Using Expert-Cited Features to Detect Leg Dystonia in Cerebral Palsy

Leg dystonia in cerebral palsy (CP) is debilitating but remains underdiagnosed. Routine clinical evaluation has only 12% accuracy for leg dystonia diagnosis compared to gold-standard expert consensus assessment. We determined whether expert-cited leg dystonia features could be quantified to train machine learning (ML) models to detect leg dystonia in videos of children with CP.

Eight pediatric movement disorders physicians assessed 298 videos of children with CP performing a seated task at 2 CP centers. We extracted leg dystonia features cited by these experts during consensus-building discussions, quantified these features in videos, used these quantifications to train 4,664 ML models on 163 videos from one center, and tested the best performing models on a separate set of 135 videos from both centers.

We identified 69 quantifiable features corresponding to 12 expert-cited leg dystonia features. ML models trained using these quantifications achieved 88% sensitivity, 74% specificity, 82% positive predictive value, 84% negative predictive value, and 82% accuracy for identifying leg dystonia across both centers. Of the 25 features contributing to the best performing ML models, 17 (68%) quantified leg movement variability. We used these ML models to develop DxTonia, open-source software that identifies leg dystonia in videos of children with CP.

DxTonia primarily leverages detection of leg movement variability to achieve 82% accuracy in identifying leg dystonia in children with CP, a significant improvement over routine clinical diagnostic accuracy of 12%. Observing or quantifying leg movement variability during a seated task can facilitate leg dystonia detection in CP. ANN NEUROL 2026;99:1001-1013.