In this study the psychometric properties of the Trunk Control Measurement Scale (TCMS) in children with cerebral palsy (CP) were examined. Twenty-six children with spastic CP (mean age 11 years 3 months, range 8-15 years; Gross Motor Function Classification System level I n = 11, level II n = 5, level III n = 10) were included in this study. To determine the discriminant ability of the TCMS, 30 typically developing (TD) children (mean age 10 years 6 months, range 8-15 years) were also included. For inter-rater reliability, two testers scored all children simultaneously. To determine test-retest reliability, participants were reassessed on a second test occasion. For construct validity, the Gross Motor Function Measure (GMFM) was administered. Intraclass correlation coefficients (ICC) ranged from 0.91 to 0.99 for inter-rater and test-retest reliability. Kappa and weighted kappa values ranged for all but one item from 0.45 to 1. The standard error of measurement was 2.9% and 3.4%, and the smallest detectable difference for repeated measurements was 8% and 9.43% between raters and test-retest, respectively. Cronbach's alpha coefficients ranged from 0.82 to 0.94. Spearman rank correlation with the GMFM was 0.88 and increasing coefficients were found from dimension B to E. Subscale and total TCMS scores showed significant differences between children with CP and TD children (p < 0.0001). The results support the reliability and validity of the TCMS in children with spastic CP. The scale gives insight into the strengths and weaknesses of the child's trunk performance and therefore can have valuable clinical use.

AIM The aim of this study was to examine the reliability and validity of the Dyskinesia Impairment Scale (DIS). The DIS consists of two subscales: dystonia and choreoathetosis. It measures both phenomena in dyskinetic cerebral palsy (CP).METHOD Twenty-five participants with dyskinetic CP (17 males; eight females; age range 5-22y; mean age 13y 6mo; SD 5y 4mo), recruited from special schools for children with motor disorders, were included. Exclusion criteria were changes in muscle relaxant medication within the previous 3 months, orthopaedic or neurosurgical interventions within the previous year, and spinal fusion. Interrater reliability was verified by two independent raters. For interrater reliability, intraclass correlation coefficients were assessed. Standard error of measurement, the minimal detectable difference, and Cronbach's alpha for internal consistency were determined. For concurrent validity of the DIS dystonia subscale, the Barry-Albright Dystonia Scale was administered. RESULTSThe intraclass correlation coefficient for the total DIS score and the two subscales ranged between 0.91 and 0.98 for interrater reliability. The reliability of the choreoathetosis subscale was found to be higher than that of the dystonia subscale. The standard error of the measurement and minimal detectable difference values were adequate. Cronbach's alpha values ranged from 0.89 to 0.93. Pearson's correlation between the dystonia subscale and Barry-Albright Dystonia Scale was 0.84 (p<0.001).INTERPRETATION Good to excellent reliability and validity were found for the DIS. The DIS may be promising for increasing insights into the natural history of dyskinetic CP and evaluating interventions. Future research on the responsiveness of the DIS is warranted.Cerebral palsy (CP) is worldwide the most common neuromotor disorder in children, with an incidence of 2 to 3 per 1000 live births.1,2 CP can be categorized into spastic, dyskinetic, and ataxic groups. Dyskinetic CP is further differentiated into dystonia and choreoathetosis. 1,3 Spastic CP is by far the most common type of CP, with a prevalence of approximately 80%, 4 and is followed by dyskinetic CP with a prevalence between 6.5% 5 and 14. 4%. 4 According to the Surveillance of Cerebral Palsy in Europe (SCPE), 6 dyskinetic CP is characterized by involuntary, uncontrolled, recurring, occasionally stereotyped movements, in which the primitive reflex patterns predominate and muscle tone varies. 6 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.6,7 These SCPE...

Dystonia and choreoathetosis increase during activity. However, dystonia predominates and seems to have a larger impact on functional abilities. Our findings further suggest that choreoathetosis seems to be more linked to pure thalamus and basal ganglia lesions than dystonia.

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