Clinical Study on Driving a Cycling Wheel Chair in Hemiplegics

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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