Journal of Physiotherapy 62 (2016) 229

Journal of
PHYSIOTHERAPY
journal homepage: www.elsevier.com/locate/jphys

Appraisal Clinimetrics

[1_TD$IF]Tardieu Scale
Summary

Description: The Tardieu Scale is primarily used by clinicians to velocity. The scale is administered by applying passive stretch to a
describe spasticity in people with neurological conditions such as muscle group at two velocities. The first stretch is ‘as slow as
stroke, traumatic brain injury, spinal cord injury, multiple sclerosis possible’ (V1) and is used to determine angle of muscle reaction at
and cerebral palsy. Spasticity is defined by Lance as ‘a motor slow velocity; this is equivalent to passive range of motion. The
disorder characterised by a velocity-dependent increase in tonic second stretch is either at the ‘speed of the limb segment falling
stretch reflexes (muscle tone) with exaggerated tendon jerks, under gravity’ (V2) or ‘as fast as possible’ (V3) and is used to
resulting from hyper-excitability of the stretch reflex’.1 The determine both the angle of muscle reaction and the quality of
Tardieu Scale has gained momentum over the past 15 years as muscle reaction at the fast velocity. The angle at which the muscle
the preferred clinical assessment of spasticity. This is because the reaction occurs is typically measured with a goniometer, and
Tardieu Scale assesses resistance to passive movement at a slow quality of muscle reaction is measured on a 6-point scale, where
and fast velocity. Therefore, it can broadly differentiate between 0 indicates ‘no resistance through the course of the passive
the two key factors explaining increased resistance to passive movement’ and 5 indicates that ‘the joint is immobile’.2–5
stretch, namely contracture (non-neural factors) and spasticity There are large numbers of studies that have looked at different
(neural factors). aspects of the Tardieu and Modified Tardieu Scale in different
Tardieu et al2 first described their novel method for measuring patient populations. The reported Kappa statistics and intraclass
spasticity in 1954. This method was developed by Held and Pierrot- correlation coefficients are highly variable, with reliability more
Deseilligny3 and subsequently translated into English for use in a convincing in stroke than in cerebral palsy.7,8 Researchers have
randomised, controlled trial.4 In 1999, the Tardieu Scale was further validated the Tardieu Scale by comparing results with other
modified to include standardised joint positions and velocities.5,6 measures of spasticity, including electromyography. These studies
The most important components captured in the Tardieu Scale are indicate that in comparison with the Ashworth scale, the Tardieu
the angle of muscle reaction at a slow velocity, the angle of muscle Scale more effectively identifies the presence of spasticity and
reaction at a fast velocity and the quality of muscle reaction at a fast differentiates it from contracture.9,10

Commentary

The key strength of the Tardieu Scale is that, in contrast to the the Modified Tardieu Scale are freely available in publications,4–6,9[6_TD$IF]
Ashworth scale, it includes assessments at two different velocities and outcome measures websites.7,11
to discriminate between contracture and spasticity. It is this
Provenance: Invited. Not peer reviewed.
feature alone that makes the Tardieu Scale the most clinically
relevant assessment of spasticity. The Tardieu Scale has many Joanne Glinsky
limitations. Perhaps the most significant limitation is that John Walsh Centre for Rehabilitation Research, Kolling Institute,
interpretation of the scale relies on a good understanding of the Sydney Medical School/Northern, University of Sydney, Australia
difference between contracture and spasticity. A second limitation
is that some new users may consider the widely available
instructions accompanying the scale to be inadequate. Various References
authors have subsequently explained the scale, and new users will 1. Lance JW. Symposium synopsis. In: Feldman RG, ed. et al. In: Spasticity: disordered
find this additional detail useful.5,9 There are many variations of motor control. Miami: Symposia Specialists; 1980. 485-450.
the original scale currently used in clinical practice. All of these 2. Tardieu G, et al. Rev Neurol. 1954;91:143–144.
3. Held J, et al. Reeducation motrice des affections neurologiques. Paris: JB Bailliere;
variations have the potential to cause confusion. Some clinicians 1969:31–42.
use a 5-point scale rather than a 6-point scale to assess the quality 4. Gracies J. Arch Phys Med Rehabil. 2000;81:1547–1555.
of muscle reaction,9 and some ignore the option of using V2, 5. Boyd R, et al. Eur J Neurol. [3_TD$IF]1999;6:S23–S35.
6. Boyd R, et al. Physiotherapy management of spasticity. In: Barnes M, Johnson G,
instead relying on V3 when assessing at a fast velocity. In addition, eds. In: Upper Motor Neurone [7_TD$IF]Syndrome and [8_TD$IF]Spasticity. New York: Cambridge
others have introduced new terms, namely R1 and R2, to describe University Press; 2008:79–97.
the angle of muscle response for V3 and V1, respectively.5 7. http://www.rehabmeasures.org[9_TD$IF]/default.aspx. [Accessed 28th[2_TD$IF] July 2016].
8. Haugh A, et al. Disabil Rehabil. [4_TD$IF]2006;28:899–907.
The Tardieu Scale is widely used in research; however, its 9. Patrick E, et al. Clin Rehabil. 2006;20:173–182.
composite nature and reliance on a short ordinal scale can make it 10. Alhusaini A, et al. J Child Neurol. [5_TD$IF]2010;25:1242–1247.
challenging to use in some types of research. The Tardieu Scale and 11. http://www.strokengine.ca/find-assessment/. [Accessed 28th July 2016].

http://dx.doi.org/10.1016/j.jphys.2016.07.007
1836-9553/ß 2016 Australian Physiotherapy Association. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://
creativecommons.org/licenses/by-nc-nd/4.0/).