TEACHING TAPE FOR THE MOTOR SECTION OF THE TORONTO WESTERN SPASMODIC TORTICOLLIS SCALE

The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) assess es the character and severity of cervical dystonia (CD). We developed a teaching tape of the TWSTRS scoring for the motor symptoms of CD. Th e tape provides investigators with visual representations of each comp onent of the motor section of the TWSTRS as agreed upon by three indep endently scoring raters. The rate of agreement for the nondichotomous components was always significant, with a Kendall's coefficient of con cordance W ranging between 0.98 and 0.76 (p < 0.01 for all measures). For the two dichotomous components, a weighted kappa coefficient was a lso significant at 0.86 for lateral shift and 0.89 for sagittal shift (p < 0.01 for both measures). Scale deficiencies identified by the rat ers 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 tr icks. These observations should be taken into account in future revisi ons of the TWSTRS and in refinements of other rating scales for CD.