Twstrs Rating Scale Form – Fill Out and Use This PDF

The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) serves as a clinical tool for assessing and documenting the status of patients with spasmodic torticollis, also known as cervical dystonia. Developed with a focus on comprehensive evaluation, the form encompasses sections on the severity of torticollis, the impact on disability, and associated pain levels, along with a record for injections administered. For those seeking to utilize this vital resource, a button to access the form is provided below.

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Twstrs Rating Scale Form PDF Details

In the landscape of clinical tools designed to assess neurological conditions, the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) stands out for its specific focus on spasmodic torticollis, also known as cervical dystonia. This condition, characterized by involuntary muscle contractions in the neck, can significantly impact a patient's quality of life. Developed with the support of WE MOVE and partially funded by an educational grant from Allergan, TWSTRS provides a structured method for clinicians to document the severity of torticollis, the disability it imposes, and the associated pain. The scale is comprehensive, featuring a maximum severity score of 35 across various categories such as maximal excursion, sensory tricks, and shoulder elevation, as well as a disability scale and a pain scale. Alongside the examination form, the packet includes 50 tear-off copies for practical use and a laminated card for quick reference, underscoring its utility in both research and clinical settings. The inclusion of an injection record underlines its application in monitoring treatment effectiveness, specifically in cases where botulinum toxin injections are employed. This meticulous approach to quantifying the impacts of cervical dystonia underscores the TWSTRS's vital role in enhancing patient care and facilitating ongoing research.

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Toronto Western

Spasmodic Torticollisll

Rating Scalele (TWSTRS)11

WE MOVE is pleased to provide this clinical tool for assessing and documenting the status of patients with spasmodic torticollisÑalso known as cervical dystonia. Additional scales and assessment forms are available at

www.wemove.org

This packet contains

¥50 tear-off copies of the TWSTRS examination form

¥A pocket-sized laminated TWSTRS card (at right)

¥Black-and-white versions of the examination form and pocket- sized TWSTRS card for duplication

Presented by WE MOVE

PHONE: 800-437-MOV2 (6682)

E-MAIL: wemove@wemove.org

Production funded in part by an unrestricted educational grant from Allergan.

WE MOVE makes every effort to ensure the accuracy of this publication. Since there are daily advances in medical science, WE MOVE invites you to visit the Web site at www.wemove.org for view the most recent version of this document.

Toronto Western

Spasmodic

Torticollis

Rating Scale

(TWSTRS)11

I. Torticollis Severity Scale (MAXIMUM = 35)

A. Maximal Excursion

1.Rotation (turn: right or left) 0 = None [0¡]

1 = Slight [< 1/4 range, 1¡Ð 22¡]

2 = Mild [1/4 Ð 1/2 range, 23¡Ð 45¡]

3 = Moderate [1/2 Ð 3/4 range, 46¡Ð 67¡] 4 = Severe [> 3/4 range, 68¡Ð90¡]

2.Laterocollis (tilt: right or left, exclude shoulder elevation) 0 = None [0¡]

1 = Mild [1¡Ð15¡]

2 = Moderate [16¡Ð35¡]

©WE MOVEª 2002

1. Consky ES, Lang AE. Clinical assessments of patients with cervical dystonia. In: Jankovic J, Hallett M, eds. Therapy with Botulinum Toxin. New York, NY: Marcel Dekker, Inc.:1994;211-237.

TWSTRS Examination Record [to be completed by the examiner]
Patient			Chart No.
Date	\|	\|	Time	AM PM
MONTH		DAY	YEAR	©WE MOVEª 2002

I. Torticollis Severity Scale (MAXIMUM = 35)

Rate maximum amplitude of excursion asking patient not to oppose the abnormal movement; examiner may use							S C O R E
A. Maximal Excursion distracting or aggavating maneuvers. When degree of deviation is between scores, choose the higher of the two.							S C O R E
1. Rotation	0	1	2	3	4

2. Laterocollis	0	1	2	3

3. Anterocollis or Retrocollis
a. Anterocollis	0	1	2	3
b. Retrocollis	0	1	2	3

4. Lateral shift	0	1

5. Sagittal shift	0	1

B. Duration Factor	0	1	2	3	4	5
(Weighted x 2)		(X 2)	(X 2)	(X 2)	(X 2)	(X 2)

C. Effect of Sensory Tricks	0	1	2

D. Shoulder Elevation/Anterior Displacement	0	1	2	3

E. Range of Motion	0	1	2	3	4

F. Time	0	1	2	3	4


II. Disability Scale (MAXIMUM = 30)				SUBTOTAL SEVERITY



A. Work	0	1	2	3	4	5

B. Activities of Daily Living	0	1	2	3	4	5

C. Driving	0	1	2	3	4	5

D. Reading	0	1	2	3	4	5

E. Television	0	1	2	3	4	5

F. Activities Outside the Home	0	1	2	3	4	5


				SUBTOTAL DISABILITY
III. Pain Scale (MAXIMUM = 20)
III. Pain Scale (MAXIMUM = 20)

A. Severity of Pain (worst + best + (2*usual))/4	Best ____		Worst ____		Usual ____

B. Duration of Pain	0	1	2	3	4	5

C. Disability Due to Pain	0	1	2	3	4	5

INJECTION RECORD ON REVERSE SIDE

SUBTOTAL PAIN

TOTAL TWSTRS SCORE

PHYSICIAN’S SIGNATURE

Injection Record [indicate injection sites on diagrams provided]
Patient				Chart No.
Date	\|		\|	Time	AM PM
	MONTH	DAY	YEAR			©WE MOVEª 2002
						©WE MOVEª 2002
Agent Injected:	BOTOX _____ Units/ml.	Dysport _____ Units/ml.		MYOBLOC/Neurobloc _____ Units in _____ ml.
	Muscle Injected		Units	Volume	Number of	Total	Total
	Muscle Injected		Injected	Injected	Injections	Units	Volume
			Injected	Injected	Injections	Units	Volume

Total Amount Administered _____________ Total Amount Used _____________

Electromyography Utilized?

Yes

		Semispinalis capitis m.
		Splenius capitis m.
	Sternocleidomastoid m.	Spinal accessory nerve
		Spinal accessory nerve
	Scalene muscles:	Levator scapulae m.
	Anterior	Trapezius m.
	Middle	Trapezius m.
	Middle
	Posterior
		Brachial plexus

	Semispinalis capitis m.
	Splenius capitis m.
	Spinal accessory nerve	Sternocleidomastoid m.
	Spinal accessory nerve
	Levator scapulae m.	Scalene muscles:
	Trapezius m.	Anterior
	Trapezius m.	Middle
		Middle
		Posterior
	Brachial plexus

m. = muscle

		Splenius capitis m.
		Levator scapulae m.
	Trapezius m.	Rhomboideus minor m.
		Rhomboideus minor m.
		Rhomboideus major m.
		Supraspinatus m.
Deltoid m.		Infraspinatus m.
		Infraspinatus m.
		Teres major m.
		Teres minor m.
Latissimus		Serratus anterior m.
Latissimus
dorsi m.
		Serratus posterior
		inferior m.
		Oblique internus m.
		Erector spinae m.

Semispinalis m.	Splenius capitis m.
	Sternocleidomastoid m.
	Splenius cervicalis m.
	Longissimus capitis m.
Trapezius m.	Levator scapulae m.
	Rhomboid minor m.
	Rhomboid major m.

PHYSICIAN’S SIGNATURE

Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS)

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