Pilot feasibility study of a semi-automated three-dimensional scoring system for cervical dystonia

PLoS One. 2019 Aug 8;14(8):e0219758. doi: 10.1371/journal.pone.0219758. eCollection 2019.

Abstract

The objective of this study is to test the feasibility of a semi-automated scoring system for the Toronto Western Spasmodic Torticollis Scale (TWSTRS) severity scale in patients with cervical dystonia. The TWSTRS requires training and experience. We previously developed a system to measure neck angle by analyzing three-dimensional position, obtained using Kinect, a marker-less three-dimensional depth sensor. The system can track patients' faces and bodies, automatically analyze neck angles, and semi-automatically calculate the TWSTRS severity scale score. We compared the TWSTRS severity scale scores calculated by the system with the video-based scores calculated by a neurologist trained in movement disorders. A correlation coefficient analysis was then conducted. Absolute accuracy was measured using intra-class correlation (ICC) (3,1), with 95% limits of agreement. To analyze the subscales, Cohen's kappa coefficient (κ) was calculated. A p-value of < .05 was considered statistically significant. Thirty patients were enrolled. Their average age was 52.3±16.0 years, and the male to female ratio was 3:2. The average disease duration was 11.3±12.7 years. Total score measurements by the system were significantly correlated with those rated by the movement disorder-trained neurologist (r = .596, p < .05). There was a significant correlation (r = .655, p < .05) with regard to the automated part of the scale. An adequate ICC (3,1) of .562 was obtained for total severity score (p < .001, 95% confidence interval [CI]: .259-.765), while the equivalent score was .617 for the total automated part (p < .001, 95% CI .336-.798). Our three-dimensional motion capture system, which can measure head angles and semi-automatically calculate the TWSTRS severity scale score utilizing a single-depth camera, demonstrated adequate validity and reliability. This low-cost and portable system could be applied by general practitioners treating cervical dystonia to obtain objective measurements.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Feasibility Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Movement Disorders / diagnosis
  • Neurologic Examination / methods
  • Pilot Projects
  • Reproducibility of Results*
  • Severity of Illness Index*
  • Torticollis / diagnosis*
  • Torticollis / diagnostic imaging*
  • Treatment Outcome

Grants and funding

This study was supported by a grant from Novartis Pharma (Novartis Research Grants; 2015, 2016). The funders had no role in study design, data collection or analysis, decision to publish, or manuscript preparation.