• Introduced in the 1950s as a diagnostic tool of spasticity
  • Originally a qualitative measure (clinician simply observed the leg swing)
  • The use of electronic equipment to generate quantitative data was introduced in the 1980’s

Clinical Considerations

  • The Wartenberg Pendulum Test is described as a measure of spastic hypertonia
  • It was proposed as a method of measuring the effects of therapeutic intervention on spasticity
  • Its usefulness and validity in any population suffering from spasms is debatable
  • Computer equipment is required. Although the test itself is quite simple, collecting quantitative information is more consuming.
  • This test has not been validated in a SCI specific population and its validity in other populations is debated

ICF Domain

Body Function ▶ Neuromusculoskeletal & Movement-related Functions and Structures

Administration

  • The patient sits on an examination table and the examiner holds the patient’s foot with the knee fully extended (as straight as possible)
  • The examiner drops the leg, and a computer records the motion and vibration

Equipment

Typical equipment used is either electro-goniometers, uni-planar video or 3D motion analysis systems.

Scoring

Using computer data for number of oscillations and amplitude, values of the Relaxation index (R1 and R2) are calculated and compared to norms.

Number of Items

1 test, recommended to be repeated up to 4 times at 1-minute intervals.

Languages

N/A

Training Required

No formal training is required. However, knowledge of spasticity is beneficial.

Availability

The Wartenberg Pendulum Test worksheet can be found here.

# of studies reporting psychometric properties: 2

Interpretability

MCID: not applicable in SCI
SEM: not applicable in SCI
MDC: not applicable in SCI

  • Lower scores indicate more severe spasticity
  • No norms have been established for the SCI population

Reliability

  • There were no significant differences between seven trials of the pendulum test performed at the end of manual muscle testing (P = .64).
  • Inter-trial reliability is High (ICC = 0.92).

(Smith et al. 2000; n=22, 21 males, 1 female; tetraplegia and paraplegia; mean (SD) time since injury: 29.8 (43.2) months)

  • The test-retest reliability is High:
    Optical Tracking System with Pendulum test (OTS): ICC = 0.932 (95% CI)
    Inertial Measurement Units with Pendulum Test (IMU): ICC = 0.925 (95% CI

(De Santis & Perez 2024; n=23; various level of injury; AIS: 5A, 2B, 6C, 10D)

Validity

  • Average manually applied velocities during the MMT were compared to muscle tone score from pendulum testing. Higher levels of muscle tone corresponded to lower applied velocities and vice versa, suggesting an inverse relationship between these two variables.
  • Correlations between pendulum test score and average velocity were significant and High for two of the three therapists and non-significant and Moderate for the third therapist (A: Pearson’s r = 0.223, P=.32; B: Pearson’s r = 0.657, P<.001; C: Pearson’s r = 0.67, P<.001). Including all three data sets gave an average correlation of 0.638 and significance level of 0.001.

(Smith et al. 2000; n=22, 21 males, 1 female; tetraplegia and paraplegia; mean (SD) time since injury: 29.8 (43.2) months)

Responsiveness

No values were reported for the responsiveness of the Pendulum test for the SCI population.

Floor/Ceiling Effect

No values were reported for the presence of floor/ceiling effects in the Pendulum test for the SCI population.

Reviewer

Dr. Carlos L. Cano-Herrera

Date Last Updated

31 December 2024

De Santis D, Perez MA. A portable system to measure knee extensor spasticity after spinal cord injury. J Neuroeng Rehabil, 2024;21(1):50
https://pubmed.ncbi.nlm.nih.gov/38594696/

Smith AW, Kirtley C, Jamshidi M. Intrarater reliability of manual passive movement velocity in the clinical evaluation of knee extensor muscle tone. Arch Phys Med Rehabil, 2000; 81: 1428-31.
http://www.ncbi.nlm.nih.gov/pubmed/11030511

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