Clinical evaluation of the bed cycling test.
Additionally to the forearm rolling test to detect mild unilateral upper limb dysfunction, the bed cycling test (BCT) for detection of mild to moderate lower limb dysfunction was developed, evaluated and compared to the leg holding test.



In a prospective observer-blinded study, 60 patients with MRI/CT-proven focal cerebral hemisphere lesions and a mild to moderate unilateral paresis of the lower limb (graduated MRC 3-4/5), and 60 control persons with normal imaging were examined and filmed. Nine observers blinded to the diagnosis evaluated these videos. The sensitivity, specificity and the positive and negative predictive values of the clinical tests were analyzed.



The observers gave a correct evaluation of BCT in 35.5% of all patients with focal cerebral lesions compared to 26.0% for the leg holding test. On the other hand, observers had false negative results in 29.1% of cases with BCT and 44.7% with leg holding test. In 36.7% of patients, only BCT was pathological while leg holding test was unremarkable. The sensitivity of the combination of both tests was 0.68 (95% CI 0.61-0.75). The BCT is more sensitive (64.3%) than leg holding test (46.2%) while the specificity of leg holding test (85.6%) is higher than of BCT (70.1%) to detect a cerebral lesion affecting the lower limb. The inter-rater variability is high with no differences comparing different types of clinical experience.



The BCT is a useful additional clinical bedside test to detect subtle unilateral cerebral lesions. The BCT is easy to perform and can be added to the routine neurological examination.
Department of Neurology University Hospital Munich Germany; German Center for Vertigo and Balance Disorders University Hospital Munich Germany.
Katharina
K
Feil
German Center for Vertigo and Balance Disorders University Hospital Munich Germany.
Nicolina
N
Boettcher
Department of Anesthesiology and Operative Intensive Care Medicine Charité University Berlin Germany.
Franziska
F
Lezius
Department of Neurology University Hospital Munich Germany; German Center for Vertigo and Balance Disorders University Hospital Munich Germany.
Maximilian
M
Habs
Department of Neurology University Hospital Munich Germany.
Tobias
T
Hoegen
Department of Neurology University Hospital Munich Germany.
Katrin
K
Huettemann
German Center for Vertigo and Balance Disorders University Hospital Munich Germany.
Carolin
C
Muth
German Center for Vertigo and Balance Disorders University Hospital Munich Germany.
Ozan
O
Eren
Department of Neurology University Hospital Munich Germany; German Center for Vertigo and Balance Disorders University Hospital Munich Germany.
Florian
F
Schoeberl
Department of Neurology University Hospital Munich Germany; German Center for Vertigo and Balance Disorders University Hospital Munich Germany.
Andreas
A
Zwergal
German Center for Vertigo and Balance Disorders University Hospital Munich Germany.
Otmar
O
Bayer
Department of Neurology University Hospital Munich Germany; German Center for Vertigo and Balance Disorders University Hospital Munich Germany.
Michael
M
Strupp
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000000981:diagnostic imaging; D005080:Exercise Test / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D006801:Humans; D035002:Lower Extremity / Q000503:physiopathology*; D008875:Middle Aged; D009460:Neurologic Examination / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D010291:Paresis / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D055815:Young Adult
Cerebrovascular disease/Stroke; clinical neurology; clinical neurology examination