I attach a very interesting paper in relationship with your question:

Pang D. Atlantoaxial rotatory fixation. Neurosurgery. 2010 Mar;66(3 Suppl):161-83.

Thank you Cesar Calvo.  I will read through it

The simple thing could be to adapt the "bucket test" proposed for the assessment of the subjective visual vertical.(see attached file).At least it is simple and cheap. Second possibility would be to see with Polhemus for 3-D-tracking, which was can be used to determine 3-D- coordinates, but may be expensive and require additional software.

You can use 2D Kinematic Software "Kinovea", available free at www.kinovea.org .

You might use the same measurements that are used for infants/children with CMT, I have used it for adults with neglected CMT.

https://www.researchgate.net/publication/5551352_Reference_values_for_range_of_motion_and_muscle_function_of_the_neck_in_infants?ev=prf_pub

Article Reference Values for Range of Motion and Muscle Function of ...

Thank you Dr. Dirk, Prasanth and Ms Anna. I will read through it.

The easiest way is to draw an imaginary horizontal and vertical line and then you can estimate the angle of the tilt. As long as it is the same person who sees the patient at consecutive visits, this should be enough to evaluate treatment effectiveness.

Hi katalin,

Thank you for your answer. I am exactly looking for some good supporting articles for the same you have mentioned. I have a thought of using imaginary line and other idea I have got is why cant we use an Inch tape to measure the distance between sternal notch and mid portion of chin for measuring rotation. 

Also, Idea of drawing a imaginary line with patients Photo will work?  Is there any software for it?

You can use a tape as long as for each visit of a certain patient he same person evaluates (also you have to make sure to put the marks to the same place every visit). I do not think patients photo method works, as you van not be sure that you have taken the photo from exactly the same angle. I don't think there is an article about this, but, not that I know of anyway.

Thank you for your suggestions 

You can read this article and see if it can be transferred to an adult.

Pediatr Phys Ther. 2010 Winter;22(4):399-406. doi: 10.1097/PEP.0b013e3181f9d72d.

Reliability of still photography measuring habitual head deviation from midline in infants with congenital muscular torticollis.

Rahlin M1, Sarmiento B.

Thank you Anna M ohman.

Dear

I send a information  but in Portuguese

 Dear Amelia, 

Thanks for your effort.  Actually I am looking for measuring combined movement measuring methods. Especially, patients with spasmodic torticollis will have mixed pattern of the head posture eg. Lateral flexion with rotation  or retro Collis with rotation. So it is difficult to measure since it is not an isolated movement. 

I am looking for a reliable or acceptable method which is easier to use in clinical set up. 

I suggest that you video tape to see function, before and after, and also measure PROM in standardised positions. To measure also adults in lying works well as they relax better in this position, head outside the bunk when measuring rotation and also when examine lateral flexion but measuring lateral flexion lying on a big protractor. I have 28 year old male I do that with now, works good, but he has a neglected CMT.

Yes. I am doing video tape. As you suggested measuring in lying will be more relaxed for the muscles. 

Hi,

 You need a pressure platform consisting of four plates under the foot, two in front, two in back. A pair for each foot. Each plate should have bottom and top pressure bridge sensors mounted on them. combination of these pressure sensors will give you axial rotation, forward backward movement and so on. There are commercial movement platforms available, you have to look for them.

Plates under the foot measuring cervical rotation???

Please send an example on this

Hi is looking for: "Actually I am looking for measuring combined movement measuring methods", cervical movements do have an impinged effect on plates if they are standing on plates. However, data calculation from the pressure sensors are needed.

These pressure sensor are so sensitive that can pick minute fluctuations.

I have not measured cervical movements as such, but have seen sensitivity of these plates in picking minute body movements.

To measure cervical, Neck rotation in a human with foot plates seems odd

do you have any link?

Taking video of the patient is only going to give you a measure of activity and is not analytical data. You can only say there is movement and categorising it as mild to severe. Alternatively, measurement of EMG from muscle would be a better way of measuring movement activity. If these movements are involuntary movements and patients are standing on a foot platform, surely such movements are reflected on the standing posture, hence some kind of activity in the pressure sensors!

Ahmad dont you think it is better to measure with a protractor or some kind of goniometer?

Still seems odd to measure degrees of cervical rotation in proposed way, please send a link so that I can understand if there is any meaning with your proposal.

He states that these movements are complex and have axial rotation components. Protractor or goniometer need a reference point, I would think it would be difficult to find a reference point for different patients and different movements. Perhaps a method that can give an indicator of activity such as MNG or Posture platform can give a better analytical result. You only need to med search to see such uses. I leave it to him to find such studies.

Thank you for your feed back Ahmad and Anna. Most of our research done on these topics were utilizing tools which is not feasible in small clinical set up. The reason for my question here to evaluate the range of motion in Spasmodic torticollis is not only to grade the prognosis. It even helps the Neurologist to determine the dose of Botox for subsequent sessions, depends on the patient improvement in their tilt and rotation.    

I have tried measuring with simple assessment of using inch tape to measure the distance with reference point as sternal notch(between two SC joint) and to the mental area( midline of chin) for measuring rotation.

Where as to measure the lateral tilt from same sternal notch to the mastoid process of tilted side.        

Though, these assesment is not reliable of measuring range of motion. But looks simple to me for grading the prognosis.

Would the Halo digital goniometer be useful?  www.halomedicaldevices.com    the laser pointers can help standardise the vertical or horizontal reference points.