Table 1.

Clinical and kinematic masures to evalute the severity in childhood dystonia

Clinical measures
Scale	Study	Features	Outcomes
The Hypertonia Assessment Tool (HAT)	Jethwa et al., 201043	Developed to differentiate the clinical features of childhood hypertonia: dystonia, spasticity and rigidity	The score is 7 items tool to assess the presence or absence of hypertonic components whereby an evaluator moves a child’s arm or leg in a series of purposeful stretches and movements
The Burke-Fahn-Marsden Movement Scale (BFM)	Burke et al., 198544	Developed to assess primary dystonia	Divided in 2 components. 1) movement scale: to assess 9 different body regions. 2) disability scale: based on the individual’s assessment of how the dystonia affects activities of daily living
Barry-Albright Dystonia Scale (BAD)	Barry et al., 199945	Developed to particularly evaluate children with secondary dystonia	The scale is a 5-point ordinal scale for each of 8 body regions: eyes, mouth, neck, trunk, left and right upper extremity and left and right lower extremity
Unified Dystonia Rating Scale (UDRS)	Comella et al., 200346	The scale includes more body regions and is more specific in defining the region than BFM scale	The scale evaluates severity and duration of excess movements in dystonia in 14 different body regions.
Global Dystonia Rating Scale (GDS)	Comella et al., 200346	A more detailed version of UDRS	Larger points ordinal scale on the 14 body regions than UDRS (from 0 to 10 instead of from 0 to 4 points)

Kinematic measures
Study	Features	Outcomes
Sanger, 200626	Kinematic analysis of the trajectory in a finger-to-nose reaching task	Children with dystonia were found to have increased spatial variability and a lack of straight-line trajectory (hand path) compared to typically developing children
Malfait & Sanger, 200636	Kinematic analysis of the trajectory in a finger-to-nose reaching task	Children diagnosed with arm dystonia due to cerebral palsy or primary dystonia showed decreased speed and greater spatial variability
Butler et al., 201047	Kinematic analysis of the trajectory during a reach-and-grasp cycle	Children with dystonia due to cerebral palsy had slower arm movements
Gordon et al., 200648	Kinematic analysis of reaching and tapping tasks to differentiate dystonia and spasticity in children with cerebral palsy	Children with dystonia made curved hand paths during reaching, whereas children with spasticity tended to demonstrate higher peak velocities. Children with dystonia also were found to display greater overflow during tapping of the contralateral arm/hand.
Sanger et al,. 200525	Measured the speed of arm movement while children attempted to contact targets of different sizes	Children with dystonia moved significantly more slowly at all button sizes, and their movement speed was more sensitive to changes in target size
Bertucco & Sanger, 201327	Measured the speed-accuracy trade-off during pointing movement using the iPad® with different distances and targets size (Fitts' law50)	Both children with dystonia and typically developing children scaled the movement speed with distance and target size. Children with dystonia had slower movement and were more sensitive to changes in target size and distance