Presence and severity of dystonia and choreoathetosis overflow movements in participants with dyskinetic cerebral palsy and their relation with functional classification scales

Abstract

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.

Development of the Dyskinesia Impairment Mobility Scale to Measure Presence and Severity of Dystonia and Choreoathetosis during Powered Mobility in Dyskinetic Cerebral Palsy

“…In the first step towards developing the adapted DIMS protocol, the DIS was examined thoroughly for dystonia and choreoathetosis characteristics which would be relevant to be included in the DIMS [9,[14][15][16]. The DIS measures the presence and severity of dystonia and choreoathetosis over 12 body regions; i.e., central body (eyes, mouth, neck and trunk) and limbs (upper and lower, proximal and distal limbs) [14].…”

“…In the DIS, the first neck requested voluntary activity is neck lateroflexion and the second neck requested voluntary activity is neck rotation. The arms scores (i.e., left proximal, left distal, right proximal and right distal) of the DIMS were compared with overflow movements (scoring the contralateral side of the arm which does the required activity [9]) and rest postures scores of the DIS. The DIS and the W1 data collection of the DIMS were administered during the same week, thereby only data of W1 was used for this analysis.…”

“…DCP is characterized by two complex movement disorders: Dystonia (i.e., involuntary movements, distorted voluntary movements and abnormal postures due to sustained muscle contractions) and choreoathetosis (i.e., chorea defined as rapid, involuntary, often fragmented movements and athetosis defined as slower and constantly changing movements) [8]. In DCP, dystonia and choreoathetosis are also present as overflow movements, defined as unintentional contractions of muscles different from the ones used during a goal-directed movement [9]. More than 70% of the DCP population presents with the highest levels of severity in gross motor functioning and fine manual abilities [10].…”

“…To date, presence and severity of dystonia and choreoathetosis are measured using the Dyskinesia Impairment Scale (DIS) [9,[14][15][16], a video-based tool which measures the movement disorders during requested but voluntary activities and rest postures. The DIS measures requested but voluntary activities in a controlled environment and may, therefore, not provide information about the occurrence of the movement disorders in a more real-life context, such as steering a powered wheelchair using a head/foot steering system.…”

Dystonia and choreoathetosis presence and severity in relation to powered wheelchair mobility performance in children and youth with dyskinetic cerebral palsy

“…4,5 Additionally, dystonia and choreoathetosis can manifest as overflow movements. 6,7 Overflow is the unintentional contraction of muscles different from the ones used in goal-directed movements, resulting in an unwanted movement associated with an intended movement. 7 More than 70% of children with DCP are classified within the highest levels of limitations in gross motor functioning and fine manual abilities.…”