Rice James, Skuza Pawel, Baker Felicity, Russo Remo, Fehlings Darcy
Paediatric Rehabilitation Department, Women's and Children's Hospital, North Adelaide, SA, Australia.
Faculty of Health Sciences, Flinders University, SA, Australia.
Dev Med Child Neurol. 2017 Dec;59(12):1249-1255. doi: 10.1111/dmcn.13502. Epub 2017 Aug 8.
To establish the prevalence and severity of dystonia in a population of children with cerebral palsy (CP) with hypertonia assessment and measurement tools.
A cross-sectional study of 151 children (84 males, 67 females) with CP who were assessed with the Hypertonia Assessment Tool (HAT) and Barry-Albright Dystonia scale (BAD) for identification and measurement of severity of dystonia. HAT dystonia items were assessed for construct and convergent validity.
Distribution by predominant motor type (PMT) was: 85% spastic, 14% dyskinetic, and 1% ataxic. Spastic and dyskinetic groups showed widespread evidence of dystonia according to HAT profiles and BAD scores. The dyskinetic PMT group had a higher mean BAD score than the spastic group (difference of 13 units, 95% CI 9.1-16.4). Dystonia severity (BAD score) increased linearly across gross motor (p<0.001), manual ability (p<0.001) and communication functional levels (p<0.001). Divergence was noted in how HAT item six identified dystonia compared to items one and two.
The HAT provided an estimate of the prevalence of both spasticity and dystonia in a large CP population, beyond predominant motor type. Dystonia is a common finding in the spastic PMT group, and its severity increases as motor function worsens.
Dystonia is readily identified in cerebral palsy (CP) using the Hypertonia Assessment Tool, regardless of the predominant motor type. Spasticity and dystonia frequently coexist in the CP population. Severity of dystonia is inversely related to motor function.
使用肌张力过高评估和测量工具，确定脑性瘫痪（CP）儿童群体中肌张力障碍的患病率和严重程度。
对151名CP儿童（84名男性，67名女性）进行横断面研究，使用肌张力过高评估工具（HAT）和巴里 - 奥尔布赖特肌张力障碍量表（BAD）来识别和测量肌张力障碍的严重程度。对HAT肌张力障碍项目进行结构效度和收敛效度评估。
按主要运动类型（PMT）分布为：痉挛型85%，运动障碍型14%，共济失调型1%。根据HAT剖面图和BAD评分，痉挛型和运动障碍型组均显示出广泛的肌张力障碍证据。运动障碍型PMT组的平均BAD评分高于痉挛型组（相差13分，95%可信区间9.1 - 16.4）。肌张力障碍严重程度（BAD评分）在粗大运动（p<0.001）、手动能力（p<0.001）和沟通功能水平（p<0.001）上呈线性增加。与项目一和项目二相比，发现HAT项目六在识别肌张力障碍方面存在差异。
HAT提供了一个大型CP群体中痉挛和肌张力障碍患病率的估计值，不受主要运动类型的限制。肌张力障碍在痉挛型PMT组中很常见，并且其严重程度随着运动功能恶化而增加。
使用肌张力过高评估工具，无论主要运动类型如何，都能在脑性瘫痪（CP）中轻松识别肌张力障碍。痉挛和肌张力障碍在CP群体中经常共存。肌张力障碍的严重程度与运动功能呈负相关。
