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Logo of armAnnals of Rehabilitation MedicineAims and ScopeInstructions for AuthorsE-SubmissionThis article
Ann Rehabil Med. 2012 August; 36(4): 538–543.
Published online 2012 August 27. doi:  10.5535/arm.2012.36.4.538
PMCID: PMC3438421

The Correlation between Modified Ashworth Scale and Biceps T-reflex and Inter-rater and Intra-rater Reliability of Biceps T-reflex

Ji Hong Min, M.D., Yong-Il Shin, M.D., Ph.D.,corresponding author Kyung Lim Joa, M.D., Sung Hwa Ko, M.D., Myung Jun Shin, M.D., Jae Hyeok Chang, M.D., and Hyun-Yoon Ko, M.D.



To establish a correlation between the modified Ashworth scale (MAS) and amplitude and latency of T-reflex and to demonstrate inter-rater and intra-rater reliability of the T-reflex of the biceps muscle for assessing spasticity after stroke.


A total of 21 patients with hemiplegia and spasticity after ischemic stroke were enrolled for this study. The spasticity of biceps muscle was evaluated by an occupational therapist using the MAS. The mean value of manual muscle test of biceps muscles was 2.3±0.79. Latency and amplitude of T-reflex were recorded from biceps muscles by two physicians. The onset latency and peak to peak amplitude of the mean of 5 big T-reflex were measured. The examinations were carried out by two physicians at the same time to evaluate the inter-rater reliability. Further, one of the physicians performed the examination again after one week to evaluate the intra-rater reliability. The correlations between MAS and T-reflex, and the intra- and inter-rater reliability of biceps T-reflex were established by calculating the Spearman correlation coefficients and the intra-class correlation coefficients (ICCs).


Amplitude of the biceps T-reflex increased with increasing level of MAS (rs=0.464 and 0.573, respectively, p<0.01). ICCs of latency and amplitude of biceps T-reflex were 0.914 and 0.822. The Spearman correlation coefficients of latency and amplitude of biceps T-reflex were 0.937 and 0.635, respectively (p<0.01).


Biceps T-reflex demonstrates a good quantitative measurement and correlation tool with MAS for spasticity, and also shows acceptable inter- and intra-rater reliability, which can be used for patients with spasticity after stroke.

Keywords: T-reflex, Spasticity, Biceps tendon reflex, Tendon reflex

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