Instrument and method of measuring torticollis

An instrument and method are provided for the simultaneous measurement of torticollis characteristics, namely, head turn, head tilt and head bend. A vertical protractor is provided for measuring both patient head tilt in a sagittal plane of a patient body and patient head bend in a frontal plane of a patient body. A horizontal protractor provides for measuring patient head turn in a transverse plane of a patient body. When used in combination, the vertical and horizontal protractors provide simultaneous measurement of either head turn or head bend or head turn and head tilt.

Torticollis is a contracted state of the cervical muscles which produce a 
twisting of the muscles and an unnatural position of the head. Torticollis 
may result from a number of conditions, for example, congenital 
torticollis is due to injury to the sternocleidomastoid muscle on one side 
at the time of birth and its transformation into a fibrous cord which 
cannot lengthen with the growing neck. Ocular torticollis is due to a high 
degree of astigmatism or to ocular muscle palsy. Spasmodic torticollis is 
that which is due to spasms of certain muscles which occurs 
intermittently. 
Botulinum toxins have been used to treat spasmodic torticollis and in that 
regard, it is necessary to provide a measurement tool for measuring 
improvement in the cervical range of motion which can provide objective 
measurements of improvement in range of motion. 
Such measurements are necessary in order to develop a treatment plan, 
monitor patient progress, and evaluate the effectiveness of the treatment. 
It is necessary to determine the range of motion about three axes of 
rotation in order to obtain a complete assessment of a patient's 
condition. 
In addition to photography for documentation of torticollis, many 
instruments have been developed to measure head turn, head tilt and head 
bend. Many of these instruments have included means for attaching the 
device to an individual. Often in these devices, the reproducibility of 
measurement is difficult since there are no established internal 
references. 
In addition, heretofore attempts to develop measurement devices for 
cervical range of motion have resulted in intricate apparatus which is not 
only expensive to produce, but complicated in its operation, often 
requiring special techniques to be learned by a clinician. 
Thus, a simple apparatus and protocol for measuring head turn, head tilt 
and head bend, preferably in a simultaneous manner, is needed to obtain 
objective and comparative measurements of cervical range of motion which, 
in turn, permits objective evaluation of a treatment plan. 
SUMMARY OF THE INVENTION 
An instrument in accordance with the present invention for the simultaneous 
measurement of torticollis characteristics, namely head turn, head tilt, 
and head bend, may include a vertical protractor which provides means for 
measuring both a patient's head tilt in a sagittal plane of the patient's 
body and patient's head bend in a frontal plane of the patient's body. 
In combination therewith, a horizontal protractor provides means for 
measuring a patient's head turn in a transverse plane of the patient's 
body. Particularly, the vertical protractor includes a scale graduated in 
arcuate degrees in a plane from an ordinal line to an abscissanal line; 
and a horizontal protractor includes a scale graduated in arcuate degrees 
from an ordinal line to an abscissanal line. 
Additionally, the horizontal protractor is of sufficient size for enabling 
manual positioning of the horizontal protractor adjacent the vertical 
protractor at approximately a right angle therebetween with the patient's 
head disposed between the horizontal protractor and the vertical 
protractor. 
More particularly, the horizontal protractor may include a cutout portion 
for enabling the horizontal protractor to be disposed under the chin of a 
patient, and the vertical protractor may include a positionable arrow, 
which may be rotatably mounted at the intersection of the ordinal and 
abscissanal lines for indicating either patient head tilt or patient head 
bend. 
Still more particularly, the vertical protractor's scale graduations may 
include lines extending from the intersection of the coordinate and 
abscissanal lines to a semicircular line interconnecting the ordinal and 
abscissanal lines. 
Further, the vertical protractor may include a measurement area bounded by 
the semicircular line and the abscissanal line which is greater than the 
cross-sectional area of the patient's head in both a frontal plane and a 
sagittal plane of the patient's head. This feature facilitates the 
assessment or measurement of head tilt or head bend, as hereinafter 
described in greater detail. 
The vertical protractor area may extend from the intersection of the 
ordinal and abscissanal lines to the semicircular line. This provides for 
an arrow length extending significantly past an outline of the patient's 
head to facilitate accurate measurement of head tilt and head bend. 
The horizontal protractor scale graduation may include lines extending from 
the cutout portion to a semicircular line interconnecting the ordinal and 
abscissanal lines. Further, the horizontal protractor measurement area, 
which is bounded by the semicircular line, the cutout portion and the 
abscissanal line, is greater than the cross-section of the patient's head 
in a transverse plane of the patient's head. This facilitates measurement 
of a patient head turn. 
A method in accordance with the present invention for simultaneously 
measuring torticollis characteristics includes the steps of positioning a 
vertical protractor behind a patient's head and a supporting horizontal 
protractor adjacent the vertical protractor at approximately a right angle 
therewith, with the patient's head therebetween. 
More particularly, the method includes the step of positioning a patient 
with a frontal plane of the patient parallel with the vertical protractor 
and thereafter measuring the patient's head bend in the frontal plane with 
the vertical protractor and measuring the patient's head turn in the 
transverse plane with the horizontal protractor. 
Specifically, a method in accordance with the present invention may include 
the alignment of a moveable arrow disposed on the vertical protractor with 
an angle of the patient's head bend. In addition, the step of measuring 
the patient's head turn may include positioning a portion of the 
horizontal protractor under each end of the patient's head. 
Alternatively, a method in accordance with the present invention may 
include the positioning of a patient with the sagittal plane of the 
patient parallel with the vertical protractor and thereafter measuring the 
patient's head tilt in the sagittal with the vertical protractor while 
measuring the patient's head turn in the transverse plane on the patient 
body with the horizontal protractor. 
As with simultaneous measurement of head bend and head turn, the method of 
simultaneously measuring head tilt and head turn may include aligning a 
movable arrow disposed on the vertical protractor with the angle of the 
patient head tilt.

DETAILED DESCRIPTION 
Turning now to FIG. 1, there is illustrated a patient head 10 and a patient 
body 12, illustrating a frontal plane 16, a sagittal plane 18, and a 
transverse plane 20, in which torticollis may be measured. 
As hereinafter shown in greater detail, head turn is defined by rotation in 
the transverse plane, as illustrated by the arrow 24; head bend is 
movement in the frontal plane, as illustrated by the arrow 26; and head 
tilt in the sagittal plane is illustrated by the arrow 28. 
Turning now to FIG. 2, there is shown a vertical protractor 32 which 
provides means for measuring both patient head tilt and patient head bend. 
As hereinafter described, the vertical protractor 32 includes a scale 34 
graduated in arcuate degrees in a plane from an ordinal line 36 to an 
abscissanal line 38. 
As will be hereinafter discussed in greater detail, the vertical protractor 
32 includes a measurement area 40 bounded by a semicircular line 42 and 
the abscissanal line 38 which is greater than a cross-sectional area of 
the patient head 10 in both frontal plane 16 and sagittal plane 18. As 
hereinafter shown, this facilitates measurement of both head bend and head 
tilt. 
Also shown in FIG. 2 is a positionable arrow 50 rotatably mounted at an 
intersection 52, the ordinal line 36, and abscissanal line 38, which 
provides a means for indicating either patient head tilt 28 or patient 
head bend 26 (see FIG. 1), as will be hereinafter described and 
illustrated. 
Turning now to FIG. 3, there is shown a horizontal protractor 54 which 
provides means for measuring patient head turn 24 and, in combination with 
vertical protractor 32, provides a means for simultaneously measuring both 
patient head turn 24 and patient head bend 26, or patient head turn and 
patient head tilt 28, as hereinafter described in greater detail. 
The horizontal protractor 54 includes a scale graduated in arcuate degrees 
from an ordinal line 58 to an abscissanal line 60. In addition, a cutout 
portion 64 provides means for enabling the horizontal protractor to be 
disposed under a chin 66 of a patient's head 10, as more clearly 
illustrated in FIGS. 4 and 5. 
As also shown in FIGS. 4 and 5, the horizontal protractor 54 is of a size 
enabling manual positioning of the horizontal protractor adjacent the 
vertical protractor 32 (see FIGS. 4 and 5) at approximately right angles 
with the vertical protractor 32 with the patient head 10 disposed between 
the horizontal protractor 32 and the vertical protractor 54. 
As shown in FIGS. 4 and 5, the vertical protractor 32 may be positioned in 
a vertical alignment behind patient head 10 and the horizontal protractor 
54 handheld by the patient. As shown in FIGS. 3 and 5, the horizontal 
protractor 54 includes scale graduations 70 extending from the cutout 
portion 64 to a semicircular line 72, intersecting the abscissanal line 
60. Further, the measurement area 74, bounded by the semicircular line 72 
of the cutout portion 64 and the abscissanal line 60, is greater than a 
cross-section of the patient's head 10 in the transverse plane 20 in order 
to facilitate the measurement of head turn 24, shown in FIGS. 1, 4, 5. 
Turning again to FIGS. 4 and 5, there is shown a method in accordance with 
the present invention for simultaneously measuring head bend and head turn 
(FIG. 4) and simultaneously measuring head tilt and head turn (FIG. 5). 
As illustrated in FIG. 4, a method in accordance with the present invention 
includes positioning a vertical protractor 32 behind a patient's head 10 
and supporting a horizontal protractor 54 adjacent the vertical protractor 
32 at approximately a right angle therewith, with the patient's head 10 
therebetween. 
In the simultaneous measurement of head turn and head bend, the patient is 
positioned with the frontal plane 16 approximately parallel with the 
vertical protractor 32. Thereafter, the patient head bend in the frontal 
plane is measured with the vertical protractor utilizing the moveable 
arrow 52 indicating the angle of the patient's head bend. 
Simultaneously, the patient's head turn is measured by observing such head 
turn against the horizontal protractor 54. It should be noted in this 
regard that the cutout portion 64 enables the horizontal protractor to be 
positioned in an almost abutting relationship with the vertical protractor 
54. This feature effectively isolates the patient's head 10 so that 
objective measurement of head turn and head bend may be made without 
obfuscation by the patient body 12 contortion, if any. 
FIG. 5 illustrates a method in accordance with the present invention of the 
simultaneous measurement of head tilt 28 and head turn 24. Similar to the 
procedure illustrated in FIG. 4, the vertical protractor 32 is positioned 
behind the patient head 10, and the horizontal protractor 54 is supported, 
or positioned, adjacent the vertical protractor, at approximately a right 
angle therewith, with the patient head 10 therebetween. 
In this method, the patient is positioned with the sagittal plane 18 
parallel with the vertical protractor 32. Patient head tilt 28 is measured 
utilizing the movable arrow 50 and patient head turn is measured with the 
horizontal protractor 54, as hereinabove described. 
Although there has been hereinabove described a particular arrangement of 
an instrument and method for the simultaneous measurement of torticollis 
characteristics for the purpose of illustrating the manner in which the 
invention may be used to advantage, it should be appreciated that the 
invention is not limited thereto. Accordingly, any and all modifications, 
variations, or equivalent arrangements which may occur to those skilled in 
the art, should be considered to be within the scope of the present 
invention as defined in the appended claims.