Table 2

Torticollis rating scale: modified from TWSTRS (Consky and Lang4)

Severity items:
 Rotation0 None
1 Mild (1/3 range)
2 Moderate (1/3 to 2/3 range)
3 Severe (>2/3 range)
 Tilt0 None
1 Mild (<15 degrees)
2 Moderate (16-35 degrees)
3 Severe (>35 degrees)
 Anterocollis or retrocollis:Anterocollis:
 0 None
 1 Mild downward deviation
 2 Moderate (1/2 range)
 3 Severe: chin approximates chest
 0 None
 1 Mild backward deviation
 2 Moderate deviation (1/2 range)
 3 Severe (full range)
 Range of motion and effort (rate for plane of motion that appears most limited):
0 Full range of motion, without obvious effort
1 Can move head well past midline, or can achieve full range of motion only be exerting obvious effort
2 Not able to move head past midline, or past midline only with great effort
3 Barely able to move head past the abnormal posture, or moves past abnormal posture briefly only with great effort
 Tremor and jerking0 Absent
1 Mild: occasional
2 Moderate: often present
3 Severe: almost always
 Global assessment severity0 None
1 Mild
2 Moderate
3 Severe
Duration factor:2-150
0 Dystonia not present
1 Occasional dystonia (<25% of the time), usually submaximal in severity
2 Intermittent (<50% of time), usually submaximal or occasional (<25%) maximal  dystonia
3 Frequent (>50%), usually submaximal or intermittent maximal
4 Constant dystonia or frequent maximal
5 Constant maximal dystonia
  • 2-150 Estimated duration of maximal dystonia as % of time dystonia is present during each video segment. This score is weighted ×2.

  • The maximum possible total score, combining severity items and the weighted duration factor (×2), is 28.