title: Novel application of a Wii remote to measure spasticity with the pendulum test: Proof of concept.
abstract: 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<R(2)<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.
  
  
  CONCLUSIONS
  Our findings suggest that the Wii remote may serve as a convenient and cost-efficient tool for the assessment of spasticity.
authors.affiliation: Department of Electrical Engineering, National Central University, Taoyuan City 32001, Taiwan; Research Center for Adaptive Data Analysis, National Central University, Taoyuan City 32001, Taiwan; Center for Dynamical Biomarkers and Translational Medicine, National Central University, Taoyuan City 32001, Taiwan; Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115, USA.
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Yeh
authors.affiliation: Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei Medical University, Taipei 110, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
authors.forename: Chi-Yao
authors.initials: CY
authors.lastname: Hung
authors.affiliation: Research Center for Adaptive Data Analysis, National Central University, Taoyuan City 32001, Taiwan; Center for Dynamical Biomarkers and Translational Medicine, National Central University, Taoyuan City 32001, Taiwan.
authors.forename: Yung-Hung
authors.initials: YH
authors.lastname: Wang
authors.affiliation: Research Center for Adaptive Data Analysis, National Central University, Taoyuan City 32001, Taiwan; Center for Dynamical Biomarkers and Translational Medicine, National Central University, Taoyuan City 32001, Taiwan.
authors.forename: Wei-Tai
authors.initials: WT
authors.lastname: Hsu
authors.affiliation: Research Center for Adaptive Data Analysis, National Central University, Taoyuan City 32001, Taiwan; Center for Dynamical Biomarkers and Translational Medicine, National Central University, Taoyuan City 32001, Taiwan; Graduate Institute of Communication Engineering, National Taiwan University, Taipei 10617, Taiwan.
authors.forename: Yi-Chung
authors.initials: YC
authors.lastname: Chang
authors.affiliation: Research Center for Adaptive Data Analysis, National Central University, Taoyuan City 32001, Taiwan; Center for Dynamical Biomarkers and Translational Medicine, National Central University, Taoyuan City 32001, Taiwan.
authors.forename: Jia-Rong
authors.initials: JR
authors.lastname: Yeh
authors.affiliation: Department of Electrical Engineering, National Central University, Taoyuan City 32001, Taiwan; Research Center for Adaptive Data Analysis, National Central University, Taoyuan City 32001, Taiwan; Center for Dynamical Biomarkers and Translational Medicine, National Central University, Taoyuan City 32001, Taiwan.
authors.forename: Po-Lei
authors.initials: PL
authors.lastname: Lee
authors.affiliation: Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Kun
authors.initials: K
authors.lastname: Hu
authors.affiliation: Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei Medical University, Taipei 110, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan. Electronic address: kang.jiunnhorng@gmail.com.
authors.forename: Jiunn-Horng
authors.initials: JH
authors.lastname: Kang
authors.affiliation: Research Center for Adaptive Data Analysis, National Central University, Taoyuan City 32001, Taiwan; Center for Dynamical Biomarkers and Translational Medicine, National Central University, Taoyuan City 32001, Taiwan; Institute of Translational and Interdisciplinary Medicine and Department of Biomedical Sciences and Engineering, National Central University, Taoyuan City 32001, Taiwan. Electronic address: mzlo@ncu.edu.tw.
authors.forename: Men-Tzung
authors.initials: MT
authors.lastname: Lo
mesh_terms: D000328:Adult; D000368:Aged; D053587:Arthrometry, Articular / Q000295:instrumentation*; D016022:Case-Control Studies; D005260:Female; D006429:Hemiplegia / Q000503:physiopathology*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D020521:Stroke / Q000503:physiopathology*; D018910:Video Games
keywords: Pendulum test; Spasticity; Stroke; Wii remote