Abstract Details

Title Identifying Upper Extremity Features of Dystonia in People with Cerebral Palsy

Topic Child Neurology and Developmental Neurology

Presentation(s) P5 - Poster Session 5 (11:45 AM-12:45 PM)

Poster/Presentation
Number 4-012

Objective To identify expert clinician-cited features of upper extremity dystonia in people with cerebral palsy (CP).

Background Dystonia in CP is debilitating yet underdiagnosed, particularly when co-existent with spasticity. Subjective expert clinician consensus remains the diagnostic gold standard, but the specific features leading experts to make a dystonia diagnosis remain unclear.

Design/Methods To determine expert clinician-cited features of dystonia, we performed a conventional content analysis of consensus-building discussions between three pediatric movement disorder specialists as they evaluated upper extremity dystonia severity in 26 neurologic exam videos of seated subjects with CP and spasticity.

Results 45.8% of discussion codes related to body region, actions, movement features, laterality, or examination features (with the remainder on severity score deliberation and dystonia diagnostic difficulty). Experts cited involvement of the “shoulder” significantly more frequently as dystonia severity increased (p<0.005, chi-squared test) as opposed to the “hand” which was cited less frequently (p<0.0005, chi-squared test). “Mirror movements” were cited significantly more frequently in videos with no or mild dystonia (p<0.005, chi-squared test). Though “unilateral” was the top cited laterality code (72%) and “variability over time” was the top cited movement feature code (34%), neither were significantly associated with dystonia severity (p=0.09, p=0.052 respectively, chi-squared test), in contrast to our previous lower extremity dystonia analysis findings. In videos where diagnostic consensus was reached only after consensus-building discussion (4/26 videos), the repetitive hand “open/close” exam maneuver was the top cited exam maneuver (28%) and was referred to significantly more frequently than for videos where consensus was reached prior to any discussion (p<0.005).

Conclusions

Experts use distinct movement features to diagnose upper extremity dystonia in people with CP and spasticity. Efforts like this can be used to target examinations and codify the defining features of dystonia in people with CP, thus helping to facilitate dystonia diagnosis.

Authors/Disclosures
Laura Gilbert, DO, MBA PRESENTER	Dr. Gilbert has nothing to disclose.
	No disclosure on file
Toni Pearson, MBBS (Nationwide Children's Hospital)	Dr. Pearson has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Teva Pharmaceuticals. The institution of Dr. Pearson has received research support from NIH.
Keisuke Ueda, MD	Dr. Ueda has nothing to disclose.
Bhooma R. Aravamuthan, MD, DPhil, FCNS, FAAN (Washington University in St. Louis)	The institution of Dr. Aravamuthan has received research support from National Institute of Neurological Disorders and Stroke. The institution of Dr. Aravamuthan has received research support from Child Neurology Foundation. The institution of Dr. Aravamuthan has received research support from American Board of Psychiatry and Neurology. The institution of Dr. Aravamuthan has received research support from Centers for Disease Control. Dr. Aravamuthan has received publishing royalties from a publication relating to health care.

��ɫ��

��ɫ��