TWSTRS Severity Subscale (Cervical Dystonia)
The severity (motor) subscale of the Toronto Western Spasmodic Torticollis Rating Scale for cervical dystonia (Consky and Lang 1994; motor section validated by Comella and colleagues 1997), scored out of 35.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Rotation
- 3
- Laterocollis (tilt to the shoulder), excluding shoulder elevation
- 1
- Sagittal deviation — anterocollis OR retrocollis
- 0
- Lateral shift
- 1
- Sagittal shift
- 0
- Duration of the deviation
- 4
- Effect of sensory tricks
- 1
- Shoulder elevation or anterior displacement
- 2
- Range of motion, without sensory tricks
- 2
- Time the head can be held in neutral, without sensory tricks
- 2
Result: TWSTRS severity 20 of 35.
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What the result means
- Maximal excursion
- Rotation 0-4, laterocollis 0-3, sagittal deviation 0-3, lateral shift 0-1, sagittal shift 0-1. Subtotal 0-12.
- Duration
- Rated 0-5 and then DOUBLED, contributing 0-10. The only weighted item; summing it raw caps the subscale at 30.
- Sagittal deviation
- Anterocollis and retrocollis are mutually exclusive and share one slot. Scoring both would reach 38.
- Remaining items
- Sensory tricks 0-2, shoulder elevation 0-3, range of motion 0-4, time in neutral 0-4.
- Total
- 0 to 35. This is one of three subscales; the full TWSTRS adds disability out of 30 and pain out of 20.
What you enter
- Rotation (turning to left or right)
- Laterocollis (tilt to the shoulder), excluding shoulder elevation
- Sagittal deviation — anterocollis OR retrocollis.
- Lateral shift
- Sagittal shift
- Duration of the deviation.
- Effect of sensory tricks
- Shoulder elevation or anterior displacement
- Range of motion, without sensory tricks
- Time the head can be held in neutral, without sensory tricks
Full field descriptions
- Rotation (turning to left or right) [0 - None; 1 - Slight (1 to 22 degrees); 2 - Mild (23 to 45 degrees); 3 - Moderate (46 to 67 degrees); 4 - Severe (68 to 90 degrees)]
- Laterocollis (tilt to the shoulder), excluding shoulder elevation [0 - None; 1 - Mild (1 to 15 degrees); 2 - Moderate (16 to 35 degrees); 3 - Severe (more than 35 degrees)]
- Sagittal deviation — anterocollis OR retrocollis. These are mutually exclusive and share one slot; a neck cannot be flexed and extended at once. [0 - None; 1 - Mild downward or backward deviation of the chin; 2 - Moderate deviation, about half the possible range; 3 - Severe (chin reaches chest, or full backward deviation)]
- Lateral shift [0 - Absent; 1 - Present]
- Sagittal shift [0 - Absent; 1 - Present]
- Duration of the deviation. THIS ITEM IS RATED 0 to 5 AND THEN DOUBLED, contributing 0 to 10. [0 - None; 1 - Occasional deviation, under 25 percent of the time, most often submaximal; 2 - Occasional under 25 percent most often maximal, or intermittent 25 to 50 percent most often submaximal; 3 - Intermittent 25 to 50 percent often maximal, or frequent 50 to 75 percent most often submaximal; 4 - Frequent 50 to 75 percent most often maximal, or constant over 75 percent most often submaximal; 5 - Constant deviation over 75 percent of the time, often maximal]
- Effect of sensory tricks [0 - Complete relief; 1 - Partial or only limited relief; 2 - Little or no benefit]
- Shoulder elevation or anterior displacement [0 - Absent; 1 - Mild (under a third of the possible range), intermittent or moderate and intermittent; 2 - Moderate (a third to two thirds of the range) and constant over 75 percent of the time, or severe (over two thirds) and intermittent; 3 - Severe and constant]
- Range of motion, without sensory tricks [0 - Able to move to the extreme opposite position; 1 - Well past midline but not to the extreme opposite position; 2 - Barely past midline; 3 - Toward but not past midline; 4 - Barely able to move the head beyond the abnormal posture]
- Time the head can be held in neutral, without sensory tricks [0 - More than 60 seconds; 1 - 46 to 60 seconds; 2 - 31 to 45 seconds; 3 - 16 to 30 seconds; 4 - Under 15 seconds]
How this is calculated
Consky ES, Lang AE. Clinical assessments of patients with cervical dystonia. In: Jankovic J, Hallett M, eds. Therapy with Botulinum Toxin. New York: Marcel Dekker; 1994:211-237. Motor section validated in Comella CL, Stebbins GT, Goetz CG, et al. Mov Disord. 1997;12(4):570-575. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.