Investigations into the potential for using reciprocal pedalling exercise to assess, measure and enhance lower limb function after stroke.

Upright Pedalling (UP) exercise offers opportunities for stroke survivors to participate in functional, repetitive lower limb activity with similarities to walking. Such functional activity is required to enhance the brain changes underlying recovery of motor function after stroke. UP might also offer opportunities for assessment and measurement of lower limb impairment during functionally-relevant activity. A systematic review using Cochrane methodology investigated effects of reciprocal pedalling (RP) on lower limb motor function after stroke. Despite some beneficial, though not definitive, effects, it was not possible to make clinical recommendations supporting or refuting RP after stroke, due to inter-study heterogeneity, wide confidence intervals around effect sizes and risks of potential biases. A feasibility study investigated participation in Upright Pedalling (UP) by people in the first month after stroke, with substantial weakness and not able to walk, and explored characterisation of lower limb movement during UP. 84.6 % (n=11) of people tested were able to participate in UP. Smooth, reciprocal pedalling was evident in stroke survivors with substantial weakness, using heterogeneous patterns. Though 84.2% (n=16) of those approached consented to participate, attrition was high due to service reorganisation, with 2.2% (n=9 of 411) of those screened actually randomised. A prospective measurement study explored the reliability and discriminative ability of impairment measures derived during instrumented UP (smoothness of pedalling, muscle activation timing, reciprocity of muscle activity). Results indicated that instrumented UP could be used to discriminate between stroke survivors and healthy age-matched volunteers for timing of onset and offset muscle activation (multi-variate ANOVA, difference in activity according to wheel position, p=0.034) and reciprocal activation (two sample t-test, difference -0.249 (CI: -0.491, -0.010; p=0.044) for quadriceps. It was not possible to establish definitive test-retest repeatability with sufficient precision to make clinical recommendations. UP is a new, promising technology for assessment, rehabilitation and measurement that is worthy of future investigation.

Name dc:type.qualificationname

phd

Level dc:type.qualificationlevel

doctoral

Grantor dc:publisher.institution

University of East Anglia

Year dc:date.issued

2013

Author dc:creator

• Hancock, Nicola

Language dc:language

en