ArticlemedRxiv : the preprint server for health sciences2025
Tasks for assessing dystonia in young people with cerebral palsy.
Article in medRxiv : the preprint server for health sciences, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Dystonia in childhood is typically associated with cerebral palsy (CP). Dystonia severity scales for CP require prolonged exam protocols with numerous tasks, often making them onerous for routine clinical use. Objective: To identify which individual tasks best approximate dystonia severity compared to the gold standard full protocol. Methods: In this cross-sectional study, comprehensive exam protocol videos were taken during routine care of ambulatory people with CP age 5 and up. Five pediatric dystonia experts reviewed individual tasks and the full protocol for dystonia using the Global Dystonia Severity Rating Scale. Experts' written scoring justifications were qualitatively analyzed to determine commonly cited features of dystonia. Results: When examining the difference in dystonia severity ratings between each task and the full protocol, seated upper extremity tasks had the lowest variance (p<0.05, F-test) and had lower score differences than the stand/walk/run and seated lower extremity tasks (p<0.05, repeated measures Friedman test). Experts most commonly identified the following movements as dystonic: wrist flexion (8.4% of all movement statements), finger flexion (7.3%), wrist ulnar deviation (6.8%), toe dorsiflexion (8.4%), ankle inversion (7.9%), and ankle plantarflexion (6.4%). Experts rated dystonic movements as more severe if they were consistently triggered by multiple stimuli (26.8% of all severity statements) or functionally impactful (20.7%). Conclusions: Seated upper extremity tasks may be valuable for identifying dystonia and estimating its severity during routine clinical care. Clinical dystonia severity assessment could be guided by assessing specific dystonic movements, the consistency with which they are triggered, and their functional impact. Cerebral palsy is the most common motor disability across the lifespan and is commonly associated with dystonia, a debilitating, frequently painful, and often treatment refractory movement disorder.
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