual neglect syndrome – line bisection The authors state better results occurred in
Comfort – questionnaire patients with more severely affected upper
limbs.
Filipetti and Decq Retrospective study 566 patients (aged 4 – 72 years) with MAS The authors conclude that anaesthetic motor
(2003) [21] diagnoses including stroke, CP and TBI Tardieu Scale blocks can be used to assess ‘‘. . . the
(French paper) Investigation of the use of anaesthetic motor Penn frequency spasm score relative contributions of overactivity and
blocks for assessment of spasticity MRC scale muscle shortening . . .’’ as well as evaluating
the activity of the agonist muscle, thereby
guiding appropriate treatment.
The anaesthetic blocks also resulted in a
temporary (between 1 – 6 hours) reduction
in spasticity (shown by the MAS and
Tardieu scale as a 2 – 3 point decrease).
Roujeau et al. Prospective design 6 patients (mean age 28 years) with varied PROM Tibial neurotomy resulted in normal stretch
(2003) [22] neurological conditions Held-Tardieu scale reflexes immediately post-operative, which
Treatment: Selective fascicular tibial Osteoarticular and tendon repercussions were maintained at 24 months follow-up in
neurotomy Quality of motor control of dorsiflexion four of the six subjects. The remaining two
H reflex required further surgery.
Wallen et al. Intervention study, 16 children (aged 2 – 12 yrs) with CP COPM The authors report a significant reduction in
(2004) [23] case series with follow-up Treatment: Botulinum toxin A injections for GAS spasticity up to 3 months post injection,
the upper limb, following identification of Melbourne Assessment of Unilateral Upper with functional improvements maintained
the appropriate injection site using Limb Function at 6 months follow-up.
electrical stimulation CHQ
MAS (muscle tone)
Tardieu Scale (spasticity)
AROM
PROM

MS, multiple sclerosis; CP, cerebral palsy; TBI, traumatic brain injury; MAS, modified Ashworth Scale; PROM, passive range of motion; AROM, active range or motion; MRC, Medical Research
Council; COPM, Canadian Occupational Performance Measure; GAS, Goal Attainment Scale; CHQ, Child Health Questionnaire.
 Review of the Tardieu Scale for the measurement of spasticity
reaction have all been published as full journal
articles. Two of the five relate to upper limb muscle
groups. None discuss the validity or reliability in
choosing the Tardieu Scale. Gracies et al. [18] justify
their choice of outcome measure as they claim that
the scale has ‘‘advantages over the Ashworth Scale,
in terms of specificity and sensitivity’’. This view is
endorsed by Wallen et al. [23] and Filipetti and Decq
who assert, a higher level of sensitivity occurs
because of the smaller graduations in the dynamic
range of movement measurement of the scale [21].
However, one could argue that even this aspect of the
scale is subjective as it involves accurately determin-
ing the position of a specific muscle reaction. In a
study by Pandyan et al. [27] regarding the modified
Ashworth Scale a rater’s ability to identify the
position of ‘catch’ was found to be unreliable.
Therefore can we expect any better of the Tardieu
Scale? This would limit both the specificity and
sensitivity of this aspect of the scale.
As already stated, Gracies [7] advocates using
speed V2, or gravity-drop, where possible, as this
speed is reproducible. However, one can argue that
the speed produced will be dependent on the
properties of the individual muscle and will there-
fore, vary from patient to patient. Could this
potentially affect the stretch reflex?
In studies by Decq et al. [17] and Filipetti and
Decq [21], the authors report using both the
modified Ashworth Scale and the Tardieu Scale to
measure ‘spasticity’; Gracies et al. [18] used only the
Tardieu Scale to measure spasticity; whereas Wallen
et al. [23] used the modified Ashworth Scale as a
measure of ‘‘muscle tone’’ with the Tardieu Scale
being used as a ‘‘dynamic measure of spasticity’’.
Roujeau et al [22] report assessing spasticity (termed
‘‘stretch reflex’’) using the ‘‘Held-Tardieu’’ Scale
but neither Held or Tardieu are referenced and the
criteria for the scale are not provided. These studies
demonstrate how ambiguous the literature can be
regarding the clinical measurement of spasticity, with
particular reference to the validity of these scales, i.e.,
what do they actually measure?
The scale to rate the quality of the muscle reaction
is quite simple to use as each grade relates to distinct
muscle reactions. Some authors consider the scale to
be ordinal [7,28]. However these reactions include
variations in resistance, the presence of a catch and
severity of clonus. The literature is unclear whether
clonus is a component of spasticity or a separate
phenomenon of the upper motor neurone syndrome.
It does seem true that spasticity is always evident in
the presence of clonus but can we absolutely refer to
it as a more severe form of spasticity as those who
claim the scale to be ordinal must? Alternatively, if
we consider clonus to be a separate phenomenon,
then the rating of the quality of the muscle reaction
905
must be classed as nominal data, reducing the quality
of the scale [29].
Conclusions and recommendations
Publications regarding the validity and reliability of
the Tardieu Scale continue to be scarce, with none
relating to the adult population. Of those found, only
the range of movement aspect (i.e., the difference
between the slow passive range and the ‘angle of
catch’) has been used with no mention of the ‘rating
of the quality of the muscle reaction’ aspect of the
scale. It is therefore, impossible to make assumptions
or draw conclusion on the validity or reliability of the
Tardieu scale from current literature.
In theory, the Tardieu Scale demonstrates several
advantages over previously used clinical scales in the
measurement of spasticity as it uses both a fast and
slow speed of movement and incorporates an interval
level measure (range of movement) as well as a
subjective rating scale. However, as previously
discussed the quality of the scale can be questioned.
Like Fosang et al. [14] and Flett [30] we would
recommend further studies into the validity and
reliability of this scale before it is adopted as a
common measure of spasticity.
Acknowledgements
We would like to thank Action Medical Research and
EU Quality of Life Programme (SPASM Thematic
Network) for their financial support; and Fredericke
van Wijck, Queen Margaret University College,
Edinburgh, for advice and guidance.
References
1. Barnes MP. An overview of the clinical management of
spasticity. In: Barnes MP, Johnson GR, editors. Upper motor
neurone syndrome and spasticity. Clinical management and
neurophysiology. Cambridge: Cambridge University Press;
2001. pp 1 – 11.
2. Lance JW. Pathophysiology of spasticity and clinical experi-
ence with Baclofen. In Lance JW. Feldman RG, Young RR,
Koella WP, editors. Spasticity: Disordered Motor Control.
Year Book: Chicago; 1980; 185 – 204. (line 786 – 788)
3. Tardieu G, Shentoub S, Delarue R. A la recherche d’une
technique de measure de la spasticite. Rev Neurol (Paris)
1954;91:143 – 144.
4. Pandyan AD, Gregoric M, Barnes MP, Wood D, van Wijck F,
Burridge J, Hermens H, Johnson GR. Spasticity: Clinical
perceptions, neurological realities and meaningful measure-
ment. Disab Rehab 2005;21(1 – 2):2 – 6.
5. van Wijck FMJ, Pandyan AD, Johnson GR, Barnes MP.
Assessing motor deficits in neurological rehabilitation: Pat-
terns of instrument usage. Neurorehab Neural Rep 2001;
15(1):23 – 30.
6. Pandyan AD, Johnson GR, Price CI, Curless RH, Barnes MP,
Rodgers H. A review of the properties and limitations of the
Ashworth and modified Ashworth Scales as measures of
spasticity. Clin Rehab 1999;13(5):373 – 383.
906 A. B. Haugh et al.
7. Gracies J-M. Évaluation de la spasticité. Apport de l’échelle de
tardieu. Motricité cérébrale 2001;22:1 – 16.
8. Vattanasilp W, Ada L, Crosbie J. Contribution of thixotropy,
spasticity, and contracture to ankle stiffness after stroke.
J Neurol Neurosurg Psychiat 2000;69(1):34 – 39.
9. Held JP, Pierrot-Deseilligny E. Reeducation mortrice des
affections neurologiques. J. B. Balliere et fils., 1969.
10. Boyd RN, Graham HK. Objective measurement of clinical
findings in the use of botulinum toxin type A for the
management of children with cerebral palsy. Eur J Neurol
1999;6(Suppl. 4):S23 – S35.
11. Morris S. Ashworth and Tardieu Scales: Their clinical
relevance for measuring spasticity in adult and paediatric
neurological populations. Phys Ther Rev 2002;7:53 – 62.
12. Boyd RN, Ada L. Physiotherapy management of spasticity. In:
Barnes MP, Johnson GR, editors. Upper motor neurone
syndrome and spasticity. Clinical management and neuro-
physiology. Cambridge, UK: Cambridge University Press;
2001. pp 96 – 121.
13. Boyd RN, Barwood SA, Ballieu C, et al. Validity of a clinical
measure of spasticity in children with cerebral palsy in a
double blinded randomised controlled clinical trial. Dev Med
Child Neurol 1998;40(Suppl. 78):7.
14. Fosang AL, Galea MP, McCoy AT, Reddihough DS, Story I.
Measures of muscle and joint performance in the lower limb
of children with cerebral palsy. Dev Med Child Neurol 2003;
45(10):664 – 670.
15. Mackey AH, Walt SE, Lobb G, Stott NS. Intraobserver
reliability of the modified Tardieu scale in the upper limb of
children with hemiplegia. Dev Med Child Neurol 2004;46:
267 – 272.
16. Boyd RN, Pliatsios V, Starr R, Wolfe R, Graham HK.
Biomechanical transformation of the gastroc-soleus muscle
with botulinum toxin A in children with cerebral palsy. Dev
Med Child Neurol 2000;42(1):32 – 41.
17. Decq P, Filipetti P, Cubillos A, Slavov V, Lefaucheur JP,
Nguyen JP. Soleus neurotomy for treatment of the spastic
equinus foot. Groupe d’Evaluation et de Traitement de la
Spasticite et de la Dystonie. Neurosurgery 2000;47(5):
1154 – 1160.
18. Gracies JM, Marosszeky JE, Renton R, Sandanam J,
Gandevia SC, Burke D. Short-term effects of dynamic lycra
splints on upper limb in hemiplegic patients. Arch Phys Med
Rehab 2000;81(12):1547 – 1555.
19. Love SC, Valentine JP, Blair EM, Price CJ, Cole JH, Chauvel PJ.
The effect of botulinum toxin type A on the functional ability of
the child with spastic hemiplegia a randomized controlled trial.
Eur J Neurol 2001;8(Suppl. 5):50 – 58.
20. Booth MY, Yates CC, Edgar TS, Bandy WD. Serial casting
vs. combined intervention with botulinum toxin A and serial
casting in the treatment of spastic equinus in children. Pediat
Phys Ther 2003;15(4):216 – 220.
21. Filipetti P, Decq P. Interest of anesthetic blocks for
assessment of the spastic patient. A series of 815 motor
blocks. Neurochirurgie 2003;49(2 – 3 Pt 2):226 – 238.
22. Roujeau T, Lefaucheur JP, Slavov V, Gherardi R, Decq P.
Long-term course of the H reflex after selective tibial neurotomy.
J Neurol Neurosurg Psychiat 2003;74(7):913 – 917.
23. Wallen MA, O’Flaherty SJ, Waugh MCA. Functional out-
comes of intramuscular botulinum toxin type a in the upper
limbs of children with cerebral palsy: A phase II trial. Arch
Phys Med Rehab 2004;85(2):192 – 200.
24. Ward A. Assessment of muscle tone. Age Aging 2000;
29(5):385 – 386.
25. Hodgkinson I, Vadot JP, Berard C. Clinical assessment of
spasticity in children. Neurochirurgie 2003;49(2 – 3 Pt 2):
199 – 204.
26. Rankin G, Stokes M. Reliability of assessment tools in
rehabilitation: An illustration of appropriate statistical ana-
lyses. Clin Rehab 1998;12:187 – 199.
27. Pandyan AD, Price CI, Rodgers H, Barnes MP, Johnson GR.
Biomechanical examination of a commonly used measure of
spasticity. Clin Biomech (Bristol, Avon) 2001;16(10):859 – 865.
28. Pierson SH. Outcome measures in spasticity management.
Muscle Nerve 1997;20(Suppl. 6):S36 – S60.
29. Hicks CM. Practical research methods for physiotherapists.
Edinburgh: Churchill Livingstone; 1988.
30. Flett PJ. Rehabilitation of spasticity and related problems in
childhood cerebral palsy. [Review]. J Paediatr Child Health
2003;39(1):6 – 14.
Appendix
The grading aspect of the Tardieu Scale as
developed by Held and Pierrot-Deseilligny
(1969) [9]:
The strength and duration of the stretch reflex:
0 No stretching
1 Only visible contraction
2 Simple jump felt during mobilisation but
that passes just as suddenly as it came
3 Lasting contraction or a few clonic tremors
that go away after a few seconds
4 Contraction or clonus that does not cease,
even after a few seconds
The Tardieu Scale as provided in more recent
publications [11,12]:
Criteria for performing the Tardieu Scale
[11,12]:
Grading is always performed at the same time of day,
in a constant position of the body for a given limb.
Other joints, particularly the neck, must also remain
in a constant position throughout the test and
between tests. For each muscle group, reaction to
stretch is rated at a specified stretch to velocity with
two parameters X and Y.
The patient is positioned in sitting for upper limbs
Lower limbs are tested in supine
Criteria for scoring the Tardieu Scale [11]:
Velocity to stretch:
V1 as slow as possible
V2 speed of the limb segment falling under gravity
V3 as fast as possible (faster than the rate of the
natural drop of the limb segment under
gravity)
V1 is used to measure the passive range of motion
(PROM)
 Review of the Tardieu Scale for the measurement of spasticity
Only V2 and V3 are used to rate spasticity
Quality of muscle reaction (X):
0 no resistance throughout the course of the
passive movement
1 slight resistance throughout the course of
the passive movement, with no clear catch
at precise angle
2 Clear catch at precise angle, interrupting
the passive movement, followed by release
907
3 Fatigable clonus (510 seconds when
maintaining pressure) occurring at precise
angle
4 Infatigable clonus (410 seconds when
maintaining pressure) occurring at precise
angle
Angle of muscle reaction (Y):
Measured relative to the position of minimal stretch
of the muscle (corresponding to angle) where it is
relative to the resting anatomic position.