title: Towards Upright Pedalling to drive recovery in people who cannot walk in the first weeks after stroke: movement patterns and measurement.
abstract: OBJECTIVE
  To examine whether people who are within 31days of stroke onset are able to produce controlled lower limb movement, and phasic activity in antagonistic lower limb muscle groups, during Upright Pedalling (UP).
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Acute stroke unit within a University Hospital.
  
  
  METHODS
  Eight adults between 3 and 30days from stroke onset, with unilateral lower limb paresis and unable to walk without assistance. Participants were considered fit to participate as assessed by a physician-led medical team and were able to take part in UP for one, one minute session.
  
  
  METHODS
  Participants took part in one session of instrumented UP at their comfortable cadence, as part of a feasibility study investigating UP early after stroke.
  
  
  METHODS
  Reciprocal activation of lower limb muscles derived from muscle activity recorded with surface EMG, quantified using Jaccards Coefficient (J); smoothness of pedalling determined from standard deviations of time spent in each of eight 45° wheel position bins ("S-Ped"). Motor behavioural measures: Motricity Index, Trunk Control Test, Functional Ambulatory Categories.
  
  
  RESULTS
  Participants were all unable to walk (FAC 0) with severe to moderate lower limb paresis (Motricity Index score/100 median 48.5, IQR 32 to 65.5). Smooth pedalling was observed; some participants pedalling similarly smoothly to healthy older adults, with a variety of muscle activation patterns in the affected and unaffected legs.
  
  
  CONCLUSIONS
  These observational data indicate that people with substantial paresis early after stroke and who cannot walk, can produce smooth movement during UP using a variety of muscle activation strategies.
authors.affiliation: Acquired Brain Injury Rehabilitation Alliance, School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK. Electronic address: n.hancock@uea.ac.uk.
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Hancock
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich Research Park, NR4 7TJ, UK.
authors.forename: Lee
authors.initials: L
authors.lastname: Shepstone
authors.affiliation: Biomedical Engineering Department, University of Strathclyde, Wolfson Centre, 106 Rotten Row, Glasgow G4 ONW, Scotland, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Rowe
authors.affiliation: AGEING, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, UK.
authors.forename: Phyo K
authors.initials: PK
authors.lastname: Myint
authors.affiliation: Acquired Brain Injury Rehabilitation Alliance, School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK.
authors.forename: Valerie M
authors.initials: VM
authors.lastname: Pomeroy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001642:Bicycling / Q000502:physiology*; D004576:Electromyography; D005260:Female; D006785:Hospitals, University; D006801:Humans; D035002:Lower Extremity / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D000071939:Stroke Rehabilitation / Q000379:methods*
keywords: Function; Lower limb; Pedalling; Rehabilitation; Stroke; Walking