Turkish Translation , Validity and Reliability of the Hypertonia Assessment Tool in Children With Motor Disorders

Translating batteries with good psychometric properties into Turkish will increase the number of assessment batteries we can use in our language for clinical and academic studies. Therefore, the aim of our study was to verify the validity, reliability, and translation into Turkish of the Hypertonus Assessment Tool for children with motor disorders.

Study Overview

• Status: Recruiting
• Conditions: Motor Disorder; Reliability and Validity; Hypertonia

Detailed Description

Among children with omotor disorders, particularly those with cerebral palsy, abnormalities in muscle tone are among the most common clinical symptoms. Damage occurring in various structures such as the thalamus, cerebral cortex, and basal ganglia can adversely affect muscle tone. Hypertonia is defined as an abnormal increase in resistance to externally imposed movement about a joint. It leads to limitations in activity participation, loss of motor control, and reduced quality of life. Hypertonia, which causes impairments in gross motor skills such as walking, stair climbing, and crawling, negatively affects the quality of life in childhood.

Muscle tone disorders in childhood can be classified into three main types: spasticity, dystonia, and rigidity. Spasticity is defined as a velocity-dependent increase in muscle tone associated with hyperexcitability of the tonic stretch reflex. Dystonia is a movement disorder characterized by sustained or intermittent involuntary muscle contractions that cause twisting, repetitive movements, abnormal postures, or a combination of these. Rigidity refers to bidirectional, velocity-independent resistance to passive movement, which may involve simultaneous co-contraction of agonist and antagonist muscles. In some cases, more than one type of tone abnormality may coexist.

Several assessment tools have been developed to evaluate different subtypes of hypertonia or general increases in tone. The most commonly used methods in clinical and research settings include the Modified Ashworth Scale (MAS), the Modified Tardieu Scale (MTS), and the Barry-Albright Dystonia Scale (BADS). While these scales evaluate different aspects of hypertonia, they do not distinguish between its subtypes. The Hypertonia Assessment Tool (HAT) was developed to address the need for a single instrument capable of differentiating among hypertonia subtypes. Introduced to the literature by Fehlings et al. in 2010, the HAT has been shown to be a valid and reliable tool for assessing the three subtypes of hypertonia in children with cerebral palsy.

The HAT involves observing an extremity joint during passive stretch and voluntary movement to detect increased tone or resistance. The scale consists of seven items-two assessing spasticity, two rigidity, and three dystonia. It can differentiate hypertonia subtypes in both upper and lower extremities and takes approximately five minutes to administer per limb. Studies in various patient populations have reported moderate to good levels of validity and reliability.

Translating psychometrically robust assessment tools into Turkish will expand the number of instruments available for clinical and research use in our native language. Therefore, the aim of this study was to translate the Hypertonia Assessment Tool into Turkish and to evaluate its validity and reliability in children with motor disorders.

• Study Type: Observational
• Enrollment (Estimated): 70

Contacts and Locations

• Study Contact: Name: Hidayet Cuha, PhD(c); Phone Number: +90 534 646 01 06; Email: hcuha@kastamonu.edu.tr
• Study Contact Backup: Name: Esra Serdaroglu, MD, Assoc. Prof.; Phone Number: +90 312 202 6090; Email: esras@gazi.edu.tr

Study Locations

• Turkey (Türkiye)
  • Ankara, Turkey (Türkiye)
    • Recruiting
    • Gazi University
    • Contact: Hidayet Cuha, PhD(c); Phone Number: +90 534 646 01 06; Email: hidayet.cuha@gazi.edu.tr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

This methodological study was designed as a Turkish language adaptation, validity, and reliability study. It will be conducted at the Developmental Physiotherapy and Pediatric Rehabilitation Unit of the Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, between January 15, 2025, and January 15, 2026. Children with neuromotor disorders diagnosed by a pediatric neurologist and attending routine clinical follow-up visits will be recruited through convenience sampling. The total sample size was determined as 70 participants, corresponding to ten times the number of items in the scale. Children whose parents provide written and verbal informed consent will be included in the study.

Description

Inclusion Criteria:

• as voluntary participation in the study,
• a diagnosis of a neuromotor disorder under the age of 18,
• sufficient cognitive ability to follow verbal commands

Exclusion Criteria:

• Patients with any other systemic disease,
• Who had received botulinum toxin A injections or undergone surgery within the past three months,
• Be unable to follow verbal instructions
• Medical treatment had been modified within the last month

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Children with motor disorders

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hypertonia Assessment Tool	The Hypertonia Assessment Tool (HAT) was developed to address the need for a single instrument capable of evaluating different subtypes of increased muscle tone within one assessment battery. The HAT involves observing a patient's limb during a targeted passive stretch and during voluntary movement to assess increased tone or resistance. The scale consists of seven items in total: two assess spasticity, two assess rigidity, and three assess dystonia.	The patient, diagnosed by a pediatric neurologist, is evaluated by the researcher. A second evaluation is repeated one week later after a follow-up examination to ensure test-retest reliability.

Collaborators and Investigators

• Sponsor: Kastamonu University
• Collaborators: Gazi University
• Investigators: Study Chair: Bulent Elbasan, Prof. Dr., Gazi University

Publications and helpful links

General Publications

• Marsico P, Frontzek-Weps V, Balzer J, van Hedel HJ. Hypertonia Assessment Tool. J Child Neurol. 2017 Jan;32(1):132-138. doi: 10.1177/0883073816671681. Epub 2016 Oct 15.
• Jethwa A, Mink J, Macarthur C, Knights S, Fehlings T, Fehlings D. Development of the Hypertonia Assessment Tool (HAT): a discriminative tool for hypertonia in children. Dev Med Child Neurol. 2010 May;52(5):e83-7. doi: 10.1111/j.1469-8749.2009.03483.x.
• Haberfehlner H, Goudriaan M, Bonouvrie LA, Jansma EP, Harlaar J, Vermeulen RJ, van der Krogt MM, Buizer AI. Instrumented assessment of motor function in dyskinetic cerebral palsy: a systematic review. J Neuroeng Rehabil. 2020 Mar 5;17(1):39. doi: 10.1186/s12984-020-00658-6.
• Hadders-Algra M. Early Diagnostics and Early Intervention in Neurodevelopmental Disorders-Age-Dependent Challenges and Opportunities. J Clin Med. 2021 Feb 19;10(4):861. doi: 10.3390/jcm10040861.

Study record dates

Study Major Dates

• Study Start (Actual): January 10, 2025
• Primary Completion (Estimated): January 10, 2026
• Study Completion (Estimated): June 10, 2026

Study Registration Dates

• First Submitted: November 23, 2025
• First Submitted That Met QC Criteria: December 4, 2025
• First Posted (Actual): December 5, 2025

Study Record Updates

• Last Update Posted (Actual): December 5, 2025
• Last Update Submitted That Met QC Criteria: December 4, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: Reliability and Validity; Hypertonia; Motor Disorder
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Neuromuscular Manifestations; Mental Disorders; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Motor Disorders; Muscle Hypertonia
• Other Study ID Numbers: 2024 - 1944

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: All IPD collected throughout the trial, only IPD used in the results publication.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No