Are You At Risk?

Ever wonder if you
are at risk for developing the most common form of dystonia?

It’s called cervical dystonia, also called Spasmodic Torticollis
(ST), which involves twisting and turning of the neck along with a
great deal of associated pain.

Take our online CD Risk Assessment Tool and find
out today!

Are You or a Loved One at Risk for
CD?

Name ______________________________ Today’s Date _______

How to complete this Risk Assessment Tool :

1. Read each statement carefully.
2. Check all the statements that apply to you.
3. Enter the number of points shown for each of your checked
   statements in the space to your right.
4. Add up all your points to reach your total CD Risk Score.
5. Share your results with your physician or other healthcare
   provider.

Add 1 point for each of the following statements that apply
to you :

• Are You Female? ___
• Are you between the ages of 30 to 60? ___
• Do you experience neck pain with restricted mobility? ___
• Do you experience involuntary twisting or turning of your neck in
  a certain direction? ___
• Do you experience head shaking or jerk-like movements ?___
• Has a healthcare professional ever informed you that you have
  “wry neck?“ ___
• Have you ever experienced a neck injury resulting from a fall,
  motor vehicle or other accident? ___
• Have you ever been exposed to anti-nausea medications such as
  Reglan or Compazine? ___
• Have you ever been exposed to anti-psychotic medications such as
  Haldol? ___
• Do you have a family history of a movement disorder such as
  Tremor, Parkinsons disease or dystonia? ___

Add up all your points to get your total CD Risk Score ___

What does Your CD Risk Score mean?

• 0 to 3: Low Risk
• 4: Moderate Risk
• 5+: High Risk

What should I do about my CD Risk Score?

• A Low Risk means that you may not be at risk for CD, but it would
  be a good idea to reassess your risk for CD during your regular yearly
  annual exams.
• Moderate Risk means that you should share this tool and your
  results with your healthcare provider as soon as possible to prevent
  mis-diagnosis.
• Your High Risk score means that you that may have CD and require
  a thorough evaluation by a movement disorder specialist. Talk to a
  healthcare professional today about CD - the First Step to Diagnosis of
  CD.

Note: CD = cervical dystonia = ST = torticollis

Copyright C4D, 2007-10