Skip to content
  • There are no suggestions because the search field is empty.

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