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International Parkinson and Movement Disorder Society
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Toronto Western Spasmodic Torticollis Rating Scale and Psychiatric Screening Tool (TWSTRS-2 &TWSTRS-PSYCH)

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Revised Toronto Western Spasmodic Torticollis Rating Scale and Psychiatric Screening Tool (TWSTRS-2 &TWSTRS-PSYCH) 


Authors of TWSTRS-2: Cynthia L. Comella MD; Glenn T. Stebbins PhD; Kailash P. Bhatia FRCP; Susan H. Fox MRCP, PhD; William M. McDonald MD

Authors of TWSTRS-PSYCH: Mateusz Zurowski MD, MSc, FRCP; William M. McDonald MD; Laura Marsh MD; Cynthia L. Comella MD; Glenn T. Stebbins PhD; Hyder A. Jinnah MD, PhD

The TWSTRS-2 is a revision of the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) originally developed in the 1990s. The revision to address identified deficiencies was made by a committee of dystonia experts at a dystonia rating scales workshop organized by the Dystonia Medical Research Foundation. Following further validation testing, certain items were deleted, resulting in the final TWSTRS-2 as a simplified scale to be used efficiently in a clinical study. 

The TWSTRS-PSYCH was developed during the same workshop as a first of its kind screening tool to evaluate psychiatric features associated with cervical dystonia. The TWSTRS-PSYCH demonstrated good clinimetric properties.

The TWSTRS-2, TWSTRS-PSYCH, and the previously validated Cervical Dystonia Impact Profile (CDIP-58) were combined to produce the modular Comprehensive Cervical Dystonia Rating Scale (CCDRS), which measures motor severity, disability, pain, psychiatric disorders, and quality of life. The components can be used separately or together as a complete scale. The CDIP-58 is not managed by MDS.

Original PublicationView the Scale (PDF)

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Year Published: 2016

Scale Last Updated: No updates since publication

Assessment Type: ClinRO

Estimated Time to Complete: 15 minutes

Available Translations: None


Additional Scale Publications:

Clinimetric Testing of the Comprehensive Cervical Dystonia Rating Scale
Comella CL, Perlmutter JS, Jinnah HA, Waliczek TA, Rosen AR, Galpern WR, Adler CA, Barbano RL, Factor SA, Goetz CG, Jankovic J, Reich SG, Rodriguez RL, Severt WL, Zurowski M, Fox SH, Stebbins GT.
April 2016
Movement Disorders, 31(4):563-569.

Development of the Comprehensive Cervical Dystonia Rating Scale: Methodology
Comella CL, Fox SH, Bhatia KP, Perlmutter JS, Jinnah HA, Zurowski M, McDonald WM, Marsh L, Rosen AR, Waliczek T, Wright LJ, Galpern WR, Stebbins GT.
June 2015
Movement Disorders Clinical Practice, 2(2):135-141.

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