This study demonstrates that muscle volume may be estimated accurately in typically developing individuals and individuals with cerebral palsy by a combination of anatomical cross-sectional area and muscle length. 2D ultrasound may be a convenient method of making these measurements routinely in the clinic.

Aim To assess test–retest reliability of the Dyskinesia Impairment Scale (DIS) in children and young adults with dyskinetic cerebral palsy (CP). Method Dystonia and choreoathetosis were assessed in 15 participants with dyskinetic CP (13 males, 2 females; age range 5–22y, mean 14y, SD 4y) using the DIS in two separate sessions over 7 days. Exclusion criteria were changes in muscle relaxant medication within the previous 3 months, orthopaedic or neurosurgical interventions within the previous year, and spinal fusion. Intraclass correlation coefficient, confidence intervals (CI), standard error of measurement, and the minimal detectable difference (MDD) were determined for test–retest reliability. Result Intraclass correlation coefficients of the DIS, the dystonia subscale of the DIS, and the choreoathetosis subscale of the DIS were 0.98 (95% CI 0.94–0.99), 0.97 (95% CI 0.92–0.99), and 0.96 (95% CI 0.90–0.99). The standard error of measurement and MDD were 2.6% and 7.2%. Interpretation The DIS is a reliable tool to assess dystonia and choreoathetosis; it remains stable over time in children and young adults with dyskinetic CP. These results add to the current evidence for good clinimetric properties of the DIS. What this paper adds The Dyskinesia Impairment Scale (DIS) shows stability in scoring dystonia and choreoathetosis. The total DIS score and dystonia and choreoathetosis subscales are clinically useful.

Background: This cross-sectional study aims to investigate the presence and severity of overflow movements of dystonia and horeoathetosis in dyskinetic cerebral palsy (CP) and to assess the relationship of overflow movements with functional classification scales. Methods: Fifty-two subjects with dyskinetic CP were included. Presence and severity of dystonia and choreoathetosis overflow movements were assessed with the Dyskinesia Impairment Scale. Functional abilities were classified with the Gross Motor Function Classification System, Manual Ability Classification System, Viking Speech Scale, Communication Function Classification System, and Eating and Drinking Ability Classification System. Results: Dystonia and choreoathetosis overflow movements were simultaneously present. Median scores of dystonia overflow movements were significantly higher than choreoathetosis overflow movements. Dystonia and choreoathetosis overflow movements were significantly higher in extremities than in the central body. Correlations between dystonia and choreoathetosis overflow movements were fair. Moderate to good correlations were found between dystonia overflow score and Gross Motor Function Classification System, Manual Ability Classification System, and Eating and Drinking Ability Classification System. Conclusions: This is the first study to assess overflow movements in dyskinetic CP. All participants presented with dystonia and choreoathetosis overflow movements, with higher values for dystonia overflow movements. Dystonia overflow movements seem to have a larger impact on functional abilities. Implications for rehabilitation • Dystonia and choreoathetosis overflow movements are both present in children with dyskinetic cerebral palsy, with dystonia overflow movements being more severe than choreoathetosis overflow movements. • Overflow movements impact heavily on daily functional ability and the execution of voluntary activities. • Dystonia overflow movements show good correlations with functional classification scales. • The measurable characteristics of overflow movements can be used as a guideline for targeted treatment with, e.g., botulinum-toxin-A injections.

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Dystonia is a movement disorder in which involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both. 1 Choreoathetosis can be separated into chorea and athetosis, where chorea is defined as rapid involuntary, jerky, and fragmented movements, while athetosis consists of slower, constantly changing, writhing, or contorting movements. 1 Dystonia and choreoathetosis are prevalent in dyskinetic cerebral palsy (CP) and in different inherited or acquired conditions. 2,3 Assessment of dystonia and choreoathetosis through a reliable and valid scale is fundamental for research and in clinical decision-making. Assessment scales for dystonia are available for different populations, for example, for dystonia in children with CP or for inherited or idiopathic dystonia in adults, 4-6 but their psychometric properties have been questioned. 7,8 Only one scale that evaluates both dystonia and choreoathetosis is available-the Dyskinesia Impairment Scale (DIS)-which was designed for children and young adults with dyskinetic CP. 9

Background: Studies aiming to objectively quantify movement disorders during upper limb tasks using wearable sensors have recently increased, but there is a wide variety in described measurement and analyzing methods, hampering standardization of methods in research and clinics. Therefore, the primary objective of this review was to provide an overview of sensor set-up and type, included tasks, sensor features and methods used to quantify movement disorders during upper limb tasks in multiple pathological populations. The secondary objective was to identify the most sensitive sensor features for the detection and quantification of movement disorders on the one hand and to describe the clinical application of the proposed methods on the other hand.Methods: A literature search using Scopus, Web of Science, and PubMed was performed. Articles needed to meet following criteria: 1) participants were adults/children with a neurological disease, 2) (at least) one sensor was placed on the upper limb for evaluation of movement disorders during upper limb tasks, 3) comparisons between: groups with/without movement disorders, sensor features before/after intervention, or sensor features with a clinical scale for assessment of the movement disorder. 4) Outcome measures included sensor features from acceleration/angular velocity signals.Results: A total of 101 articles were included, of which 56 researched Parkinson’s Disease. Wrist(s), hand(s) and index finger(s) were the most popular sensor locations. Most frequent tasks were: finger tapping, wrist pro/supination, keeping the arms extended in front of the body and finger-to-nose. Most frequently calculated sensor features were mean, standard deviation, root-mean-square, ranges, skewness, kurtosis/entropy of acceleration and/or angular velocity, in combination with dominant frequencies/power of acceleration signals. Examples of clinical applications were automatization of a clinical scale or discrimination between a patient/control group or different patient groups.Conclusion: Current overview can support clinicians and researchers in selecting the most sensitive pathology-dependent sensor features and methodologies for detection and quantification of upper limb movement disorders and objective evaluations of treatment effects. Insights from Parkinson’s Disease studies can accelerate the development of wearable sensors protocols in the remaining pathologies, provided that there is sufficient attention for the standardisation of protocols, tasks, feasibility and data analysis methods.

The majority of individuals with dyskinetic cerebral palsy cannot use powered mobility with a joystick, due to the lack of manual abilities by the severe presence of dystonia and choreoathetosis. Reliable measurements of these movement disorders is indispensable for good evaluation towards evidence–based insights during powered mobility. This study aimed to develop and assess the Dyskinesia Impairment Mobility Scale (DIMS), a video–based tool to measure presence and severity of dystonia and choreoathetosis during powered mobility. DIMS was measured for the neck and arms region during five mobility tasks. Interrater reliability, test–retest reliability, internal consistency and concurrent validity of the DIMS were assessed. Interrater reliability coefficients ranged between 0.68 and 0.87 for the total DIMS, and the dystonia and choreoathetosis subscales. Test–retest reliability was moderate to excellent (range 0.51–0.93) while Cronbach’s alpha was good (range 0.69–0.81) for the total scale and subscale scores. Concurrent validity showed during mobility tasks significant correlations with rest postures in the arm region, and with requested but voluntary activity in the neck region. The DIMS reliably measures the presence and severity of the movement disorders during powered mobility, increasing insights into the underlying mechanisms of independent mobility. This scale may therefore be a promising tool to evaluate mobility training.

Introduction:Children with dyskinetic cerebral palsy (DCP) suffer from involuntary movements, reflected in abnormal postures and jerky, fragmented movements (1). The severity of their motor abnormalities is currently evaluated with qualitative evaluation scales which are subjective and time-consuming. To objectify the deviating movement patterns of children with DCP, inertial sensors provide a userfriendly and cheap alternative. Inertial sensors have previously been successfully used to differentiate pathological and non-pathological populations (2-4). Research Question:Can inertial sensors be used to detect deviating movement patterns in participants with dyskinetic cerebral palsy during a reach forward task? Methods:Nine participants with DCP (mean age 17y 6m, range 11-25y) were included, with five bilateral participants leading to 14 DCP measurements. For comparison, 14 age-matched TD children were included (mean age 17y2m, range 12-23y). Participants were asked to perform 10 repetitions of a reach forward task with sensors attached on the sternum, scapula, upper arm, wrist and hand. Root mean square (RMS) and maximal values of acceleration, angular velocity, acceleration jerk and angular jerk were calculated from raw sensor measurements and sample entropy was calculated for the acceleration and angular velocity signal. Mann-Whitney-U tests were used to explore differences between TD participants and the participants with DCP.