A comparison of the assessment of spasticity by the Wartenberg pendulum test and the Ashworth grading scale in patients with multiple sclerosis

Abstract

The Wartenberg pendulum test is an objective quantitative method for the assessment of muscle tone. We have compared the results of measurements of muscle tone using this method with traditional clinical assessments graded on the Ashworth scale. Two indices ( R 1 and R 2 ) were measured from the Wartenberg test. Both were related to readings from the Ashworth scale. The ratio R 2 (the ratio of the amplitude of the first swing to the difference in angle between the start and finish positions), however, showed a linear relationship throughout the range of spasticity tested in contrast to the curvilinear relationship shown by R 1 (the ratio of the amplitude of the first swing to the difference between the rebound angle and the start angle). Significant changes in the ratio R 2 without any corresponding change in the Ashworth grading were observed. It is concluded that the Wartenberg ratio R 2 and the Ashworth scale assess similar features of the muscle and/or its motor control, but that the pendulum test provides a more finely graded observerindependent measurement.

Modification of spasticity by transcutaneous spinal cord stimulation in individuals with incomplete spinal cord injury

“…The index correlates well with the clinical evaluation of muscle hypertonia graded on the Ashworth scale, and provides a more objective and finely graded measurement. 38 Here, mean R 2n values were averaged over the three repetitions on each side. In addition, the magnitude of total ipsilateral lower limb EMG activity generated during the pendulum test was calculated as the sum of the root mean square (RMS) of the EMG activity across the four ipsilateral muscle groups, between the onset of the maneuver, drop of leg from horizontal position, and the time when the resting angle was reached.…”

Spasticity-assessment: a review

“…[55][56][57][58][59] In its most simple form, the patient is seated or lying with the lower leg hanging over the end of a couch. The examiner then extends the leg to the horizontal position, while the patient is told to relax.…”

“…This ratio shows a clear correlation to the severity of spasticity as evaluated by the AS. 59 The advantage of the pendulum test is its simplicity, and the more refined quantification of the severity of spasticity that is obtained compared to the AS. However, it also has several drawbacks.…”

Wartenberg pendulum test: objective quantification of muscle tone in children with spastic diplegia undergoing selective dorsal rhizotomy

“…Different test positions have been studied in adults: lying supine (Jamshidi and Smith 1996), semi-supine , Leslie et al 1992 and sitting up (Katz et al 1992). Brown and collaborators studied the importance of the test position in non-disabled elderly individuals and found that the position contributed very little to the total variability (Brown et al 1988a).…”