{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T01:00:33Z","timestamp":1768870833068,"version":"3.49.0"},"posted":{"date-parts":[[2025,9,8]]},"group-title":"Neurology","reference-count":26,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,9,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Dystonia in childhood is typically associated with cerebral palsy (CP). Dystonia severity scales for CP require prolonged exam protocols with numerous tasks, often making them onerous for routine clinical use.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To identify which individual tasks best approximate dystonia severity compared to the gold standard full protocol.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In this cross-sectional study, comprehensive exam protocol videos were taken during routine care of ambulatory people with CP age 5 and up. Five pediatric dystonia experts reviewed individual tasks and the full protocol for dystonia using the Global Dystonia Severity Rating Scale. Experts\u2019 written scoring justifications were qualitatively analyzed to determine commonly cited features of dystonia.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>When examining the difference in dystonia severity ratings between each task and the full protocol, seated upper extremity tasks had the lowest variance (p&lt;0.05, F-test) and had lower score differences than the stand\/walk\/run and seated lower extremity tasks (p&lt;0.05, repeated measures Friedman test). Experts most commonly identified the following movements as dystonic: wrist flexion (8.4% of all movement statements), finger flexion (7.3%), wrist ulnar deviation (6.8%), toe dorsiflexion (8.4%), ankle inversion (7.9%), and ankle plantarflexion (6.4%). Experts rated dystonic movements as more severe if they were consistently triggered by multiple stimuli (26.8% of all severity statements) or functionally impactful (20.7%).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Seated upper extremity tasks may be valuable for identifying dystonia and estimating its severity during routine clinical care. Clinical dystonia severity assessment could be guided by assessing specific dystonic movements, the consistency with which they are triggered, and their functional impact.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2025.09.07.25334597","type":"posted-content","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T23:00:15Z","timestamp":1757372415000},"source":"Crossref","is-referenced-by-count":1,"title":["Tasks for assessing dystonia in young people with cerebral palsy"],"prefix":"10.64898","author":[{"given":"Emma","family":"Lott","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alyssa","family":"Rust","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leon","family":"Dure","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darcy","family":"Fehlings","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toni","family":"Pearson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roser","family":"Pons","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan W.","family":"Mink","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0205-2149","authenticated-orcid":false,"given":"Bhooma R.","family":"Aravamuthan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2025091211200557000_2025.09.07.25334597v1.1","unstructured":"About Cerebral Palsy | Cerebral Palsy (CP) | CDC [online]. Accessed at: https:\/\/www.cdc.gov\/cerebral-palsy\/about\/. Accessed October 14, 2024."},{"key":"2025091211200557000_2025.09.07.25334597v1.2","unstructured":"McIntyre S , Goldsmith S , Webb A , et al. Global prevalence of cerebral palsy: A systematic analysis. Dev Med Child Neurol [online serial]. Dev Med Child Neurol; Epub 2022 Aug 11. Accessed at: https:\/\/pubmed.ncbi.nlm.nih.gov\/35952356\/. Accessed September 4, 2022."},{"key":"2025091211200557000_2025.09.07.25334597v1.3","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1111\/dmcn.13502","article-title":"Identification and measurement of dystonia in cerebral palsy","volume":"59","year":"2017","journal-title":"Dev Med Child Neurol [online serial]"},{"key":"2025091211200557000_2025.09.07.25334597v1.4","first-page":"901","article-title":"Epidemiology of Parkinson\u2019s disease","volume":"124","year":"2017","journal-title":"J Neural Transm (Vienna) [online serial]. J Neural Transm (Vienna)"},{"key":"2025091211200557000_2025.09.07.25334597v1.5","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2015-4450"},{"key":"2025091211200557000_2025.09.07.25334597v1.6","doi-asserted-by":"crossref","unstructured":"Lott E , Fehlings D , Gelineau-Morel R , et al. Physician Approaches to the Pharmacologic Treatment of Dystonia in Cerebral Palsy. Pediatrics [online serial]. Pediatrics; 2024;154. Accessed at: https:\/\/pubmed.ncbi.nlm.nih.gov\/38836309\/. Accessed July 15, 2024.","DOI":"10.1542\/peds.2023-065512"},{"key":"2025091211200557000_2025.09.07.25334597v1.7","doi-asserted-by":"crossref","unstructured":"Bohn E , Goren K , Switzer L , Falck-Ytter Y , Fehlings D. Pharmacological and neurosurgical interventions for individuals with cerebral palsy and dystonia: a systematic review update and meta-analysis. Dev Med Child Neurol. 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