{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T08:47:38Z","timestamp":1782895658780,"version":"3.54.5"},"reference-count":28,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Research and Innovation Agency","award":["P3-0043"],"award-info":[{"award-number":["P3-0043"]}]},{"name":"Research and Innovation Agency","award":["J7-60125"],"award-info":[{"award-number":["J7-60125"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Modified Ashworth Scale is a widely used tool for assessing spasticity. The aim of this study was to evaluate the intra- and interrater reliability of the Modified Ashworth Scale and its association with the Tardieu Scale in children with cerebral palsy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this cross-sectional study, 23 children with cerebral palsy were included. The intra- and interrater reliability of the Modified Ashworth Scale was assessed for the elbow, knee, and plantar flexors of the foot. The results of the Tardieu Scale were included to evaluate the association between the two scales. The intraclass correlation coefficient (ICC) was used to assess reliability, and Spearman\u2019s correlation coefficient was used to assess the association between the Modified Ashworth Scale and the Tardieu Scale. All muscles assessed were included in the analysis, regardless of the anatomical classification of physical impairment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Intrarater reliability (ICC) in our sample was excellent for all muscles assessed (ICC = 0.91\u20130.99). Interrater reliability was generally good, with confidence intervals indicating moderate to good reliability in certain muscle groups (ICC = 0.80\u20130.89). A moderate positive correlation was observed between the Tardieu Scale and the Modified Ashworth Scale for all muscles assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The results demonstrated excellent intrarater and generally good interrater reliability in a heterogeneous primary healthcare sample, with a moderate positive correlation between the scales studied. However, caution is warranted when interpreting findings at the individual level.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7717\/peerj.21349","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T08:15:51Z","timestamp":1782893751000},"page":"e21349","source":"Crossref","is-referenced-by-count":0,"title":["Intra- and interrater reliability of the Modified Ashworth Scale and its association with the Tardieu Scale in children with cerebral palsy"],"prefix":"10.7717","volume":"14","author":[{"given":"Da\u0161a","family":"Mik\u0161a Pu\u0161nik","sequence":"first","affiliation":[{"name":"Community Health Centre Ljubljana, Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergej","family":"Pirkmajer","sequence":"additional","affiliation":[{"name":"Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina","family":"Tomc Z\u02d8argi","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4443","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"10.7717\/peerj.21349\/ref-1","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.pediatrneurol.2015.10.005","article-title":"Localization of Basal Ganglia and thalamic damage in dyskinetic cerebral palsy","volume":"54","author":"Aravamuthan","year":"2016","journal-title":"Pediatric Neurology"},{"issue":"2","key":"10.7717\/peerj.21349\/ref-2","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1093\/ptj\/67.2.206","article-title":"Interrater reliability of a modified Ashworth scale of muscle spasticity","volume":"67","author":"Bohannon","year":"1987","journal-title":"Physical Therapy"},{"issue":"5","key":"10.7717\/peerj.21349\/ref-3","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/s0166-2236(99)01535-0","article-title":"Central control components of a \u2018simple\u2019 stretch reflex","volume":"23","author":"Clarac","year":"2000","journal-title":"Trends in Neurosciences"},{"issue":"4","key":"10.7717\/peerj.21349\/ref-4","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1097\/01.pep.0000186509.41238.1a","article-title":"Interrater and intrarater reliability of the Modified Ashworth Scale in children with hypertonia","volume":"17","author":"Clopton","year":"2005","journal-title":"Pediatric Physical Therapy"},{"issue":"10","key":"10.7717\/peerj.21349\/ref-5","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1017\/s0012162203001245","article-title":"Measures of muscle and joint performance in the lower limb of children with cerebral palsy","volume":"45","author":"Fosang","year":"2003","journal-title":"Developmental Medicine & Child Neurology"},{"issue":"5","key":"10.7717\/peerj.21349\/ref-6","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1002\/mus.20284","article-title":"Pathophysiology of spastic paresis, I: paresis and soft tissue changes","volume":"31","author":"Gracies","year":"2005","journal-title":"Muscle Nerve"},{"issue":"3","key":"10.7717\/peerj.21349\/ref-7","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1016\/j.apmr.2009.11.017","article-title":"Reliability of the Tardieu Scale for assessing spasticity in children with cerebral palsy","volume":"91","author":"Gracies","year":"2010","journal-title":"Archives of Physical Medicine and Rehabilitation"},{"key":"10.7717\/peerj.21349\/ref-8","doi-asserted-by":"publisher","first-page":"15082","DOI":"10.1038\/nrdp.2015.82","article-title":"Cerebral palsy","volume":"2","author":"Graham","year":"2016","journal-title":"Nature Reviews Disease Primers"},{"issue":"5","key":"10.7717\/peerj.21349\/ref-9","doi-asserted-by":"publisher","first-page":"409","DOI":"10.3109\/09638280903171469","article-title":"Upper limb motor and sensory impairments in children with hemiplegic cerebral palsy. 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