Clinical Study on Driving a Cycling Wheel Chair in Hemiplegics

本研究的目的是建立临床实用性的新开发的自行车轮椅偏瘫。具体如下。蹬踏运动过程中神经生理参数的变化：对健康和偏瘫受试者单腿（健侧）蹬踏时对侧（患侧）肌进行H反射和运动诱发电位（MEP）的测定。正常人H反射波幅降低，MEP增高。偏瘫患者虽然H反射无明显变化，但在蹬踏运动时MEP明显增高。提示单腿主动蹬踏可增强运动皮层的兴奋性，而非抑制脊髓运动神经元.偏瘫患者驾驶自行车轮椅时腿部肌肉活动的变化：我们测量了不能行走的重度偏瘫患者驾驶自行车轮椅时双腿肌肉的EMG活动。瘫痪的肌肉 关于我们 与等长随意收缩相比，蹬踏时r肢的活动显著。这一结果表明，即使在重度偏瘫患者中，驾驶自行车轮椅也能诱发瘫痪腿部肌肉的某些活动.虚拟现实（VR）训练机的开发：开发了VR系统驾驶训练设备和可测量每条腿旋转扭矩的卧位式测力计。我们将其用于偏瘫中风患者的功能训练。这些测试仪器为定量地测量自行车轮椅驾驶技能提供了一些有用的参数.自行车轮椅运动的实用性：在一些研究所测量了使用自行车轮椅后身体和精神活动的变化。驾驶自行车轮椅不影响心肺功能。从这个角度来看，自行车轮椅和标准型轮椅一样安全。在使用机构的老年残疾人中，与标准型轮椅相比，骑自行车轮椅时的体力和脑力活动增加，一天内的运动距离显著延长。3名受试者在使用自行车轮椅训练后步行速度提高，本研究在一定程度上揭示了自行车轮椅的临床实用性和安全性，以及自行车轮椅对蹬踏运动临床效应的背景机制。自行车轮椅的临床应用不仅限于偏瘫患者，还应推广到广大残疾人。少

The aim of this study is to establish clinical usefulness of the newly developed cycling wheel chair for hemiplegics. Details are as below.1. Change of neurophysiological parameters during pedaling movement : We easured H reflex and motor evoked potential (MEP) from the opposite (palytic) leg muscles during pedaling by one leg (healthy leg) in the healthy and hemiplegic subjects. Decrase of the amplitude of H reflex and increase of MEP were observed in the healthy subjects. On the other hand, in the hemiplegic patients, though H reflex did not show any change MEP clearly increased during pedaling movement. It was suggested that active pedaling by one leg could augment excitability of motor cortex rather than inhibition of spinal motor neuron.2. Change of leg muscle activity during driving the cycling wheel chair in hemiplegics : We measured EMG activities from both leg muscles during driving the cycling wheel chair in non-ambulatory severe hemiplegics. The muscles in the paralytic lowe … More r limb showed significant activities during pedaling compared with isometric voluntary contraction. This result indicates driving the cycling wheel chair can induce some activities in the paralytic leg muscles even in the patients with severe hemiplegia.3. Development of training machine with virtual reality (VR) : The equipment for driving training with VR systems and a recumbent type ergometer that can measure rotation torque in each leg were developed. We used them for functional training in hemiplegic stroke patients. These apparatus provided some useful parameters to measure the skill of driving the cycling wheel chair quantitatively.4. Practical usefulness of cycling wheel chair for locomotion : Change of physical and mental activities after use of cycling wheel chair was measured in some institutes. Driving the cycling wheel chair did not affect cardio-pulmonary function. In this point of view cycling wheel chair is as safe as standard type wheel chair. I the cases of elderly disabled who use an institute, physical and mental activities increased and the distance of locomotion in a day remarkably extended when driving the cycling wheel chair comparing with the standard type wheel chair. Walking speed in three subjects improved after training using the cycling wheel chair.Clinical usefulness and safety of cycling wheel chair and background mechanism of clinical effect on pedaling movement were revealed to some extent through this study. Extension of clinical application of cycling wheel chair not only for hemiplegics but also for lots of disabled is necessary in the future. Less