---
title: "Guide: Pediatric Tone & Spasticity"
description: Being able to differentiate between tone and spasticity adds to your clinical reasoning
---
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# Guide: Pediatric Tone & Spasticity
## This guide is designed to help clinicians clearly identify, assess, and document the nuances of muscle tone in pediatric populations.
### **1. The Clinical Distinction: High Tone vs. Spasticity**
It is vital to distinguish between these two in your documentation to determine the best intervention (e.g., bracing vs. medical management).
| **Term** | **Physiological Definition** | **Clinical "Feel"** |
| --- | --- | --- |
| **Hypertonia** | An umbrella term for increased muscle tension at rest. | Resistance is present **regardless of speed**. It feels stiff or "lead-pipe" like. |
| **Spasticity** | A specific subset of hypertonia; an overactive stretch reflex. | **Velocity-dependent**. The faster you move the limb, the more resistance or "catch" you feel. |
> **Clinical Pearl:** If you move the limb slowly and the resistance disappears, you are dealing with **Spasticity**. If the resistance remains the same no matter the speed, you are dealing with **Hypertonia/Rigidity**.
---
### **2. Essential Assessment Scales**
#### **Modified Ashworth Scale (MAS)**
*Best for: A quick snapshot of general resistance.*
- **0:** No increase in tone.
- **1:** Slight catch and release at the end of ROM.
- **1+:** Catch followed by minimal resistance through the remainder (less than half) of ROM.
- **2:** Marked increase in tone through most of ROM, but limb is easily moved.
- **3:** Considerable increase in tone; passive movement is difficult.
- **4:** Affected part is rigid in flexion or extension.
#### **Modified Tardieu Scale (MTS)**
*Best for: Differentiating spasticity from contracture.*
- **V1 (Slow):** Move as slowly as possible to find the "True" muscle length (**R2**).
- **V3 (Fast):** Move as fast as possible to find the "Catch" angle (**R1**).
- **The Formula:** A large **R2 minus R1** gap indicates high **dynamic spasticity**. A small gap indicates a **fixed contracture**.
---
### **3. Qualitative Markers for Hypotonia (Low Tone)**
Since there is no "Reverse Ashworth," use these classic pediatric screens:
- **Ventral Suspension:** The "Inverted U" sign—the child drapes over your hand with no trunk/neck extension.
- **Pull-to-Sit:** Significant head lag beyond 4 months of age.
- **Vertical Suspension:** The child "slips through" your hands at the axilla due to shoulder girdle laxity.
- **Scarf Sign:** The elbow easily crosses the chest midline without resistance.
---
### **4. Functional "Red Flags" & Compensations**
Watch how the child "fixes" their body to move or play:
- **W-Sitting:** Providing a wide base of support to compensate for low core tone.
- **High Guard:** Arms up and out while walking to stabilize a floppy trunk.
- **Toe Walking:** Often a sign of spasticity in the gastrocnemius/soleus.
- **Gower’s Sign:** Walking hands up the legs to stand, indicating proximal weakness or low tone.
---
### **5. Summary Table for Documentation**
| **Metric** | **Spasticity** | **General Hypertonia** | **Hypotonia** |
| --- | --- | --- | --- |
| **Speed Dependent?** | **Yes** | No | No |
| **Reflexes** | Hyperreflexive (Brisk) | Normal or Brisk | Hyporeflexive (Diminished) |
| **End Feel** | Springy / Catch | Constant / Rigid | Soft / Lax |
| **Joints** | Limited ROM | Limited ROM | Hypermobile / Lax |
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