Novel application of a Wii remote to measure spasticity with the pendulum test: Proof of concept

Background: The pendulum test is a standard clinical test for quantifying the severity of spasticity. In the test, an electrogoniometer is typically used to measure the knee angular motion. The device is costly and difficult to set up such that the pendulum test is normally time consuming. Objective: The goal of this study is to determine whether a Nintendo Wii remote can replace the electrogroniometer for reliable assessment of the angular motion of the knee in the pendulum test. Methods: The pendulum test was performed in three control participants and 13 hemiplegic stroke patients using both a Wii remote and an electrogoniometer. The correlation coefficient and the Bland-Altman difference plot were used to compare the results obtained from the two devices. The Wilcoxon signed-rank test was used to compare the difference between hemiplegia-affected and nonaffected sides in the hemiplegic stroke patients. Results: There was a fair to strong correlation between measurements from the Wii remote and the electrogoniometer (0.513<R²<0.800). Small but consistent differences between the Wii remote and electrogoniometer were identified from the Bland-Altman difference plot. Within the hemiplegic stroke patients, both devices successfully distinguished the hemiplegia-affected (spastic) side from the nonaffected (nonspastic) side (both with p<.0001*). In addition, the intraclass correlation coefficient, standard error of measurement, and minimum detectable differences were highly consistent for both devices. Conclusion: Our findings suggest that the Wii remote may serve as a convenient and cost-efficient tool for the assessment of spasticity.