Skip to main content
  

Rehab Measures: Tardieu Scale/Modified Tardieu Scale

Link to instrument

Available on the mdvu.org website 

Title of Assessment

Tardieu Scale/Modified Tardieu Scale  

Acronym

MTS

Instrument Reviewer(s)

Initially reviewed by Christopher Newman, PT, MPT, NCS, Jennifer H. Kahn, PT, DPT, NCS, and the SCI EDGE task force of the Neurology Section of the APTA in 8/2012

Summary Date

12/23/2013 

Purpose

To assess the muscle's response to stretch at various given velocities.

Description

Tardieu is a scale for measuring spasticity that takes into account resistance to passive movement at both slow and fast speed. The scale originally began development in the 1950s and has gone through multiple revisions (reviewed in Haugh 2006). The most recent versions of the scale use the following criteria:

  • Individuals are positioned in sitting to test the UEs and supine to test the LEs
  • 2 Measurements:
    • Quality of muscle reaction
    • Angle of muscle reactio
  • 3 Speed definitions:
    • V1 is slow as possible
    • V2 speed of limb falling under gravity
    • V3 moving as fast as possible
  • Quality of Muscle Reaction (scored 0-5); 0 is no resistance to passive ROM to 5 indicating joint is immobile. (Some versions scored 0-4)
  • Joint Angle: Modified Tardieu describes R1 and R2; R1 is the angle of muscle reaction, R2 is the full PROM
  • The angle of full ROM (R2) is taken at a very slow speed (V1). The angle of muscle reaction (R1) is defined as the angle in which a catch or clonus is found during a quick stretch (V3). R1 is then subtracted from R2 and this represents the dynamic tone component of the muscle. (Boyd 1999)

Area of Assessment

Functional Mobility 

Body Part

Not Applicable 

ICF Domain

Body Structure; Body Function 

Domain

Motor 

Assessment Type

Performance Measure 

Length of Test

 

Time to Administer

Dependent on number of joints being tested.

Number of Items

Dependent on number of joints being tested. 

Equipment Required

Goniometer

Training Required

No formal training required.  Recommend training from an experienced tester for better understanding of how to correctly administer test.

Type of training required

No Training 

Cost

Free 

Actual Cost

Free

Age Range

 

Administration Mode

 

Diagnosis

Cerebral Palsy; Geriatrics; Stroke; Traumatic Brain Injury 

Populations Tested

  • Cerebral Palsy
  • Adults with severe brain injury
  • Stroke
  • Adults with profound intellectual and multiple disabilities (PIMD)

Standard Error of Measurement (SEM)

Stroke:

(Paulis et al, 2011; n = 13 subjects living in a nursing home; mean age = 70.2(12.30) years; compared test-retest and interrater reliability of Tardieu of elbow flexors measured with goniometry vs. inertial sensors (IS))

 

· Tardieu (R2-R1) SEM Goni = 6.19, IS = 8.81

· Passive ROM (R2) SEM Goni= 5.04, IS= 6.80

· Angle of Catch (R1) SEM Goni = 4.47, IS= 5.72

 

Severe Brain Injury:

(Mehrholz et al, 2005; n = 30, patients with impaired consciousness due to severe cerebral damage of various etiologies; mean age = 63.9(12.9) years)

 

SEM for Intra-rater Reliability

Domain

SEM

Shoulder flexion

0.05

Shoulder external rotation

0.05

Elbow flexion

0.04

Elbow extension

0.04

Wrist flexion

0.02

Wrist extension

0.04

Hip flexion

0.02

Hip extension

0.04

Knee flexion

0.05

Knee extension

0.03

Ankle extension (knee joint flexed)

0.02

Ankle extension (knee joint fully extended)

0.04

 

SEM for Inter-rater Reliability

Domain

SEM

Shoulder flexion

0.05

Shoulder external rotation

0.05

Elbow flexion

0.03

Elbow extension

0.03

Wrist flexion

0.07

Wrist extension

0.03

Hip flexion

0.04

Hip extension

0.03

Knee flexion

0.04

Knee extension

0.03

Ankle extension (knee joint flexed)

0.03

Ankle extension (knee joint fully extended)

0.04

 

Minimal Detectable Change (MDC)

Stroke:

(Paulis et al, 2011)

 

Smallest Detectable Difference (SDD) calculated from above referenced SEM data and test retest data:

 

· Tardieu (R2-R1) SEM Goni = 17.16, IS = 24.41

· Passive ROM (R2) SEM Goni= 13.98, IS= 18.85

· Angle of Catch(R1) SEM Goni = 12.39, IS= 15.85

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Not Established

Normative Data

Severe brain injury:

(Mehrholz et al, 2005)

 

Patient Characteristics

Characteristic

Patients, n = 30

Age (years)a

63.9 (±12.9)

Sex (female/male)

9/21

Diagnosis

Ischemic Stroke

7

Intracerebral Hemorrhage

11

Traumatic brain injury

5

Cerebral hypoxia

7

Duration of illness (days)a

78 (±93)

Antispastic therapy

Local (botulinum toxin)

0

Systemic (baclofen or tizanidine)

2

Implanted intrathecal baclofen pump system

0

Glasgow Coma Scale scorea

6.9 (±2.3)

Coma Remission Scale scorea

8.0 (±4.5)

Body mass index (kg/m^2)a

24.1 (±3.8)

a Mean ± standard deviation.

Test-retest Reliability

Severe Brain Injury:

(Mehrholz et al, 2005)

 

  • Adequate Intrarater reliability k = 0.65-0.87 for muscle groups tested; except shoulder ER k = 0.53
  • Angle of muscle reaction: joint (ICC = elbow flexors, 0.73 (Adequate); knee flexors, 0.72 (Adequate); ankle PF with knee flexed, 0.70 (Adequate); ankle PF with knee extended, 0.65 (Adequate))

 

Children with CP:

(Fosang et al, 2003; n = 18, ages 2-10 yrs old, determine reliability and magnitude of error for MAS, PROM, and Tardieu Scale)

 

  • Adequate to Excellent Correlation for MTS at Hamstrings (ICC = 0.68-0.90)
  • Poor to Excellent Coorelation of MTS at Gastroc (ICC = 0.38-0.90)
  • Adequate to High Correlation MTS at Hip Add (ICC = 0.61-0.93)

 

Stroke:

(Paulis et al, 2011)

 

Test-retest reliability of Tardieu performed with goniometer and with inertial sensors (IS) of elbow flexors

 

R2-R1

ICC

Goniometric

Excellent 0.86

IS

Excellent 0.76

PROM, R2

ICC

Goniometric

Excellent 0.87

IS

Excellent 0.86

 

AoC (R1)*

ICC

Goniometric

Excellent 0.91

IS

Excellent 0.82

*AoC: Area of Catch

Interrater/Intrarater Reliability

Severe Brain Injury:

(Mehrholz et al, 2005)

 

Intrarater reliability

Domain

Cohen’s kappa

Standards for use

Shoulder flexion

0.65

Poor

Shoulder external rotation

0.53

Poor

Elbow flexion

0.78

Adequate

Elbow extension

0.75

Adequate

Wrist flexion

0.87

Excellent

Wrist extension

0.71

Adequate

Hip flexion

0.76

Adequate

Hip extension

0.72

Adequate

Knee flexion

0.67

Poor

Knee extension

0.81

Excellent

Ankle extension (knee joint flexed)

0.82

Excellent

Ankle extension (knee joint fully extended)

0.72

Adequate

 

Interrater reliability

Domain

Cohen’s kappa

Standards for use

Shoulder flexion

0.44

Poor

Shoulder external rotation

0.39

Poor

Elbow flexion

0.48

Poor

Elbow extension

0.51

Poor

Wrist flexion

0.33

Poor

Wrist extension

0.38

Poor

Hip flexion

0.42

Poor

Hip extension

0.37

Poor

Knee flexion

0.53

Poor

Knee extension

0.44

Poor

Ankle extension (knee joint flexed)

0.47

Poor

Ankle extension (knee joint fully extended)

0.29

Poor

 

Stroke:

(Ansari et al, 2008; n = 30 individuals with hemiplegia > 1 month post stroke)

 

Interrater reliability for MTS used to assess elbow flexor spasticity:

 

  • Adequate interrater reliability for R2-R1 (ICC = 0.72)
  • Adequate interater reliability for MTS quality (ICC = 0.74) and R1 (ICC = 0.74) and R2 (ICC = 0.56)

 

Stroke:

(Paulis et al, 2011)

 

R2-R1

ICC

Goniometric

Adequate 0.66

IS

Excellent 0.84

PROM, R2

ICC

Goniometric

Excellent 0.89

IS

Excellent 0.89

 

AoC* (R1)

ICC

Goniometric

Adequate 0.60

IS

Excellent 0.87

*AoC: Angle of Catch

 

Stroke:

(Singh et al, 2011; n = 91 people with acute stroke; mean age = 64 (SD = 11.1) years)

 

ICCs

elbow flexors

ankle plantar flexors

R1

Excellent 0.998

Excellent 0.990

R2

Excellent 0.978

Excellent 0.995

R2-R1

Excellent 0.991

Excellent 0.907

MTS scores

Excellent 0.847

Excellent 0.863

p < 0.0001 for all of the above

 

Children with CP:

(Yam and Leung, 2006; n = 17 children with CP; mean age = 7yr 9mo)

Interrater reliability between MAS and MTS, 4 joints in LE tested:

 

  • Poor to Adequate: Modified Tardieu (ICC = 0.22-0.71)
  • Poor to Adequate: R1 (ICC = 0.37-0.71); R2 (ICC = 0.17-0.74; R2-R1 (ICC = 0.4-0.69)

 

Children with CP:

(Fosang et al, 2003)

 

  • Adequate interrater reliability (ICC = 0.58-0.72)

Internal Consistency

Not Established

Criterion Validity (Predictive/Concurrent)

Not Established

Construct Validity (Convergent/Discriminant)

Stroke:

(Patrick and Ada, 2006; n = 16, chronic stroke living in the community, comparing MAS, MTS, and clinical measure of spasticity in laboratory - EMG)

 

· PEA (Percentage of exact agreement) of Tardieu and laboratory measure of spasticity, 100% for elbow flexors and plantar flexors

· Excellent Convergent Validity (r = 0.86 elbow flexors; 0.62 ankle)

· PFPEA of Tardieu and laboratory measures of contracture was 94% for elbow flexors and plantar flexors

· Excellent Convergent Validity (r = 0.89 for elbow flexors; 0.84 for plantar flexors)

Content Validity

Not Established

Face Validity

Not Established

Floor/Ceiling Effects

Not Established

Responsiveness

Not Established

Professional Association Recommendations

Recommendations from the Neurology Section of the American Physical Therapy Association’s StrokEDGE Taskforce, MSEDGE Taskforce, SCI EDGE Taskforce, and the TBI EDGE Taskforce are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

 

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

 

Abbreviations:

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

 

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

StrokEDGE

R

R

R

SCI EDGE

LS

LS

LS

 

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

StrokEDGE

R

R

R

R

R

MS EDGE

UR

UR

UR

UR

UR

 

Recommendations based on SCI AIS Classification:

 

AIS A/B

AIS C/D

SCI EDGE

LS

LS

 

Recommendations based on EDSS Classification:

 

EDSS 0.0 – 3.5

EDSS 4.0 – 5.5

EDSS 6.0 – 7.5

EDSS 8.0 – 9.5

MS EDGE

UR

UR

UR

UR

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Is this tool appropriate for use in intervention research studies? (Y/N)

StrokEDGE

Yes

Yes

Yes

SCI EDGE

No

No

No

MS EDGE

No

No

No

Considerations

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Bibliography

Ansari, N. N., Naghdi, S., et al. (2008). "The Modified Tardieu Scale for the measurement of elbow flexor spasticity in adult patients with hemiplegia." Brain Injury 22(13-14): 1007-1012. Find it on PubMed

Boyd, R. N. and Graham, H. K. (2007). "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(S4): s23-s35.

Fosang, A. L., Galea, M. P., et al. (2003). "Measures of muscle and joint performance in the lower limb of children with cerebral palsy." Developmental Medicine and Child Neurology 45(10): 664-670. Find it on PubMed

Haugh, A. B., Pandyan, A. D., et al. (2006). "A systematic review of the Tardieu Scale for the measurement of spasticity." Disability and Rehabilitation 28(15): 899-907. Find it on PubMed

Mehrholz, J., Wagner, K., et al. (2005). "Reliability of the Modified Tardieu Scale and the Modified Ashworth Scale in adult patients with severe brain injury: a comparison study." Clinical Rehabilitation 19(7): 751-759. Find it on PubMed

Patrick, E. and Ada, L. (2006). "The Tardieu Scale differentiates contracture from spasticity whereas the Ashworth Scale is confounded by it." Clinical Rehabilitation 20(2): 173-182. Find it on PubMed

Paulis, W. D., Horemans, H. L., et al. (2011). "Excellent test-retest and inter-rater reliability for Tardieu Scale measurements with inertial sensors in elbow flexors of stroke patients." Gait and Posture 33(2): 185-189. Find it on PubMed

Singh, P., Joshua, A. M., et al. (2011). "Intra-rater reliability of the modified Tardieu scale to quantify spasticity in elbow flexors and ankle plantar flexors in adult stroke subjects." Ann Indian Acad Neurol 14(1): 23-26. Find it on PubMed

Yam, W. K. and 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. Find it on PubMed

Year published

 

Instrument in PDF Format

Yes 
Approval Status Approved 
 
Attachments
Created at 9/28/2012 1:05 PM  by Jason Raad 
Last modified at 1/31/2014 9:30 AM  by Jason Raad