Aim: To determine the specific movement features in children with cerebral palsy (CP) that prompt expert identification of dystonia Methods: Dystonia identification in CP, particularly when co-morbid with spasticity, can be difficult. For this retrospective case-control study, we conducted a qualitative thematic analysis of consensus-building discussions between three pediatric movement disorders physicians as they attempted to identify the presence or absence of dystonia in gait videos of 40 subjects with spastic CP and periventricular leukomalacia. Results: Initial unanimous consensus regarding the presence or absence of dystonia was achieved in 12 videos (30%). Following consensus building discussion, 22 additional videos (55%) yielded unanimous consensus. Two main themes were generated: 1) Unilateral leg or foot adduction that was variable over time, and 2) Difficulty in identifying dystonia. Codes contributing to Theme 1 were more likely to appear when a discussant was favoring the presence of dystonia in a video (Chi-square, p=0.004). Discussion: These results provide specific movement features that could aid dystonia diagnosis in ambulatory children with CP. However, these results also suggest that, even amongst putative motor phenotyping experts, visual dystonia diagnosis in CP remains difficult, highlighting the need for developing and using objective dystonia diagnosis measures.

中文翻译：

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运动特征的客观提取促使专家鉴定动态性脑瘫患儿的肌张力障碍

目的：确定脑瘫（CP）患儿的特定运动特征，以提示专家鉴定肌张力障碍方法：很难识别CP的肌张力障碍，尤其是在合并痉挛症的情况下。对于这项回顾性病例对照研究，我们对三位儿科运动障碍医师之间的共识建立讨论进行了定性主题分析，他们试图确定40例痉挛性CP和脑室周围性白内障的步态影像中是否存在肌张力障碍。结果：在12个视频中（30％）达成了关于肌张力障碍存在或不存在的初步共识。在建立共识之后，又有22个视频（占55％）达成了共识。产生了两个主要主题：1）单侧腿或脚的内收随时间变化，并且2）难以识别肌张力障碍。当讨论者赞成视频中存在肌张力障碍时，更有可能出现有助于主题1的代码（卡方，p = 0.004）。讨论：这些结果提供了特定的运动特征，可以帮助患有卧床不卧床患儿的肌张力障碍诊断。但是，这些结果也表明，即使在假定的运动表型专家中，CP的视觉肌张力障碍诊断仍然很困难，这突出了开发和使用客观肌张力障碍诊断措施的必要性。这些结果提供了特定的运动特征，可以帮助患有卧床不卧床患儿的肌张力障碍诊断。但是，这些结果也表明，即使在假定的运动表型专家中，CP的视觉肌张力障碍诊断仍然很困难，这突出了开发和使用客观肌张力障碍诊断措施的必要性。这些结果提供了特定的运动特征，可以帮助患有卧床不卧床患儿的肌张力障碍诊断。但是，这些结果也表明，即使在假定的运动表型专家中，CP的视觉肌张力障碍诊断仍然很困难，这突出了开发和使用客观肌张力障碍诊断措施的必要性。