Title: Dyskinetic CP: Pathological signs and clinical evaluation of dystonia and choreoathetosis in CP
Authors: Monbaliu, Elegast
Ortibus, Els
Feys, Hilde #
Issue Date: Oct-2012
Conference: International Cerebral Palsy Conference edition:4 location:Pisa, Italy date:10-13 October 2012
Abstract: Instructional Course
course level: basic
Aim: This training course aims to improve insights in the second largest Cerebral Palsy group namely
Dyskinetic CP.
Course summary: In the past two decades, interest in cerebral palsy (CP) has increased remarkably.
However, compared with the spastic CP type, the assessment and treatment of patients with dyskinetic
CP are still underreported. This lack of research is understandable in view of the complexity of
dystonia and choreoathetosis in dyskinetic CP, rendering it difficult to measure. According to the
Surveillance of Cerebral Palsy in Europe (SCPE), dyskinetic CP is characterized by involuntary,
uncontrolled, recurring, occasionally stereotyped movements in which the primitive reflex patterns
predominate and muscle tone varies.1 Dyskinetic CP is further subdivided into dystonia and
choreoathetosis. 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. These clinical characteristics are of major importance to differentiate dystonia and
choreoathetosis in dyskinetic CP.
This course is subdivided in four parts. First, definition and classification of CP will be presented with
special attention for the discrimination between dystonia and choreoathetosis. Secondly, pathological
signs will be reviewed in accordance with the International Classification of Functioning, Health and
Disability model (ICF), specifically within the ICF body function and structure. The third part will
focus on clinical assessment, with special attention for the newly developed Dyskinesia Impairment
Scale.2 In the fourth part, the possibility will be given to evaluate dystonia and choreoathetosis in an
interactive way with the audience using videos of clinical cases.
1 Cans C, Dolk H, Platt MJ, Colver A, Prasauskiene A, Krägeloh-Mann I. Recommendations from the SCPE collaborative
group for defining and classifying cerebral palsy. Dev Med Child Neurol 2007; 49(Suppl. 109):35–8.
1 Monbaliu E, Ortibus E, De Cat J, Dan B, Heyrman L, Prinzie P, De Cock P, Feys H. The dyskinesia impairment scale: a
new instrument to measure dystonia and choreoathetosis in dyskinetic cerebral palsy. Dev Med Child Neurol 2012; 54: 278–
Course outline:
10min : part one - Definition and Classification
15min : part two - Pathological Signs
15min : part three - Evaluation
10min : part four - Clinical cases
10min : questions
Publication status: published
KU Leuven publication type: IMa
Appears in Collections:Research Group for Neuromotor Rehabilitation
Department of Development and Regeneration - miscellaneous (+)
# (joint) last author

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