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Dyskinesia Impairment Scale (DIS)
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Dyskinesia Impairment Scale.
Exploratory: Cerebral Palsy (CP)
Short Description of Instrument
Construct measured: Dystonia and Choreoathetosis
Generic vs. disease specific: Generic
Means of administration: Videotaped with scoring completed based on video analysis.
Intended respondent: Administrator.
Background: The Dyskinesia Impairment Scale (DIS) is a clinical tool developed to assess presence and severity of dystonia and choreoathetosis in 12 body regions including eyes, mouth, neck, trunk, and limbs.
Comments/Special Instructions
The DIS is intended to be administered via a standard videotaping protocol of specific movements in as comfortable or familiar an environment as possible. Videotaping is  a maximum of 30 minutes and specific positions and movements needed to be captured are outlined in Monbaliu et al. (2012). It then is scored by individuals familiar with the instrument.
Dystonia and choreoathetosis are scored separately. Twelve body regions are scored at both rest and with action. Duration and amplitude of movements for each region at both rest and action are scored. For action activities, 2 activites are scored. The score ranges from 0 to 4, with 0 being that the abnormal movement is absent and 4 being that the abnormal movement is always present. A score of 0–288 is possible for both the dystonia subscale and the choreoathetosis subscale. The total DIS score ranges from 0 to 576.
Administration: Videotaping up to 30 minutes. Scoring up to 45 minutes.
In a study of individuals with dyskinetic CP, ranging rorm 5 to 22 years of age, interrater reliability for the DIS was excellent (ICC 0.96 for total, 0.91 for dystonia subscale, and 0.98 for choreoathetosis subscale). Lower reliability was noted for specific regions of the dystonia subscale for duration and amplitude during action testing with neck and trunk; duration only for eyes; and amplitude only for right proximal arm and bilateral proximal legs. Lower reliability was noted for specific regions of the dystonia subscale for duration during rest for neck, right procimal leg and left distal leg. Amplitude was of moderate to high reliability for dystonia subscale during rest. Choreoathetosis subscale showed moderate to high reliability for duration and amplitude of movement in all areas except duration for left distal leg and both duration and amplitude for eyes. Internal consistency was high for all aspects of the dystonia subscale and all aspects of the choreoathetosis subscale except amplitude at rest (Chronbach’s alpha 0.89). Pearson’s Correlation for comparison of Barry-Albright Dystonia Scale with dystonia subscale was 0.84 (95% CI 0.66-0.92, p<0.001).
This scale adds to current recommended scales for evaluating dyskinesia in CP in that it assesses choreoathetosis.
Monbaliu E, Ortibus E, De Cat J, Dan B, Heyrman L, Prinzie P, De Cock P, Feys H. The Dyskinesia Impairment Scale: a new instrument to measure dystonia and choreoathetosis in dyskinetic cerebral palsy. Dev Med Child Neurol. 2012;54(3):278–283.
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