Family-Centered Physiotherapy in Dyskinetic Cerebral Palsy

The Dyskinesia Impairment Scale (DIS) was used to assess the duration and amplitude of distonia and choreoathetosis in 12 body regions, including the eyes, mouth, neck, trunk, and extremities. It provides scores for each region during both action and rest, resulting in a total action score ranging from 0 to 192 and a total rest score ranging from 0 to 96 for both the subscales. The action and rest scores combine to create a total score between 0 and 288, representing the sum of the distonia and choreoathetosis subscales.

The Dyskinesia Impairment Mobility Scale (DIMS) assesses dyskinesia in motorized wheelchair mobility performance. It has two subscales, Dyskinesia-Dystonia (DIMS-D) and Dyskinesia-Choreoathetosis (DIMS-CA), which use video-based protocols. Each subscale evaluated dyskinesia duration (time during mobility tasks) and amplitude (maximum Range of Motion (ROM) due to dyskinesia) in five motorized mobility tasks. The scores ranged from 0 to 4 for both factors. DIMS assesses overflow movements during mobility tasks and voluntary movements for wheelchair navigation, representing various body regions. The assessment covers the neck and proximal and distal parts of the right and left arms, excluding the feet. DIMS is excluded for assessing the feet due to minimal movement during wheelchair acceleration and braking.

The Wong-Baker FACES Pain Rating Scale was employed for pain assessment, particularly for patients aged 3 and above. This validated and recommended scale represents pain levels through facial expressions. The scale ranges from face 0, indicating no pain, to face 5, representing the possibility of the worst pain. The faces expressed increasing levels of pain intensity, with face 1 for mild pain, face 2 for moderate pain, face 3 for severe pain, and face 4 for very severe pain.

Dyskinetic Cerebral Palsy Functional Impact Scale (D-FIS) assesses the impact of dyskinesia on daily activities in children with DSP, featuring 18 items, including Pain and Fatigue, and 16 items on daily activities. Parent-proxy completion takes 10 minutes; D-FIS scores on the Impact Scale (0-72) and Priority Scale (1-4) evaluate dyskinesia impact and activity priority. Ratings consider unassisted functions and offer comprehensive evaluation. Higher scores suggest a greater dyskinesia impact, guiding intervention focus on priority areas for children and families.

The Gross Motor Function Classification System (GMFCS) was used to assess gross motor function.

The Manual Ability Classification System (MACS) was used to assess fine motor skills.

The Communication Function Classification System (CFCS) was used for assess communication function.

The Communication Function Classification System (CFCS) is USED for ASSESSING communication function.

The Eating and Drinking Classification System (EDACS) was used for assess eating and drinking skills.

The Visual Function Classification System (VFCS) was used for assess visual function.

To assess and measure the impact of individualized goal-oriented physiotherapy and rehabilitation programs on children with SP, the Goal Attainment Scale (GAS) was employed. To evaluate the effectiveness of the intervention, specific goals determined by the child, family, and experts were rated on a scale from -2 to 2, representing five levels of achievement. These goals are established through collaboration between the physiotherapist and family, and the attainment of these goals after the intervention is evaluated through discussions between the physiotherapist and family.

The Life-Habits Questionnaire (Life-H) was used to assess the multidimensional aspects of children's participation. Life-H examines the participation of children with SP in various life activities under 12 subheadings, including participation in daily activities and social roles, providing both total and subsection scores. The daily activities include six subscales: "nutrition," "physical fitness," "personal care," "communication," "housing," and "mobility," while the social roles encompass "responsibilities," "interpersonal relationships," "social life," "education," "employment," and "leisure activities." Achievement scores range from 0 (failed or not completed) to 9 (performed without difficulty and assistance), varying based on the degree of difficulty and type of assistance required to accomplish a task. The Turkish version of Life-H has been demonstrated to be valid and reliable for assessing participation in children with SP.

The European Child Environment Questionnaire (ECEQ) will be used to assess environmental factors, considering that environmental factors can influence assessment outcomes when evaluating children using different assessment methods and recognizing the need for a comprehensive evaluation within the framework of the International Classification of Functioning, Disability, and Health (ICF). The ECEQ, consisting of 60 questions assessing conditions in the home, school, and community under three main subheadings: physical environment, social support, and attitudes, was designed to evaluate environmental factors in children with SP and determine their needs and accessibility. The scale is valid and reliable. Scoring is done on a scale of 0 (not necessary), 1 (necessary and mostly accessible), or 2 (necessary but mostly inaccessible) to determine the necessity and accessibility of needs.

The Parental Stress Scale (PSS) was used to assess parental stress (Appendix-11). It was utilized to evaluate the perceived parental stress levels of parents of children with SP participating in the study. The scale employs 18 items to measure parenting stress, considering the impact of children on the parental role and avoiding questions that could be confounded by general stress. Items are scored on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The total score, ranging from 18 to 90, was obtained by summing the sub-scores of the four main areas: rewards, loss of control, stressors, and satisfaction. Higher scores indicated higher levels of parenting stress. The psychometric properties of this scale have recently been shown to be adequate for families with chronic health conditions.

The Cerebral Palsy Quality of Life Questionnaire Child and Teen (CP QOL Child\&Teen) will be utilized to assess the quality of life. It consists of two versions: one completed by the caregiver and another self-administered by the adolescent. The adolescents' self-administered questionnaire included six categories: family and friends, school, participation, communication, health, and special equipment, which were assessed under four subsections: general well-being and participation, communication and physical health, school situation, and social well-being. In addition, the caregiver questionnaire included two additional categories for evaluating services and family health. Respondents used a 9-point Likert scale to answer the questionnaire items based on the nature of the questions, marking a number from 1 to 9, indicating responses such as very unhappy, very important-not important at all, never sad-very sad, and no pain at all.