Dyskinetic Cerebral Palsy

Dystonia is involuntary, repetitive muscle contractions that cause twisting, awkward or abnormal postures that tend to come and go. These movements are often triggered by voluntary attempts to move or by being moved such as transfers. Dystonia may worsen when a person is tired, excited, upset or with physical touch.  Dystonia tends to go away during sleep, but some posturing may be seen during brief moments of being awake. Dystonia can sometimes be painful. It occurs in Dyskinetic CP but also occurs in Spastic CP. 

Dystonic postures have a twisting quality to the movement. Common postures include:

• Back arching
• Twisting of the neck
• Twisted extension of the arms or legs
• Swanning (bent) posturing of the fingers
• Intermittent scissoring of the legs

Examples of Dystonia:

• When the person tries to move one body part, A DIFFERENT BODY PART starts moving unintentionally or out of their control.

Someone tries to intentionally move their legs, their arms begin moving unintentionally. Or when they pick something up with their left hand, their right hand also start moving unintentionally.

• During activities that involve other people handling their body, the person starts moving body part(s) that are NOT BEING HANDLED BY OTHERS unintentionally or out of their control.

During transfers, the individual unintentionally arches their back or moves their arms or legs uncontrollably. Or, when doing leg stretches during physical therapy, they unintentionally start moving their arms or hands.

Diagnosing Dystonia:

Dystonia is diagnosed by performing a neurological examination and observing how patients move and respond to stimulation. The Hypertonia Assessment Tool (HAT) is an examination tool that clinicians can use to detect dystonia. The HAT is a seven item tool developed for children/youth between 4 to 19 years old. The HAT is used to differentiate the various types of pediatric hypertonia, namely spasticity, dystonia, and rigidity. 

Chorea is characterized as ongoing random-appearing sequence of one or more irregular, brief, involuntary movements or movement fragments. These movements can be jerky or writhing and tend to migrate from one body part to another. It can have a twitchy quality.

• People with chorea may look like they are constantly fidgeting or clumsy, just can't keep the body still.
• Subtle chorea can look like wiggly, distracted movements in an active child; however the person is unable to hold the movement in.
• More pronounced chorea can include flinging movements of the extremities, especially when going through doorways.
• Chorea can affect speech and swallowing.
• Movements will worsen with attempts to move during stress or anxiety and reduce when asleep.
• Chorea may occur with athetosis, and this is known as choreoathetosis.

   

Diagnosing Chorea

Chorea is best diagnosed by a physician who specializes in movement disorders, such a neurologist, physiatrist, neuro-developmental or developmental pediatrician.  They will take a clinical history, perform a neurological examination and observe how an individual moves and responds to stimulation. They may also order neuro-imaging, such as an MRI.

Treatment

The aim of treatment and management is to improve functional outcomes, improve caregiving, prevent complications or declines and increase quality of life. 

Athetosis is a slow, continuous, involuntary, writhing movement that prevents the ability to maintain a stable posture. Individuals with athetosis appear restless and constantly moving. The movements may look almost like writhing or contorting and tend to migrate from one body part to another. These movements usually affect the hands, arms, legs and feet, but they can affect the whole body, including the muscles of the face, lips and tongue. This means that speech, eating and drinking can all be affected. 

Athetosis also impacts muscle tone, meaning that sometimes the individual may be floppy (hypotonic) while other times they will be constantly moving.

• As with the other movement disorders, stress can make it worse.
• Symptoms lessen when the individual is at rest or and can disappear when asleep.
• Unlike dystonia, movements are not sustained, patterned or repetitive.
• Sometimes it is described as a slow form of chorea.
• True Athetosis in cerebral palsy is uncommon and often occurs in combination with Chorea, called Choreathetosis.

Diagnosing Athetosis

Athetosis is best diagnosed by a physician who specializes in movement disorders, such a neurologist, physiatrist, neuro-developmental or developmental pediatrician.  They will take a clinical history, perform a neurological examination and observe how the individual moves and responds to stimulation. They may also order neuro-imaging, such as an MRI.

Treatment

The aim of treatment and management is to improve functional outcomes, improve caregiving, prevent complications or declines and increase quality of life.