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PEDIATRICS Vol. 111 No. 1 January 2003, pp. e89-e97

CLINICAL PRACTICE GUIDELINE

Classification and Definition of Disorders Causing Hypertonia in Childhood

Terence D. Sanger, MD, PhD*, Mauricio R. Delgado, MD{ddagger}, Deborah Gaebler-Spira, MD§, Mark Hallett, MD and Jonathan W. Mink, MD, PhD Task Force on Childhood Motor Disorders

* Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, California
{ddagger} Department of Neurology and Neurosciences, Texas Scottish Rite Hospital for Children, Dallas, Texas
§ Department of Pediatrics, Rehabilitation Institute of Chicago, Chicago, Illinois
Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
Department of Child Neurology, University of Rochester Medical Center, Rochester, New York

--> Objective. This report describes the consensus outcome of an interdisciplinary workshop that was held at the National Institutes of Health in April 2001. The purpose of the workshop and this article are to define the terms "spasticity," "dystonia," and "rigidity" as they are used to describe clinical features of hypertonia in children. The definitions presented here are designed to allow differentiation of clinical features even when more than 1 is present simultaneously.

Methods. A consensus agreement was obtained on the best current definitions and their application in clinical situations.

Results. "Spasticity" is defined as hypertonia in which 1 or both of the following signs are present: 1) resistance to externally imposed movement increases with increasing speed of stretch and varies with the direction of joint movement, and/or 2) resistance to externally imposed movement rises rapidly above a threshold speed or joint angle. "Dystonia" is defined as a movement disorder in which involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both. "Rigidity" is defined as hypertonia in which all of the following are true: 1) the resistance to externally imposed joint movement is present at very low speeds of movement, does not depend on imposed speed, and does not exhibit a speed or angle threshold; 2) simultaneous co-contraction of agonists and antagonists may occur, and this is reflected in an immediate resistance to a reversal of the direction of movement about a joint; 3) the limb does not tend to return toward a particular fixed posture or extreme joint angle; and 4) voluntary activity in distant muscle groups does not lead to involuntary movements about the rigid joints, although rigidity may worsen.

Conclusion. We have provided a set of definitions for the purpose of identifying different components of childhood hypertonia. We encourage the development of clinical rating scales that are based on these definitions, and we encourage research to relate the degree of hypertonia to the degree of functional ability, change over time, and societal participation in children with motor disorders.

Key Words: spasticity • dystonia • rigidity • movement disorders • hypertonia • pediatric • childhood

Abbreviations: CP, cerebral palsy

Received for publication Jul 2, 2002; Accepted Oct 3, 2002.




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