{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-12T08:32:04Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 21.5, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a094bd-b7df-75e0-9462-e3e972fa941c\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: cervical dystonia\nSense to describe: (none recorded)\nDomain code: XCT.STA\nAlso known as: (none)\n\n\nContext for this batch of 1001 things:\n# Batch 043: 10", "usd": 0.0, "recall": true }, "codex": { "seconds": 68.3, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a094bd-b7e7-79f1-9ce4-8cea2e1a3c7a\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: cervical dystonia\nRegistry id: vr.tr.cervical-dystonia\nPlane / domain: XCT / XCT.STA\nRegistry definition: (none recorded)\nNames folded into this entr" } }, "enrichment": { "pass": 3, "engine": "claude", "producedAt": "2026-10-06T12:00:00Z", "ingestedAt": "2026-10-06T08:44:00+00:00", "fields": [ "agent_conduct", "ethics", "failure_modes_and_hazards", "owners", "standards_and_regulation", "visual_identification" ] }, "gate": { "passed": true, "version": "1.0", "at": "2026-10-07T10:10:32+00:00", "evidence": [ "completeness 1.00", "sense: Wikidata description", "2 live sources", "review by codex: pass" ] } }, "metaModel": { "id": "THING-Q6152510", "registryId": "vr.tr.cervical-dystonia", "name": "cervical dystonia", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q6152510/", "model": { "registry_id": "vr.tr.cervical-dystonia", "name": "cervical dystonia", "purpose": "Enable an agent to recognize a documented cervical dystonia presentation, assess its burden and course, and support clinician-directed evaluation and care.", "definition": "Cervical dystonia is a focal movement disorder characterized by sustained or intermittent involuntary contractions of neck muscles that produce abnormal, often repetitive head or neck movements and postures, sometimes with tremor and pain.", "scope_statement": "This model owns the cervical dystonia phenotype and its assessment for vr.tr.cervical-dystonia in XCT/XCT.STA: involuntary patterned head and neck movements or postures, their consequences, diagnostic uncertainty, and response to care; underlying causes and broader neurological syndromes remain linked entities.", "in_scope": [ "Pattern, direction, variability, and anatomical distribution of cervical dystonia", "Clinical evidence distinguishing dystonia from other causes of abnormal head posture", "Onset, course, associated manifestations, and suspected causes", "Neck pain, functional limitations, and patient priorities", "Treatment exposure, benefit, adverse effects, and reassessment needs" ], "out_of_scope": [ "Complete models of generalized dystonia or associated neurological diseases", "Cervical spine disease, muscular torticollis, and ocular disorders as independent conditions", "Drug manufacturing, prescribing protocols, and autonomous injection planning", "Genetic variants and inheritance mechanisms beyond their relationship to this presentation", "Detailed surgical procedures and implanted stimulation-device engineering" ], "distinguishing_features": [ "Look for involuntary, patterned head or neck deviation rather than identifying cervical dystonia from neck pain alone. [Diagnostic validation study](https://pmc.ncbi.nlm.nih.gov/articles/PMC10129917/)", "Assess whether posture reflects dystonic movement, weakness, structural restriction, or visual compensation; an abnormal head position alone is insufficient. [Diagnostic validation study](https://pmc.ncbi.nlm.nih.gov/articles/PMC10129917/)", "Record whether a light touch or other alleviating maneuver improves the posture; this supports recognition but its absence does not exclude the condition. [Clinical consensus](https://pmc.ncbi.nlm.nih.gov/articles/PMC10528915/)", "Distinguish head tremor with cervical dystonic postures from isolated head tremor, retaining uncertainty when the examination is inconclusive. [Clinical consensus](https://pmc.ncbi.nlm.nih.gov/articles/PMC10528915/)" ], "characteristics": [ { "name": "Observed cervical pattern", "kind": "category", "unit_or_values": "Rotation, lateral tilt, flexion, extension, translation, or mixed; record side and anatomical reference", "why_it_matters": "Makes the observed presentation explicit instead of relying on the ambiguous label torticollis." }, { "name": "Postural deviation", "kind": "measurement", "unit_or_values": "Degrees where measurable, with head-on-neck or neck-on-trunk reference, task, and method", "why_it_matters": "Supports comparison without conflating different anatomical movements." }, { "name": "Temporal expression", "kind": "state", "unit_or_values": "Sustained, intermittent, tremulous, or mixed; observation duration and provoking context", "why_it_matters": "Captures presentations that a single resting observation may miss." }, { "name": "Diagnostic assessment", "kind": "state", "unit_or_values": "Suspected, clinician-supported, uncertain, or revised; assessor, date, and criteria", "why_it_matters": "Separates an observed phenotype from a settled diagnostic conclusion." }, { "name": "Distribution and associated syndrome", "kind": "relation", "unit_or_values": "Affected body regions and links to associated neurological findings", "why_it_matters": "Keeps cervical involvement identifiable within a broader presentation." }, { "name": "Neck pain burden", "kind": "measurement", "unit_or_values": "Patient-reported 0-10 score with recall period, location, and assessment date", "why_it_matters": "Tracks pain independently of visible head deviation." }, { "name": "Cervical dystonia assessment score", "kind": "measurement", "unit_or_values": "Named instrument and version, component scores, assessor, and treatment-cycle timing", "why_it_matters": "Prevents comparison of incompatible scores or different phases of treatment." }, { "name": "Treatment-cycle response", "kind": "state", "unit_or_values": "Baseline, onset of benefit, best response, wearing off, or unclear; dated observations", "why_it_matters": "Distinguishes sustained burden from variation within a treatment cycle." } ], "affordances": [ "Assemble a structured movement-disorder assessment from examination and patient reports.", "Identify missing evidence or conflicting observations requiring clinician review.", "Compare posture, pain, and function across matched assessment contexts.", "Link cervical manifestations to a broader dystonia syndrome or suspected cause.", "Track clinician-directed treatment against patient priorities and adverse effects." ], "agent_conduct": { "may": [ "Explain cervical dystonia in general terms from reputable medical sources.", "Help a person find specialist movement disorder services and support groups." ], "must_not": [ "Diagnose the condition from a video of a person's movements.", "Recommend injections, medicines or surgery for a specific person.", "Mock involuntary movements or suggest they are put on.", "Disclose a person's diagnosis to employers without consent." ], "requires_human": [ "Any treatment decision." ] }, "ethics": { "considerations": [ "Visible involuntary movements expose people to stigma and are often misread as nervousness.", "Chronic pain and disability affect work and independence." ], "affected_parties": [ "Patients", "Families", "Employers and colleagues" ] }, "owners": { "steward": "Nobody owns the condition; patients and their clinicians answer for care.", "master_systems": [] }, "visual_identification": [ "Head turned, tilted or pulled forward or back by sustained neck muscle contraction.", "Sometimes with jerky head tremor or a raised shoulder." ], "failure_modes_and_hazards": [ "Chronic neck pain and fatigue.", "Difficulty driving or working when head control is poor." ], "standards_and_regulation": [ "International Classification of Diseases (ICD-11), World Health Organization." ], "what_it_is_for": [ "Cervical dystonia is encountered in neurological and rehabilitation care when involuntary neck muscle activity disrupts head posture or movement.", "Clinical assessment considers pain, movement patterns and effects on daily activities such as reading, working and maintaining visual orientation." ] }, "sources": [ { "id": "wikidata", "title": "Wikidata item Q6152510: cervical dystonia", "url": "https://www.wikidata.org/wiki/Q6152510", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Spasmodic torticollis", "url": "https://en.wikipedia.org/wiki/Spasmodic_torticollis", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "cervical-motor-phenotype", "name": "Cervical motor phenotype", "description": "Describe the actual head and neck movement pattern.", "rationale": "The registry name alone does not specify which cervical movements are abnormal.", "layers": [ { "id": "posture-and-anatomy", "name": "Posture and anatomy", "description": "Locate and describe the observed deviation.", "findings": [ { "id": "direction-and-reference", "name": "Direction and reference", "description": "Record movement direction, laterality, anatomical reference, and whether the pattern is mixed.", "questions": [ { "text": "Which rotations, tilts, flexions, extensions, or translations are observed?", "kind": "measurement", "id": "direction-and-reference-q01" }, { "text": "Does the description distinguish head movement relative to the neck from neck movement relative to the trunk?", "kind": "definition", "id": "direction-and-reference-q02" } ] } ] }, { "id": "movement-modulation", "name": "Movement modulation", "description": "Record variation across activities and alleviating maneuvers.", "findings": [ { "id": "context-and-alleviation", "name": "Context and alleviation", "description": "Capture tremulous versus sustained expression and repeatable changes during examination.", "questions": [ { "text": "How does the pattern change at rest, during walking, or during attempted head turning?", "kind": "measurement", "id": "context-and-alleviation-q01" }, { "text": "Does an alleviating maneuver change posture or tremor, and was the effect observed or only reported?", "kind": "provenance", "id": "context-and-alleviation-q02" } ] } ] } ] }, { "id": "diagnostic-boundaries", "name": "Diagnostic boundaries", "description": "Preserve the evidence and uncertainty behind recognition.", "rationale": "Diagnosis relies on clinical evaluation rather than a definitive test for isolated cervical dystonia. [Clinical consensus](https://pmc.ncbi.nlm.nih.gov/articles/PMC10528915/)", "layers": [ { "id": "clinical-attribution", "name": "Clinical attribution", "description": "Separate observed signs from diagnostic interpretation.", "findings": [ { "id": "assessment-evidence", "name": "Assessment evidence", "description": "Record who assessed the presentation and which observations support the diagnosis.", "questions": [ { "text": "Who attributed the cervical movements to dystonia, when, and using which criteria?", "kind": "provenance", "id": "assessment-evidence-q01" }, { "text": "Which observations remain inconsistent with or insufficient for that attribution?", "kind": "boundary", "id": "assessment-evidence-q02" } ] } ] }, { "id": "alternative-explanations", "name": "Alternative explanations", "description": "Document assessed mimics and unresolved alternatives.", "findings": [ { "id": "posture-and-tremor-differential", "name": "Posture and tremor differential", "description": "Record evidence concerning weakness, structural restriction, ocular compensation, tics, and isolated head tremor. [Diagnostic validation study](https://pmc.ncbi.nlm.nih.gov/articles/PMC10129917/)", "questions": [ { "text": "What evidence distinguishes the observed posture from weakness, mechanical restriction, or visual compensation?", "kind": "boundary", "id": "posture-and-tremor-differential-q01" }, { "text": "What additional examination would resolve uncertainty about isolated head tremor or another movement disorder?", "kind": "action", "id": "posture-and-tremor-differential-q02" } ] } ] } ] }, { "id": "onset-distribution-and-cause", "name": "Onset, distribution, and cause", "description": "Place cervical involvement within its clinical history.", "rationale": "Anatomical distribution, associated motor features, and cause are separate classification dimensions. [Dystonia classification consensus](https://pmc.ncbi.nlm.nih.gov/articles/PMC3729880/)", "layers": [ { "id": "onset-and-spread", "name": "Onset and spread", "description": "Track when cervical manifestations began and whether their distribution changed.", "findings": [ { "id": "cervical-course", "name": "Cervical course", "description": "Preserve onset estimates and the chronology of involvement beyond the cervical region.", "questions": [ { "text": "At what age and over what interval did the abnormal neck posture or movement emerge?", "kind": "provenance", "id": "cervical-course-q01" }, { "text": "Which additional regions show dystonia, and when were they first affected?", "kind": "boundary", "id": "cervical-course-q02" } ] } ] }, { "id": "etiologic-attribution", "name": "Etiologic attribution", "description": "Link proposed causes to supporting evidence.", "findings": [ { "id": "cause-and-associated-signs", "name": "Cause and associated signs", "description": "Keep suspected causation distinct from established findings and associated neurological syndromes.", "questions": [ { "text": "What medication exposures, family history, investigations, or neurological events support a proposed cause?", "kind": "provenance", "id": "cause-and-associated-signs-q01" }, { "text": "Which associated neurological signs require linkage to a broader syndrome model?", "kind": "boundary", "id": "cause-and-associated-signs-q02" } ] } ] } ] }, { "id": "burden-and-care-response", "name": "Burden and care response", "description": "Connect cervical manifestations to daily limitations and evaluated care.", "rationale": "The model must support decisions based on the person's priorities as well as observed movement.", "layers": [ { "id": "pain-and-function", "name": "Pain and function", "description": "Record consequences relevant to the affected person.", "findings": [ { "id": "priority-limitations", "name": "Priority limitations", "description": "Specify neck pain and concrete activities limited by head position or movement.", "questions": [ { "text": "How severe is neck or shoulder pain over a stated recall period?", "kind": "measurement", "id": "priority-limitations-q01" }, { "text": "Which activities, such as reading, working, sleeping, or looking over a shoulder, does the person most want to improve?", "kind": "action", "id": "priority-limitations-q02" } ] } ] }, { "id": "treatment-follow-up", "name": "Treatment follow-up", "description": "Organize treatment records and comparable outcome observations.", "findings": [ { "id": "benefit-tolerability-and-review", "name": "Benefit, tolerability, and review", "description": "For each documented intervention, retain treatment details, benefit timing, reported harms, and the clinician's follow-up plan.", "questions": [ { "text": "For a botulinum toxin cycle, what formulation, treated muscles, administration date, and clinician-recorded doses accompany the outcome assessment?", "kind": "provenance", "id": "benefit-tolerability-and-review-q01" }, { "text": "When did improvement begin and wear off, and how did posture, pain, and priority activities change?", "kind": "measurement", "id": "benefit-tolerability-and-review-q02" }, { "text": "What new swallowing difficulty, neck weakness, or other reported problem requires review under the treating clinician's plan?", "kind": "action", "id": "benefit-tolerability-and-review-q03" } ] } ] } ] }, { "id": "evidence-and-external-alignment", "name": "Evidence and external alignment", "description": "What the world already says about this thing, gathered so the model can be checked against it.", "rationale": "A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.", "layers": [ { "id": "reported-evidence", "name": "Reported evidence", "description": "Findings from the breadth pass, kept separate from the structural claims.", "findings": [ { "id": "evidence-confidence-notes", "name": "Check these first", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "This is a recall-based description; no sources were consulted.", "Directional patterns frequently coexist; specialist classifications also distinguish movement of the head relative to the neck from movement of the neck relative to the trunk.", "The measurement ranges are possible instrument scores, not typical patient values; verify the scale version before use." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of cervical dystonia this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-kinds", "name": "Kinds and varieties", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Rotational torticollis: predominantly turning the head", "Laterocollis: predominantly tilting the neck sideways", "Anterocollis: predominantly forward neck flexion", "Retrocollis: predominantly backward neck extension", "Mixed-pattern cervical dystonia" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of cervical dystonia this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-identifiers", "name": "Identifiers and schemes", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "scheme": "ICD-10", "value_or_pattern": "G24.3", "note": "Spasmodic torticollis; distinguish this dystonia category from codes for other causes of torticollis." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of cervical dystonia this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-real-world-use", "name": "Real-world use", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Clinical diagnosis and characterization in movement-disorders practice", "Selection of affected muscles for botulinum toxin treatment", "Assessment of pain, disability and treatment response", "Clinical trials of treatments for focal dystonia" ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of cervical dystonia this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-measurements", "name": "Typical measurements", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "quantity": "Toronto Western Spasmodic Torticollis Rating Scale total score", "typical_range": "0-85 possible on the original scale; higher scores indicate greater severity, disability and pain", "unit": "points" }, { "quantity": "Tsui scale score", "typical_range": "0-25 possible; higher scores indicate greater motor impairment", "unit": "points" } ], "questions": [ { "id": "evidence-measurements-q01", "text": "Which of these typical measurements hold for the sense of cervical dystonia this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-failure-modes-and-hazards", "name": "Failure modes and hazards", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Neck pain, restricted movement and impaired everyday activities", "Head tremor and abnormal posture interfering with visual orientation, work or driving", "Social embarrassment and reduced quality of life", "Misclassification as an orthopedic neck disorder or as essential tremor", "Treatment-related swallowing difficulty or neck weakness following botulinum toxin injections" ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of cervical dystonia this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-neighbours", "name": "Neighbouring kinds and how to tell them apart", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "name": "Dystonia", "difference": "Dystonia is the broader movement-disorder category; cervical dystonia specifically involves the neck region." }, { "name": "Torticollis", "difference": "Torticollis describes a twisted head or neck posture with multiple possible causes; cervical dystonia identifies a neurological cause involving involuntary muscle contractions." }, { "name": "Congenital muscular torticollis", "difference": "Typically presents in infancy with sternocleidomastoid shortening or imbalance rather than a dystonic movement disorder." }, { "name": "Essential tremor", "difference": "Dystonic head tremor is associated with dystonic postures or movements; distinguishing isolated head tremor can require specialist assessment." }, { "name": "Tardive dystonia", "difference": "Defined by its association with exposure to dopamine receptor-blocking drugs; it can have a cervical distribution and therefore overlap with cervical dystonia." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of cervical dystonia this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Which diagnostic criteria should govern this registry model across isolated, acquired, and combined presentations, given the narrower scope of the isolated cervical dystonia consensus?", "How should isolated head tremor with equivocal cervical posturing be represented pending longitudinal reassessment?", "Which anatomical terminology and observation protocol best support reproducible head-on-neck versus neck-on-trunk descriptions?", "Which assessment instruments and change thresholds best capture meaningful improvement across posture, pain, and patient-prioritized function?", "What evidence is sufficient to distinguish treatment nonresponse from targeting issues, assessment timing, or an incorrect initial diagnosis?" ], "statistics": { "bundles": 5, "layers": 9, "findings": 15, "questions": 24 } }