Benefits of Cycling Wheelchair Training for Elderly with Physical Disability: A Prospective Cohort Study

AIM

In order to investigate the effect of cycling wheelchair training as an exercise for aged 65+ disabled patients on cognitive function, quality of life, aerobic capacity and physiological parameters.

METHODS

Participants in nursing home performed cycling wheelchair training for 30 min a day, 5 days a week, for a total of 4 weeks. The main outcome measure was the short form 12 survey (SF-12). Other outcome measures included the Mini-Mental State Examination (MMSE), aero bike work rate test, resting blood pressure, and heart rate.

RESULTS

In this study, 41 volunteers were recruited and no participants dropped out of the study voluntarily during training, and no serious adverse effect was identified. Physical and mental component summary total scores of SF-12 were significantly higher after training with statistical significance (p = 0.001). 8 subscales also showed significant improvements after training (p = 0.025 ~ <0.001). Total MMSE score has no difference before and after training. Attention/calculation (p = 0.018), short term memory (p = 0.041), and aerobic capacity (p < 0.001) as measured by subscales of MMSE and aero bike test showed marked improvements, while resting systolic blood pressure (p = 0.931) and heart rate (p = 0.793) did not change.

CONCLUSIONS

Cycling wheelchair is practical for the disabled elderly to exercise, and a 4-week exercise program enhanced their quality of life and aerobic capacity.

Different temporal weight-bearing tendencies of persons with right and left hemiplegia while sitting in a wheelchair

The tendency of persons with hemiplegia to sit for prolonged periods can cause excessive interface pressure (IP) on their buttocks. Due to the different neuromusculoskeletal conditions, different buttock IP relief methods are required for persons with left hemiplegia (LH) and right hemiplegia (RH). Therefore, this study investigates temporal characteristics of IP on the right and left buttocks for RH, LH, and able-bodied individuals (AB) sitting in a wheelchair for 30 min. Thirty-five males participated in the study: 13 LH, 12 RH, and 10 AB. In the initial adjustment phase, the participants maintained an erect sitting posture for 7 min (2 min for posture and 5 min for creep adjustments). After the adjustments, experiments were conducted for 30 min to measure the IP. In the experiments, significant right-sided asymmetries of the mean IP were found for each group (P < 0.05). The right buttocks of LH exhibited significantly more right-sided asymmetry of the mean IP than that of AB (p < 0.01). Moreover, the right buttocks of RH exhibited insignificant asymmetry of the mean IP compared to that of AB (p >0.21). The peak IPs of RH and LH were significantly higher than those of AB (p <0.05), and temporal changes of the mean and peak IP of hemiplegia were significant (p <0.05) and not significant (p >0.05), respectively. The RH exhibited affected-side weight-bearing based on the mean IP. In contrast, the LH relieved the mean IP on the affected-side buttock. Due to the right-sided asymmetric mean and high peak IP, hemiplegia in acute and recovery stages using wheelchairs can cause ulceration. Therefore, different rehabilitation approaches are required for the RH and LH to reduce the peak IP and avoid an uneven distribution of the mean IP.

Ergometer cycling improves the ambulatory function and cardiovascular fitness of stroke patients-a randomized controlled trial

[Purpose] The aim of this study was to assess the effects of ergometer cycling on the ambulatory function and cardiovascular fitness of patients with stroke in the sub-acute phase. [Participants and Methods] Twenty (20) patients with stroke in the sub-acute phase were randomly allocated to either an ergometer cycling group (n=10) or a control group (n=10). The experimental (ergometer cycling) group performed cycling exercises in addition to conventional physiotherapy for 60 minutes per session, three times per week for 8 weeks. The control group only received conventional physiotherapy for the same duration as the experimental group. Assessments of participants' functional ambulatory category, ambulatory velocity, 6-minute walk test, heart rate and blood pressure were conducted at baseline and at the end of the 8-week intervention. [Results] The means of the ambulatory velocity and distance walked in 6 minutes were significantly higher in the ergometer cycling group than those of the control group at week 8. However, the increase in the FAC score was not significant. The means of heart rate, systolic and diastolic blood pressures significantly decreased in the ergometer cycling group compared to the control group at the end of the 8-week of intervention. [Conclusion] This study demonstrated that ergometer cycling improved the ambulatory function and cardiovascular fitness of patients with stroke in the sub-acute phase.

Cycling Wheelchair Provides Enjoyable Pedaling Exercises with Increased Physiological Indexes

The cycling wheelchair (CWC) can be used as a pedaling exercise machine. However, physiological indexes in the CWC at various pedaling rates and the difference between the CWC and the existing pedaling machines such as the portable ergometer (ERG) are unclear. The aim of this study was to measure physiological indexes in the CWC at various pedaling rates and compare the CWC to the ERG, focusing on psychological stress. The present non-randomized crossover study included ten healthy men (22.3 ± 1.2 years) who performed pedaling exercise with the CWC and the ERG. Both experiments were composed of three pedaling exercise sessions (40, 60, and 80 rpm). Physiological indexes, consisting of oxygen consumption, heart rate, perceived breathlessness and leg fatigue, and salivary amylase activity (SAA), an index of psychological stress, were measured. The metabolic equivalent (METs) and the rate of change in SAA from rest to immediately after each pedaling session (ΔSAA) were calculated. In the CWC, all physiological indexes significantly increased with pedaling rates. The METs were 2.2 ± 0.3, 2.7 ± 0.4, and 3.5 ± 0.4 at 40, 60, and 80 rpm, respectively. In comparison between the CWC and the ERG, ΔSAA was lower in the CWC than in the ERG at 60 and 80 rpm. Our results indicate that the CWC pedaling can provide low or moderate intensity exercises with adjusting pedaling rates and is less stressful than the ERG. Thus, the CWC is a useful pedaling machine to promote regular and enjoyable exercises.

The application of cycling and cycling combined with feedback in the rehabilitation of stroke patients: a review

Stroke is a leading cause of long-term disabilities, such as hemiparesis, inability to walk without assistance, and dependence of others in the activities of daily living. Motor function rehabilitation after stroke demands for methods oriented to the recovery of the walking capacity. Because of the similarities with walking, cycling leg exercise may present a solution to this problem. The aim of this article is to review the state of the art applications of cycling leg exercise as a (1) motor function rehabilitation method and an (2) aerobic training method for stroke patients as well as the commonly used (3) assessment tools. The cycling characteristics and applications, the applied test protocols as well as the tools used to assess the state and the recovery of patients and types of cycling devices are presented. In addition, the potential benefits of the use of other therapies, like feedback, together with cycling are explored. The application of cycling leg exercise alone and combined with feedback in stroke rehabilitation approaches has shown promising results. Positive effects on motor abilities were found in subacute and chronic patients. However, larger and normalized studies and assessments are needed because there is a high heterogeneity in the patients' characteristics, protocols and metrics. This wil allow the comparison between different studies related with cycling.

Preliminary tests of a prototype FES control system for cycling wheelchair rehabilitation

The cycling wheelchair "Profhand" developed by our research group in Japan has been found to be useful in rehabilitation of motor function of lower limbs. It is also expected for rehabilitation of paraplegic subjects to propel the cycling wheelchair by lower limbs controlled by functional electrical stimulation (FES). In this paper, a prototype FES control system for the cycling wheelchair was developed using wireless surface stimulators and wireless inertial sensors and tested with healthy subjects. The stimulation pattern that stimulated the quadriceps femoris and the gluteus maximus at the same time was shown to be effective to propel the Profhand. From the analysis of steady state cycling, it was shown that the cycling speed was smaller and the variation of the speed was larger in FES cycling than those of voluntary cycling. Measured angular velocity of the crank suggested that stimulation timing have to be changed considering delay in muscle response to electrical stimulation and cycling speed in order to improve FES cycling. It was also suggested that angle of the pedal have to be adjusted by controlling ankle joint angle with FES in order to apply force appropriately.

Evaluation of motor performances of hemiplegic patients using a virtual cycling wheelchair: an exploratory trial

Cycling is known to be an effective rehabilitation exercise for hemiplegic patients who face difficulty during walking because of stroke or other brain disorders. A cycling wheelchair (CWC) is a useful tool to provide exercise for these patients and improve their quality of life. In previous studies, our group developed a system that allows patients to safely practice driving a CWC in a virtual environment. However, it has been difficult to check their motor performances and determine the effects of the exercise on a daily basis. This study is an exploratory trial for developing a method to evaluate the motor performances of users based on their CWC pedaling patterns. An experiment with some hemiplegic patients and healthy subjects was conducted and their pedaling patterns were analyzed. Results showed a significant difference between the hemiplegic patients and healthy subjects in an index that reflects pedaling balance between the feet. This result indicates a possible method of evaluating the motor performances of users based on their pedaling patterns.

Investigation of User Load and Evaluation of Power Assistive Control on Cycling Wheelchair

Wheelchairs, walkers, and electric wheelchairs are well-known support devices for patients with lowerlimb disabilities. However, disuse of lower limbs presents an ongoing barrier to rehabilitation, and can eventually lead to disuse syndrome. To overcome this situation, researchers have designed the cycling wheelchair. The cycling wheelchair is accessible to most patients who can bend their lower limbs. It is primarily used in rehabilitation facilities with planar floors and gentle slopes. To become practicable for everyday use, cycling wheelchairs require sufficient power to travel up steeper slopes or across bumpy surfaces. This paper aims to clarify the power consumed by users in everyday environments by measuring the tread force on the pedals. The investigation targets lower-limb disabled subjects and unimpaired subjects. It was observed that some of the users could not summon sufficient power for uphill travel. In addition, hemiplegic subjects with only one unimpaired leg placed large load on their healthy limb. As a first step to overcome this problem, we introduce traveling resistance compensation control into a cycling wheelchair and evaluate its efficacy.

Development of a virtual reality system to evaluate skills needed to drive a cycling wheel-chair

A cycling wheel chair (CWC) is a useful tool to provide physical exercise for patients who face difficulty walking, caused by stroke or other brain disorders. A system has been developed for rehabilitation, which allows patients to practice driving a CWC in a virtual environment. In this study, hardware improvements were developed and methods for evaluating driving skills were investigated to improve the practical application of this system. The hardware was changed to enable users to drive the CWC they were using in their daily lives. In addition, four types of test scenarios that focused on basic and important actions necessary to drive a CWC, such as pedaling and steering, were developed. An experiment with healthy young and elderly persons was conducted to evaluate the validity of the system. Results showed that pedaling and steering skills were improved in both the young and elderly subjects but the improvement patterns differed between them. These results indicate that repeated practice with the proposed system enhances the safety of driving a CWC, particularly for elderly users.

Effects of Lower Limb Reciprocal Pedalling Exercise on Motor Function after Stroke: A Systematic Review of Randomized and Nonrandomized Studies

This review systematically synthesized current evidence on the effects of lower limb reciprocal pedalling exercise on motor function poststroke. Detailed analysis of single studies in the review revealed multiple instances of heterogeneity including outcome measures; therefore we decided to avoid undertaking a single, potentially misleading meta-analysis. We found that despite beneficial (although nondefinitive) effects on balance, functional independence, and muscle strength, it is not possible to make clinical recommendations that support or refute the use of reciprocal pedalling exercise to enhance recovery of motor function after stroke. Our findings provide proof-of-concept for pedalling interventions and provide a foundation for subsequent research, suggesting a need for further standardized, controlled clinical trials of clearly described pedalling interventions for stroke survivors and with subsequent transparent reported findings.