The dystonic child treated with deep brain stimulation: ICF reading of a high-tech approach.

Abstract

The available tools used to describe childhood dystonia tend to offer a monodimensional view of the person functioning, which may overlook significant changes induced by treatment. We applied the International Classification of Functioning, Disability and Health (ICF) perspective to the description of the clinical picture of a dystonic child treated with deep brain stimulation (DBS) to get a more global representation of the treatment effect. An 8-year-old child with secondary dystonia was selected within the institutional program for advanced treatment of pediatric dystonia as a candidate for bilateral implantation of electrodes into globus pallidus and chronic stimulation. The International Classification of Functioning, Disability and Health -children and youth (ICF-CY) based project and program format was used by the rehabilitation team to define the clinical picture, rehabilitation objectives, and to verify the outcome. The rehabilitation project and program included 39 ICF categories: 14 body functions, two body structures, 18 activities and participation, and five environment. On such basis we defined the individualized specific rehabilitation objectives and we checked for clinical changes after DBS. The ICF-CY format provides a complete and balanced profile of functioning in secondary dystonia treated with DBS and it could offer a novel perspective for outcome evaluation.