A Virtual Reality-Cycling Training System for Lower Limb Balance Improvement.

Stroke survivors might lose their walking and balancing abilities, but many studies pointed out that cycling is an effective means for lower limb rehabilitation. However, during cycle training, the unaffected limb tends to compensate for the affected one, which resulted in suboptimal rehabilitation. To address this issue, we present a Virtual Reality-Cycling Training System (VRCTS), which senses the cycling force and speed in real-time, analyzes the acquired data to produce feedback to patients with a controllable VR car in a VR rehabilitation program, and thus specifically trains the affected side. The aim of the study was to verify the functionality of the VRCTS and to verify the results from the ten stroke patients participants and to compare the result of Asymmetry Ratio Index (ARI) between the experimental group and the control group, after their training, by using the bilateral pedal force and force plate to determine any training effect. The results showed that after the VRCTS training in bilateral pedal force it had improved by 0.22 (p = 0.046) and in force plate the stand balance has also improved by 0.29 (p = 0.031); thus both methods show the significant difference.

Cycling exercise with functional electrical stimulation improves postural control in stroke patients.

The aim of this study is to determine whether short term functional electrical stimulation (FES)-assisted cycling training can affect the postural control of stroke patients, and whether the application of FES can enhance the effect of cycling training. 20 stroke patients were randomly assigned to the FES-cycling group (FES-CG) or the cycling group (CG). Measurements were completed before and immediately after each 20 min training sessions. The measurements included a balance test (to quantify the postural control ability), a Hoffmann's reflex/motor response ratio (H/M ratio) test and a pendulum test (to quantify the muscle tone). In the balance test, some parameters in all directions exhibited significant intervention effects between the FES-CG group and the CG group. The H/M ratios (p=.014; .005, FES-CG and CG respectively) and relaxation index (p=.005; .047, FES-CG and CG respectively) revealed significant difference between FES-CG and CG group. The change ratios of directional control in the forward direction and H/M ratio revealed significant difference (p=.022; .015) between FES-CG and CG among subjects with higher muscle tone. The stroke subjects' postural control was improved while their muscle tone was reduced after the 20 min cycling training program both with and without FES. We conclude that cycling training, with or without FES may reduce spasticity in stroke patients. The application of FES in cycling exercise was shown to be more effective in stroke patients with higher muscle tone.

Effect of a bout of leg cycling with electrical stimulation on reduction of hypertonia in patients with stroke.

OBJECTIVES: To evaluate whether a bout of leg cycling in patients with stroke reduces muscle tone and to determine whether neuromuscular functional electrical stimulation (FES) to the affected leg during cycling is more effective than cycling without FES. DESIGN: Within-subject comparison. SETTING: University hospital. PARTICIPANTS: Patients with stroke (N=16; age range, 42-72y; <8wk poststroke) with hypertonia in the affected leg. INTERVENTIONS: Subjects' affected leg (1) performed cycling exercise with the assistance of FES (assisted-cycling session) and (2) performed cycling exercise without the assistance of FES (nonassisted-cycling session). Subjects sat in a specially designed wheelchair positioned on a resistance-free roller for each 20-minute session. MAIN OUTCOME MEASURES: Changes in muscle tone pre- and posttest session were compared by using the Modified Ashworth Scale and the pendulum test (relaxation index and peak velocity). RESULTS: Modified Ashworth Scale scores were significantly lower (P<.05) and relaxation index and peak velocity values were significantly higher (P<.05) after both sessions. Changes in Modified Ashworth Scale scores, relaxation index, and peak velocity values showed a significant (P<.05) difference between the 2 sessions, and assisted cycling reduced hypertonia more than nonassisted cycling. CONCLUSIONS: The hypertonia of patients with stroke showed a significant decrease immediately after a bout of leg-cycling exercise. FES-assisted leg cycling was better than nonassisted cycling for reducing hypertonia.

Comparison of energy costs leg-cycling with or without functional electrical stimulation and manual wheelchairs for patients after stroke.

OBJECTIVE: To determine whether, for patients after stroke, propelling a functional electrical stimulation (FES)-assisted leg-cycling wheelchair requires less energy than propelling a manual wheelchair, and whether leg propulsion with FES has lower energy costs than without FES. DESIGN: Within-subject comparison. SUBJECTS: A total of 16 patients after stroke were recruited from the university hospital. METHODS: Subjects propelled 2 leg-cycling wheelchairs (a FES-leg-cycling wheelchair and a leg-cycling wheelchair) and a manual wheelchair for 200 m as quickly as possible. Cardiopulmonary responses (heart rate, oxygen consumption, carbon dioxide production, minute ventilation, and respiratory exchange ratio) and energy costs (physiological cost index and oxygen cost) data for each wheelchair-type were compared for each subject. RESULTS: The cardiopulmonary responses were significantly higher, and energy costs significantly lower for propelling the FES-leg-cycling wheelchair and leg-cycling wheelchair compared with the manual wheelchair. No significant difference was found between the FES-leg-cycling wheelchair and the leg-cycling wheelchair. CONCLUSION: Propulsion of a leg-cycling wheelchair with or without FES yielded significantly higher cardiopulmonary responses and required less energy than propulsion of a manual wheelchair. The energy costs of cycling with FES was comparable to the energy costs of cycling without FES.

Effects of a functional electrical stimulation-assisted leg-cycling wheelchair on reducing spasticity of patients after stroke.

OBJECTIVE: To determine whether short-term propulsion of a functional electrical stimulation-assisted leg-cycling wheelchair (FES-LW) in patients with stroke can reduce spasticity of the affected leg and whether FES has additional effects on reducing spasticity. DESIGN: Within-subject comparison. SUBJECTS: A total of 17 patients after stroke were recruited from the university hospital. METHODS: Subjects propelled 2 leg-cycling wheelchairs (the FES-LW and the LW) and a manual wheelchair along an oval pathway. The Modified Ashworth Scale (MAS), H reflex/maximal M response (H/M ratio) and relaxation index were used to evaluate the immediate effects on leg spasticity. The changes in MAS, H/M and relaxation index were used to evaluate the effect of FES in comparing 2 leg-cycling wheelchairs. RESULTS: The MAS and H/M ratio were significantly decreased and the relaxation index significantly increased by FES-LW and LW usage. For subjects with higher muscle tone, significant lowering of the changes in MAS, H/M ratio and higher relaxation index were found for FES-LW usage compared with LW usage. CONCLUSION: Leg spasticity is reduced after short-term propulsion of the FES-LW and LW. The application of FES has an additional effect on reducing spasticity in subjects with higher muscle tone.

Evaluation of functional electrical stimulation-assisted leg-propelled wheelchair in hemiplegic patients.

BACKGROUND: Manual wheelchairs are an important mobility device for hemiplegic stroke patients, but understandably difficult to operate. A novel mobility device termed the functional electrical stimulation-assisted leg-propelled wheelchair (FES-LW) was proposed and a field test conducted to evaluate its clinical performance by comparison against a manual wheelchair (MW). METHODS: A total of 20 hemiplegic patients were recruited from the National Cheng Kung University Hospital. They were instructed to successively propel the FES-LW and MW comfortably, as fast as possible, in along an oval pathway. The finish time, deviation frequencies, deviation percentage, physiological cost index (PCI), and modified Ashworth scale (MAS) of affected ankle were measured and compared. FINDINGS: Subjects can propel the FES-LW with 40.1% less finish time (P=0.003); 23.7% lower deviation frequencies (P=0.009) and 36.7% lower deviation percentage (P=0.001); and 17.7% lower PCI (P=0.022) than the MW. In addition, the MAS of the affected ankle was noticeably reduced (P=0.002) after propelling the FES-LW. INTERPRETATION: The FES-LW showed better controllability, cardiopulmonary response and positive effects on reducing spasticity versus the MW. The FES-LW is a suitable alternative to a MW for the needs of hemiplegic stroke patients.

Controllability and physiological evaluation of three unilaterally-propelled wheelchairs for patients with hemiplegia.

OBJECTIVE: To evaluate the controllability of, and physiological responses to, 2 newly designed unilaterally-propelled wheelchairs for patients with hemiplegia. DESIGN: Within-subject comparison. SUBJECTS: A total of 15 patients after stroke were recruited from the rehabilitation centre of Chung Shan Medical University, Taichung, Taiwan. METHODS: Two newly designed wheelchairs (an ankle-propelled wheelchair and a knee-propelled wheelchair) were compared with a commercially available 2-hand-rim propelled wheelchair. Patients propelled the 3 wheelchairs along an oval pathway. Videotapes were made for analysis. The following parameters: total propulsion time, deviation frequency, deviation percentage, physiological cost index (VO2) and rating of perceived exertion were measured and compared. RESULTS: The knee-propelled wheelchair gave the best results for controllability, cardiopulmonary and perceived exertion. However, the gear ratio of this wheelchair's force transmission was fixed, and some patients felt that its propulsion was heavy when starting off. CONCLUSION: The knee-propelled wheelchair showed good controllability and physiological responses for hemiplegic patients. If some details were improved, it would suitable for use by patients with hemiplegia.