Recommendations from the SCPE collaborative group for defining and classifying cerebral palsy

Cans, Christine; Dolk, Helen; Platt, Martin Ward; Colver, Allan; Prasauskienė, Audronė; Krägeloh‐Mann, Ingeborg

doi:10.1111/j.1469-8749.2007.tb12626.x

Cited by 226 publications

(227 citation statements)

References 28 publications

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“…9 The DIS also allows the measurement of dystonia and choreoathetosis separately. This is important for further determining the dominant type of movement abnormality, as recommended by Rosenbaum et al 3 The description and definitions of dystonia and choreoathetosis [5][6][7] were the starting point of the DIS. In accordance with the clinical evaluation recommendations of the Taskforce on Childhood Movement Disorders, 9 we have included several components such as action, rest, duration, and amplitude so that dyskinetic movement disorders could be measured in their predominant presence and the context in which they occur.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, we explored the content and scale construct of the Toronto Western Spasmodic Torticollis Rating Scale 25 and the Unified Parkinson's Disease Rating Scale 26 (Movement Disorder Society). Based on this analysis and the SCPE definitions of dystonia, choreoathetosis, and dyskinetic CP, 3,6,7 the DIS was developed according to the methodological framework of Kirshner and Guyatt. 27 Its content was thoroughly discussed with a clinical expert team (EO, JD, HF, PD, and FR) from the Cerebral Palsy Reference Centre (University Hospital Pellenberg, Leuven, Belgium).…”

Section: Methods Development Of the Dyskinetic Impairment Scalementioning

confidence: 99%

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The Dyskinesia Impairment Scale: a new instrument to measure dystonia and choreoathetosis in dyskinetic cerebral palsy

Monbaliu

Ortibus

Cat

et al. 2012

Develop Med Child Neuro

110

134

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AIM The aim of this study was to examine the reliability and validity of the Dyskinesia Impairment Scale (DIS). The DIS consists of two subscales: dystonia and choreoathetosis. It measures both phenomena in dyskinetic cerebral palsy (CP).METHOD Twenty-five participants with dyskinetic CP (17 males; eight females; age range 5-22y; mean age 13y 6mo; SD 5y 4mo), recruited from special schools for children with motor disorders, were included. Exclusion criteria were changes in muscle relaxant medication within the previous 3 months, orthopaedic or neurosurgical interventions within the previous year, and spinal fusion. Interrater reliability was verified by two independent raters. For interrater reliability, intraclass correlation coefficients were assessed. Standard error of measurement, the minimal detectable difference, and Cronbach's alpha for internal consistency were determined. For concurrent validity of the DIS dystonia subscale, the Barry-Albright Dystonia Scale was administered. RESULTSThe intraclass correlation coefficient for the total DIS score and the two subscales ranged between 0.91 and 0.98 for interrater reliability. The reliability of the choreoathetosis subscale was found to be higher than that of the dystonia subscale. The standard error of the measurement and minimal detectable difference values were adequate. Cronbach's alpha values ranged from 0.89 to 0.93. Pearson's correlation between the dystonia subscale and Barry-Albright Dystonia Scale was 0.84 (p<0.001).INTERPRETATION Good to excellent reliability and validity were found for the DIS. The DIS may be promising for increasing insights into the natural history of dyskinetic CP and evaluating interventions. Future research on the responsiveness of the DIS is warranted.Cerebral palsy (CP) is worldwide the most common neuromotor disorder in children, with an incidence of 2 to 3 per 1000 live births.1,2 CP can be categorized into spastic, dyskinetic, and ataxic groups. Dyskinetic CP is further differentiated into dystonia and choreoathetosis. 1,3 Spastic CP is by far the most common type of CP, with a prevalence of approximately 80%, 4 and is followed by dyskinetic CP with a prevalence between 6.5% 5 and 14. 4%. 4 According to the Surveillance of Cerebral Palsy in Europe (SCPE), 6 dyskinetic CP is characterized by involuntary, uncontrolled, recurring, occasionally stereotyped movements, in which the primitive reflex patterns predominate and muscle tone varies. 6 The SCPE described dystonia in CP as dominated by abnormal postures that may give the impression of hypokinesia and muscle tone that is fluctuating (but with easily elicitable tone increase). Characteristics are involuntary movements, distorted voluntary movements, and abnormal postures due to sustained muscle contractions. Choreoathetosis in CP is dominated by hyperkinesia and tone fluctuation (but mainly decreased). Chorea refers to rapid, involuntary, jerky, often fragmented movements. Athetosis means slower, constantly changing, writhing, or contorting movements.6,7 These SCPE...

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Section: Discussionmentioning

confidence: 99%

Section: Methods Development Of the Dyskinetic Impairment Scalementioning

confidence: 99%

The Dyskinesia Impairment Scale: a new instrument to measure dystonia and choreoathetosis in dyskinetic cerebral palsy

Monbaliu

Ortibus

Cat

et al. 2012

Develop Med Child Neuro

110

134

View full text Add to dashboard Cite

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“…[22], [23] Severe intellectual impairment was defined as IQ below 50; epilepsy as a history of two unprovoked seizures before confirmation of CP diagnosis, excluding febrile or neonatal seizures; severe visual impairment as visual acuity of < 6/60 (Snellen scale) or 0.1 (Decimal scale) in the better eye following correction and severe hearing impairment as a loss of > 70 dB in the better ear before correction. Severity of CP was assigned to three categories.…”

Section: Characteristics Of the Childrenmentioning

confidence: 99%

“…Data are recorded and coded according to agreed definitions. [22] This paper aims to establish whether the prevalence of CP in NBW children altered in Europe between 1980 and 1998 using multicentre analysis methods. Reporting of secular trends for main neurologic subtypes and severity of impairment were also made possible as a result of the large database available.…”

Section: Introductionmentioning

confidence: 99%

Trends in prevalence of cerebral palsy in children born with a birthweight of 2,500 g or over in Europe from 1980 to 1998

et al. 2010

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“…1 More recently, several ordinal scales have been proposed related to the activity limitations of children with CP based on International Classification of Functioning, Disability and Health concepts. The study from Hidecker et al presents the results for three scales: the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), and the Communication Function Classification System (CFCS).…”

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confidence: 99%

Description of children with cerebral palsy: steps for the future

Cans

2012

Develop Med Child Neuro

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This commentary is on the original article by Hidecker et al. on pages 737-742 of this issue.Describing children with cerebral palsy (CP) has long been a challenge for both clinicians and researchers, from the neurological (spastic, dyskinetic, ataxic) to the topographical subtypes (unilateral or bilateral, upper and ⁄ or lower limbs), and to the description of the accompanying impairments. 1 More recently, several ordinal scales have been proposed related to the activity limitations of children with CP based on International Classification of Functioning, Disability and Health concepts. The study from Hidecker et al. presents the results for three scales: the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), and the Communication Function Classification System (CFCS).2 A clinical series of 222 children with CP were assessed, half of whom were born very preterm. Examples of the advantages of knowing each child's functional profile are given, as well as excellent demonstrations of how awareness of these children's needs might be increased and care improved when using information from these three scales. In addition, the reliability of describing groups of children with CP might also be improved. As CP is an umbrella term, with many different types, good reliability in describing subgroups of these children is useful for (1) clinical research trials conducted on CP subgroups, (2) longer-term evaluation of new therapies, and (3) epidemiological studies comparing data between registries or population-based surveys.The authors hypothesized that the three scales would not be strongly correlated. This weak correlation most probably results from combining different types of CP. For instance, the observed high correlation of GMFCS and MACS could have been expected in the group of children assigned to the quadriplegia type, with similar scores on the MACS and GMFCS. A lower correlation between MACS and GMFCS in the group labeled diplegic was observed and expected. The terms 'diplegia' and 'quadriplegia' raise questions because they differ in the number of limbs involved or predominantly involved, with this inaccuracy already mentioned several times.3 Controversy on this issue persists in the literature, 4 probably unnecessarily. At the individual level of a child with CP, all professionals will agree that more detailed knowledge than 'the child has a bilateral spastic CP subtype' is useful; but when used to describe a group of children with CP in clinical or epidemiological studies the reliability of the terms diplegia and quadriplegia are severely limited. The expertise of referral physicians in classifying the child by neurological ⁄ topographical subtype might differ greatly. Consequently, if the GMFCS and MACS were used as a proxy for lower and upper limbs involvement respectively, the reliability of a high GMFCS score and a low MACS score is likely to be much better than the reliability of the term diplegia. The GMFCS and MACS correlation results in the Hidecker et a...

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Recommendations from the SCPE collaborative group for defining and classifying cerebral palsy

Cited by 226 publications

References 28 publications

The Dyskinesia Impairment Scale: a new instrument to measure dystonia and choreoathetosis in dyskinetic cerebral palsy

The Dyskinesia Impairment Scale: a new instrument to measure dystonia and choreoathetosis in dyskinetic cerebral palsy

Trends in prevalence of cerebral palsy in children born with a birthweight of 2,500 g or over in Europe from 1980 to 1998

Description of children with cerebral palsy: steps for the future

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