Teaching tape for the motor section of the toronto western spasmodic torticollis scale

Abstract

The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) assesses the character and severity of cervical dystonia (CD). We developed a teaching tape of the TWSTRS scoring for the motor symptoms of CD. The tape provides investigators with visual representations of each component of the motor section of the TWSTRS as agreed upon by three independently scoring raters. The rate of agreement for the nondichotomous components was always significant, with a Kendall's coefficient of concordance W ranging between 0.98 and 0.76 (p < 0.01 for all measures). For the two dichotomous components, a weighted kappa coefficient was also significant at 0.86 for lateral shift and 0.89 for sagittal shift (p < 0.01 for both measures). Scale deficiencies identified by the raters were an explicit definition of midline for assessment of range of motion, the absence of a separate scoring category assessing dystonic tremor, and the specification of duration for the effect of sensory tricks. These observations should be taken into account in future revisions of the TWSTRS and in refinements of other rating scales for CD.

Nonmotor symptoms in primary adult‐onset cervical dystonia and blepharospasm

“…Motor symptom of CD was evaluated by Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS)‐ severity scale (Comella et al., 1997). Motor symptom of BSP was evaluated by using the Jankovic rating scale (JRS) (Jankovic, Comella, Hanschmann, & Grafe, 2011).…”

Dystonia and Peripheral Nerve Surgery in the Cervical Area

“…The TWSTRS (Comella et al, 1997) (Table 1) is comprised of three main sections, including torticollis severity scale, disability scale, and pain scale. The Tsui score (Moore & Blumhardt, 1991;Tsui et al, 1986) (Table 2) is a composite score calculated by a formula.…”

“…The Tsui score (Moore & Blumhardt, 1991;Tsui et al, 1986) (Table 2) is a composite score calculated by a formula. By both the methods, a higher level of score indicates increased severity of cervical dystonia (Comella et al, 1997;Moore & Blumhardt, 1991). The score can be used for comparison between before and after a treatment or between among various alternatives of treatment.…”

“…The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) (Comella et al, 1997) A Table 2. The Tsui score (Tsui et al, 1986) …”

How Effective and Safe is Botulinum Toxin Therapy in Cervical Dystonia: The Current Stand

“…Scoring at baseline, at the time of peak efect (approximately 1 month after injection) and before retreatment would allow the injectors to assess the outcome of the previous injection and make the necessary adjustment in the dosing and targeting in the next injection cycle [8]. The most frequently used instrument to assess the response to therapeutic interventions in patients with CD is the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) [9]. The TWSTRS, together with the Cervical Dystonia Impact Scale (CDIP-58) and the Cervical Dystonia Questionnaire (CDQ-24), is "recommended" for CD, while the Functional Disability Questionnaire, the Tsui Scale and the "ody Concept Scale have been rated as "suggested" [10].…”