Ellermeyer Tobias, Otte Karen, Heinrich Felix, Mansow-Model Sebastian, Kayser Bastian, Lipp Axel, Seidel Adrian, Krause Patricia, Lauritsch Katharina, Gusho Elona, Paul Friedemann, Kühn Andrea A, Brandt Alexander U, Schmitz-Hübsch Tanja
Department of Neurology Charité-Universitätsmedizin Berlin Germany.
Motognosis UG Berlin Germany.
Mov Disord Clin Pract. 2016 Mar 24;3(6):587-595. doi: 10.1002/mdc3.12340. eCollection 2016 Nov-Dec.
Reviewers of dystonia rating scales agree on the need to assess symptoms more comprehensively. During the development of a quantitative dystonia assessment by video-perceptive computing, we devised a video-based severity ranking as a procedure to create a validation standard without the use of clinical scales.
Thirty-four patients with dystonia (17 with dystonic tremor) and 2 controls were assessed with clinical scales and video-recordings of 24 short movement tasks. Two to 4 raters compared multiple permutations of videos from 22 subjects, including 2 healthy controls, until a complete rank order was achieved. Inter-rater agreement was expressed as normalized Kendall tau distance. Spearman correlations of video rank order with clinical scales and self-rating were repeated for tremor/nontremor subgroups.
Normalized Kendall tau distances were <0.3 for 15 items. The video rank order for sitting and head movements correlated with clinical scales for the whole group (rho 0.52-0.87) and in the subgroup without tremor. In the tremor subgroup such correlation was perceived in the 2 items involving sitting. Video rank order correlated with quality of life self-rating only in 1 item (arms held in front, palm down).
The agreement of video rankings between raters is remarkable. The lack of correlation in the tremor subgroup in several items may be interpreted as tremor being considered in video comparisons but not in clinical scales. This supports video-based ranking as a more comprehensive rating of dystonia and as a possible validation instrument applicable in situations in which no reference standard is available.
肌张力障碍评定量表的评审者一致认为需要更全面地评估症状。在通过视频感知计算进行定量肌张力障碍评估的开发过程中，我们设计了一种基于视频的严重程度排名，作为一种在不使用临床量表的情况下创建验证标准的程序。
对34例肌张力障碍患者（17例伴有肌张力障碍性震颤）和2例对照者进行临床量表评估以及24项简短运动任务的视频记录。2至4名评分者比较了包括2名健康对照者在内的22名受试者的视频的多种排列组合，直至获得完整的排名顺序。评分者间的一致性用标准化肯德尔tau距离表示。对震颤/非震颤亚组重复进行视频排名顺序与临床量表及自我评定的斯皮尔曼相关性分析。
15项指标的标准化肯德尔tau距离<0.3。坐位和头部运动的视频排名顺序与全组临床量表（rho 0.52 - 0.87）以及无震颤亚组的临床量表相关。在震颤亚组中，仅在涉及坐位的2项指标中观察到这种相关性。视频排名顺序仅在1项指标（双臂前伸，掌心向下）中与生活质量自我评定相关。
评分者之间视频排名的一致性非常显著。震颤亚组在多项指标中缺乏相关性，这可能解释为在视频比较中考虑了震颤，但临床量表中未考虑。这支持基于视频的排名作为肌张力障碍更全面的评定方法，以及作为在没有参考标准的情况下适用的一种可能的验证工具。
