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Barry Albright Dystonia Scale (BADS)
Availability
Please visit this website for more information about the instrument: Barry Albright Dystonia Scale
Classification
Supplemental - Highly Recommended: Cerebral Palsy (CP) and *Mitochondrial Disease (Mito)
*Recommendations for use: Indicated for studies measuring dystonia.
Short Description of Instrument
The Barry Albright Dystonia Scale (BADS) was developed to specifically assess secondary dystonia in individuals with cerebral palsy and acquired brain injury with limitations in cognition and physical ability. (Barry et al., 1999)
 
The BADS must be administered by a trained professional. Eight body regions, eyes, mouth, neck, trunk, each upper limbs (right/left) and lower limbs (right/left) are assessed for dystonia scores on the lines provided. Severity ratings are based on dystonia as evidenced by abnormal movements or postures. When assessing functional limitations, do not score as dystonia-induced functional limitation if other factors, such as weakness, lack of motor control, cognitive deficits, persistent primitive reflexes, and/or other movement disorders are contributing to functional limitation.
Scoring and Psychometric Properties
Scoring: The scoring criteria for each of the 8 body regions are scored on an ordinal severity scale from 0 to 4. The maximum total score is 32, calculated by summation of the region scores.
 
Scoring Criteria (CRE-CP, 2018)
0 = No dystonia
1 = Slight dystonia, present less than 10% of the time
2 = Mild dystonia, present less than 50% of the time and does not interfere with function
3 = Moderate dystonia, present more than 50% of the time and interferes with function
4 = Severe dystonia, present more than 50% of the time and prevents function
 
Psychometric Properties: The mean intraclass correlation coefficient for total BADS scores were as follows: interrater reliability 0.866, intrarater reliability 0.967 and 0.978, test-retest reliability 0.978 (before training) and 0.967 (after training). The BADS was found to be responsive to change, with most improved scores in patients rated by the patient, family, and neurosurgeon as 'better'. The total scores were reliable for experienced raters (Barry et al., 1999).
Rationale/Justification
Strengths: Good reliability for limbs and trunk; correlations with other functional and dystonia instruments.
Good intrarater reliability. Less training required to administer, relatively easy to administer. Uses parental input. Provides a more temporally integrated estimate of dystonia.
 
Weaknesses: Too detailed dystonia severity scale; designed for adults
References
Key Reference:
Barry MJ, VanSwearingen JM, Albright AL. Reliability and responsiveness of the Barry-Albright dystonia scale. Dev Med Child Neurol. 1999;41:404-411.
 
Additional References:
Centre of Research Excellence in Cerebral Palsy (CRE-CP). 2018. The Identification and Measurement of Dyskinesia in Children with Cerebral Palsy: A Toolkit for Clinicians. Available at: https://iaacd.net/wp-content/uploads/2019/07/Dyskinesia_Toolkit_for_clinicians2018.pdf.
Accessed: 30 January 2024.
 
Monbaliu E, Ortibus E, Roelens F, Desloovere K, Deklerck J, Prinzie P, de Cock P, Feys H. Rating scales for dystonia in cerebral palsy: reliability and validity. Dev Med Child Neurol. 2010 Jun;52(6):570-5.
 
Pavone L, Burton J, Gaebler-Spira D. Dystonia in childhood: clinical and objective measures and functional implications. J Child Neurol. 2013 Mar;28(3):340-50.
 
Document last updated March 2024