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目录ModifiedAshworthScale..........................................................................................................2Purposeofthemeasure............................................................................................................2Availableversions......................................................................................................................2Featuresofthemeasure...........................................................................................................3AlternativeformsoftheModifiedAshworthScale...................................................................7Clientsuitability.........................................................................................................................8ModifiedTardieuScale(MTS).................................................................................................10Purposeofthemeasure..........................................................................................................10Availableversions....................................................................................................................11Featuresofthemeasure.........................................................................................................12ScoringandScoreInterpretation............................................................................................15AlternativeformsoftheModifiedTardieuScale....................................................................17Clientsuitability.......................................................................................................................19ModifiedAshworthScalePurposeofthemeasureTheModifiedAshworthScaleisconsideredtheprimaryclinicalmeasureofmusclespasticityinpatientswithneurologicalconditions.However,somepublicationsquestionitsabilitytomeasurespasticityandadvocatetheModifiedAshworthScaleasaratingscaletomeasureabnormalityintoneortheresistancetopassivemovements,sincethereisnoclinicallydirectmethodformeasuringspasticity(Gregson,Leathley,Moore,Sharma,Smith&Watkins,1999;Pandyan,Johnson,Price,Curless,Barnes&Rodgers,1999).改良Ashworth是神经系统疾患肌肉痉挛的主要临床测量手段。然而，许多研究质疑它在测量痉挛的能力，并提倡将其作为测量张力异常或被动运动受阻的评定量表。因为临床尚无直接方法测量痉挛。(Gregson,Leathley,Moore,Sharma,Smith&Watkins,1999;Pandyan,Johnson,Price,Curless,Barnes&Rodgers,1999).AvailableversionsTheAshworthScalewasinitiallydevelopedintheearly1960sbyBryanAshworth,toestimatetheefficacyofanti-spasticdrugsinclientswithMultipleSclerosis.Itisa5-pointscale,withagradescoreof0,1,2,3,or4(Ashworth,1964).In1987,BohannonandSmithaddedthegrade1+andproposedslightchangesonthedefinitionsofeachscoreinordertoincreasethesensitivityofthemeasureandfacilitatescoring.ThenewmeasurewasthencalledtheModifiedAshworthScaleandisconsideredbymanyasthegoldstandardformeasuringspasticity(Bohannon&Smith,1987).FeaturesofthemeasureItems:评定条目Althoughtherearenostandardizedguidelinesforitsuse,theModifiedAshworthScalecanbeappliedtomusclesofboththeupperorlowerbody.Theratershouldextendtheclient'slimbfromapositionofmaximalflexiontomaximalextensionuntilthefirstsoftresistanceisfelt.Movingaclient'slimbthroughitsfullrangeofmotionshouldbedonewithinonesecondbycountingonethousandandone(BohannonandSmith,1987).尽管没有使用的标准指南，但改良Ashworth量表可以用于上下肢的肌肉评定。测量者应将患者肢体从最大屈曲位伸直到最大伸直位，直到感觉到软组织抵抗。全关节范围内移动患者肢体时，应在1s内完成，即数onethousandandone(BohannonandSmith,1987).Mehlroz,Wagner,Meibner,GrundmannandZange(2005)suggesttestingoftheupperlimbsshouldtakeplacewhiletheclientislyingsupine,withtheupperlimbsparalleltothetrunk,elbowsextended,wristsinaneutralposition,andthelowerlimbspositionedparalleltooneanother.Exceptionsaremadefortheshoulderextensors,wherethearmshouldbemovedfromextensionto90degreesofflexion,andfortheshoulderinternalrotators,wherethearmshouldbemovedfromneutraltoamaximumexternalrotation.Mehlroz,Wagner,Meibner,GrundmannandZange(2005)建议测量上肢应在仰卧位进行，上肢平行于躯干放置，肘关节伸直，腕关节处于中立位，双下肢平行放置，但肩关节伸肌和内旋肌测量时不同。伸肌测量时，手臂应从伸直位移动到屈曲90°，内旋肌测量时，手臂应从中立位移动到最大外旋位。Forthelowerlimbs,Blackburn,vanVliet,andMockett(2002)recommendthattheclientshouldbesidelying.Specificallyfortestingthesoleusmuscle,thehipsandkneesshouldbepositionedin45degreesofflexionandtheankleismovedfrommaximumplantarflexiontomaximumdorsiflexion.Forthegastrocnemiusmuscle,hipsshouldbein45degreesofflexionwiththekneesinmaximumextensionandtheankleismovedfrommaximumplantarflexiontomaximumdorsiflexion.Forthequadricepsfemorismuscle,kneesandhipsshouldbeinmaximalextensionandthekneeismovedfrommaximumextensiontomaximumflexion.对下肢来说，Blackburn,vanVliet,andMockett(2002)推荐患者侧卧。尤其是测量比目鱼肌时，双髋和膝应在45°屈曲位，踝关节从最大跖屈位移动到最大背伸位。对腓肠肌来说，双髋45°屈曲，双膝最大伸直位，踝关节从最大跖屈位移动到最大背伸位。对股四头肌来说，双膝髋都应在最大伸直位，膝关节从最大伸直位移动到最大屈曲位。Throughouttestingtheclientshouldbeinstructedtoremaincalmandrelaxed,andwhenrepeatedtestingisundertaken,testingshouldbeinitiatedatthesametimeofthedaytominimizepossiblechangesinspasticitylevelsduetomedicationinteraction(BohannonandSmith,1987).整个测试中，应教育患者保持冷静放松。若需要重复测试，应在同一天进行以最大程度减少因药物作用而导致的痉挛程度的变化(BohannonandSmith,1987)。Scoring:TheModifiedAshworthScalei