Clinical and goniometric evaluation of patients with spasmodic torticollis

Background. Patients with cervical dystonia have been evaluated prospectively by the Toronto Western Spasmodic Torticollis Rating Scale and by cervical electrogoniometry. Methods. Nineteen patients with cervical dystonia were studied. The Toronto Scale interobserver reliability was evaluated by two observers. An electrogoniometer was used to quantify cervical range of motion and velocity. The correlation between goniometric measurements and clinical evaluation was calculated. Findings. The interobserver reliability was excellent for the total score (rs = 99) and good for the disability and the pain score (r > 0.88). However, global severity scale was shown to have a moderate reliability (r = 0.63) with r ranging from 0.37 to 0.98 for the individual items. The average loss of range of motion for flexion and extension, lateral bending and rotation was 18%, 12% and 21% respectively. For the velocity of movement, the average loss was proportionately greater than for the range of motion. (41%, 43% and 52% respectively). Correlation between the severity scale and range of motion was moderate but significant (rs = −0.52 to −0.67). Correlation between the Toronto severity score and the sum of movement velocities was significant for flexion–extension and lateral bending velocity sums (rs = −0.51; rs = −0.61). The lateral bending and rotation velocities were significantly correlated with pain and total scores (rs = −0.51). No significant correlation was observed for the disability score. Interpretation. Three-dimensional electrogoniometry is helpful to quantify the velocity of neck movements and range of motion in patients with cervical dystonia.