Relationship Between Wheelchair Propulsion and Independent Walking in Hemiplegic Stroke

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Background and Purpose We studied the relationship between wheelchair propulsion and final walking ability in hemiplegic stroke patients who were unable to walk independently 3 or more weeks after stroke.Methods Sixty hemiplegic stroke patients unable to walk independently 3 weeks or more after stroke were entered in a study comparing independent walking and wheelchair propulsion. Eight patients were lost to follow-up. Of the remaining 52 patients, 29 were entered 3 weeks and 23 were entered 4 to 10 weeks after stroke. Assessments were performed on admission and 4 and 14 weeks later.Results Fifteen of the 17 patients able to propel a wheelchair through a simple course at 3 weeks after stroke learned to walk independently (chi2 equals 9.94, P equals .01), but none of the 12 who failed learned to walk (chi2 equals 12, P equals .001). At the final assessment, the positive association between wheelchair propulsion and walking had been lost: 21 of 21 walkers and 18 of 31 nonwalkers could propel a wheelchair (chi2 equals 0.23, P equals NS). The negative association remained: 13 of 31 nonwalkers failed the wheelchair test, but 0 of 21 walkers failed (chi2 equals 13.0, P equals .001). Visual field deficits were significantly more common in patients unable to walk or propel a wheelchair than in walkers (chi sup 2 equals 6.66, P equals .01). Laterality had no effect on outcome.Conclusions Ability to propel a wheelchair 3 weeks after stroke in hemiplegic patients unable to walk is the most accurate guide to walking potential that has been reported to date.(Stroke. 1995;26:606-608.)

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