Modified Ashworth Scale (MAS) for Spasticity: Grades & Recorder

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Reviewed by Dr. Richard Holsman, PT, DPT, NCS · Last reviewed November 14, 2026 · For clinicians

The Modified Ashworth Scale (MAS) grades resistance to passive movement (muscle tone) in people with central nervous system conditions such as stroke, brain injury, spinal cord injury and multiple sclerosis. Bohannon and Smith added the “1+” grade to the original Ashworth Scale in 1987. Use this page to record a grade for each muscle group you test and print the results.

⚠️ For clinicians. Not a self-check.

The MAS is graded by a physical therapist, physician or other trained clinician who moves the patient’s limb.
Standardize the position, speed and number of repetitions so repeat tests are comparable. Reliability differs from muscle to muscle.
Do not force a joint that is painful, recently injured or suspected of fracture or heterotopic ossification.

How to test

Place the patient supine and ask them to relax.
To test a muscle that mainly flexes a joint, start with the joint fully flexed and move it to full extension over about one second (count “one thousand one”).
To test a muscle that mainly extends a joint, start with the joint fully extended and move it to full flexion over about one second.
Grade the resistance you feel using the scale below.

Procedure summarized from the Rehabilitation Measures Database instruction sheet, derived from Bohannon and Smith (1987).

Modified Ashworth Scale grades

Grade	Description (Bohannon & Smith, 1987)
0	No increase in muscle tone
1	Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or extension
1+	Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM
2	More marked increase in muscle tone through most of the ROM, but affected part(s) easily moved
3	Considerable increase in muscle tone, passive movement difficult
4	Affected part(s) rigid in flexion or extension

Record your grades

Date tested (optional)

This is a clinical rating, not a diagnosis. The MAS measures how much resistance is felt during passive movement. It does not tell you the cause, and it should be read alongside the rest of the neurologic and musculoskeletal exam.

For patients and families

Muscle stiffness or tightness after a stroke, brain injury or spinal cord injury can affect walking, dressing and comfort. A physical or occupational therapist can measure it and build a plan with your medical team. If you or a family member would like help from a physical therapist, request an appointment with Holsman Physical Therapy or call 1-855-465-7626.

Reading the grades

MAS grades are ordered categories (0, 1, 1+, 2, 3, 4), not measurements. This page lists each muscle group’s grade; it does not add or average them.
Higher grades mean more resistance to passive movement. Record the side, the muscle group and the patient’s position each time so later tests can be compared.

Reliability

Original study: two raters grading elbow flexor spasticity in 30 patients with intracranial lesions agreed on 86.7% of ratings (Kendall’s tau 0.847) (Bohannon & Smith, 1987).
Severe brain injury: in 30 adults with severe brain injury and impaired consciousness, test-retest reliability of the MAS was moderate to good (kappa 0.47–0.62) but inter-rater reliability was poor to moderate (kappa 0.16–0.42). The Modified Tardieu Scale was more reliable in that group (Mehrholz et al., 2005).
The Rehabilitation Measures Database notes that adequate training is needed for inter-rater reliability, reliability differs from muscle to muscle, and technique must be standardized.

Sources. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67(2):206-207. Mehrholz J, Wagner K, Meissner D, et al. Reliability of the Modified Tardieu Scale and the Modified Ashworth Scale in adult patients with severe brain injury: a comparison study. Clin Rehabil. 2005;19(7):751-759. Shirley Ryan AbilityLab, Rehabilitation Measures Database: Ashworth Scale / Modified Ashworth Scale. It is one of the measures reviewed in the Academy of Neurologic Physical Therapy (ANPT) TBI EDGE outcome measure recommendations; see neuropt.org for the task force’s recommendations.

Permissions. The Modified Ashworth Scale grades are quoted from Bohannon and Smith (1987) as published in the Shirley Ryan AbilityLab Rehabilitation Measures Database instruction sheet (“Test instructions provided courtesy of Richard Bohannon PT, PhD and Melissa Smith, PT”), which lists the scale as free to use.

Clinically reviewed by Dr. Richard Holsman, PT, DPT, NCS. Last reviewed: November 14, 2026. Holsman Physical Therapy is not affiliated with these authors, organizations or journals, and they do not endorse this website.

Common Questions

What is the Modified Ashworth Scale?

The Modified Ashworth Scale is a 6-grade clinical scale (0, 1, 1+, 2, 3, 4) for rating resistance to passive movement, used to describe spasticity in people with central nervous system conditions. Bohannon and Smith published it in 1987 by adding a 1+ grade to the original Ashworth Scale.

How is the Modified Ashworth Scale tested?

With the patient supine and relaxed, the clinician moves the joint through its full range over about one second, from fully flexed to fully extended when testing a flexor muscle and the reverse for an extensor, and grades the resistance felt.

What is the difference between grade 1 and grade 1+?

Grade 1 is a catch and release or minimal resistance at the end of the range. Grade 1+ is a catch followed by minimal resistance through the rest of the range, less than half of it.

How reliable is the Modified Ashworth Scale?

In the original study, two raters agreed on 86.7% of elbow flexor grades. In adults with severe brain injury, test-retest reliability was moderate to good but agreement between different raters was poor to moderate, so the same clinician and a standardized technique help when tracking change.

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Modified Ashworth Scale (MAS)