Hello pepperstreet and welcome to the ArtRage forums 
It depends somewhat on which Wacom Tablet & Pen you have?
The Intuos Grip Pen supported: Tilt and Rotation.
The Intuos Art Pen supported: Tilt, Rotation and Barrel Roll or “twist” if you prefer.
I still use my trusty old Grip Pen that came with my Intuos4. And I can lock the Knife’s head rotation to the Pen’s OK.
The old Art Pen which was sold separately back in the day also had/has Barrel Rotation or “twist” as well. But never having had one I can’t say if the Knife head can be locked to that or not.
Maker Of Replica Macoys
Techie Stuff:
ArtRage 6.1.1 ~ 15" Macbook Pro ~ macOS 10.14.6 ~ 4 Core i7 3.1GHz CPU ~ 16GB RAM ~ Wacom Intuos4 M