Hypertonia Assessment Tool

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Objective

The Hypertonia assessment tool (HAT) is a standardized clinical tool used to identify different forms of hypertonia in the paediatric population. These subtypes include:

• Spasticity
• Dystonia
• Rigidity

There are several scales that measure the severity of hypertonia, but up until the HAT, none differentiated between the forms of hypertonia. This is important to identify as different forms of hypertonia are managed differently, including medically (in terms of drug prescription) and surgically. With regards to research, being able to identify subtypes of hypertonia enables better specificity with patient recruitment and outcome reporting.

Intended Population

The HAT is administered to children between 4 to 19 years of age. These children should demonstrate hypertonia in at least one limb. Hypertonia is defined as “abnormally increased resistance to externally imposed movement about a joint” In the HAT user manual it puts it as “increased resistance to passive stretch of a muscle”.

Tool description

The HAT is a seven-item scoring tool. These 7 items comprise of 2 spasticity items, 2 rigidity items and 3 dystonia items. These 7 items are recorded for each of the affected limbs.

Equipment required

1. HAT scoring chart (one sheet for each limb being tested)
2. Pen/ pencil to record scoring
3. Examination table for child/youth to lie down on.

Set-up

The child or youth should lie supine on the examination table/ support surface. The child should be wearing unrestrictive clothing and the hand or foot of the limb being tested bare. If possible, hands should be placed gently on their upper abdomen. A roll should be placed under the knees and a pillow under the head.

Method of Use

Before commencing administration of the HAT it is recommended to review the HAT user manual.

During the assessment, the evaluator moves a child’s limb in a series of purposeful stretches and movements.

The movement itself is observed, as well as increased tone and/or resistance.

These 7 items include:

Increased involuntary movements or postures of the designated limb with tactile stimulus of another body part

Increased Involuntary Movements or Postures with Purposeful Movement of Another Body Part

Velocity Dependent Resistance to Stretch

Presence of a Spastic Catch

Equal Resistance to Passive Stretch during Bi-Directional Movement of a Joint

Increased Tone with Movement of Another Body Part.

Maintenance of Limb Position After Passive Movement.

The test takes approximately 5 minutes per limb tested.