Submaximal physical strain and peak performance in handcycling versus handrim wheelchair propulsion

Study design: Experimental study in subjects with paraplegia and nondisabled subjects. Objective: To compare submaximal physical strain and peak performance in handcycling and handrim wheelchair propulsion in wheelchair-dependent and nondisabled control subjects Setting: Amsterdam, The Netherlands. Methods: Nine male subjects with paraplegia and 10 nondisabled male subjects performed two exercise tests on a motor-driven treadmill using a handrim wheelchair and attach-unit handcycle system. The exercise protocol consisted of two 4-min submaximal exercise bouts at 25 and 35 W, followed by 1-min exercise bouts with increasing power output until exhaustion. Results: Analysis of variance for repeated measures showed a significantly lower oxygen uptake (VO2), ventilation (Ve), heart rate (HR), rate of perceived exertion and a higher gross efficiency for handcycling at 35 W in both subject groups, while no significant differences were found at 25 W. Peak power output and peak V

Comparing unilateral and bilateral upper limb training: The ULTRA-stroke program design

<p>Abstract</p> <p>Background</p> <p>About 80% of all stroke survivors have an upper limb paresis immediately after stroke, only about a third of whom (30 to 40%) regain some dexterity within six months following conventional treatment programs. Of late, however, two recently developed interventions - constraint-induced movement therapy (CIMT) and bilateral arm training with rhythmic auditory cueing (BATRAC) - have shown promising results in the treatment of upper limb paresis in chronic stroke patients. The ULTRA-stroke (acronym for Upper Limb TRaining After stroke) program was conceived to assess the effectiveness of these interventions in subacute stroke patients and to examine how the observed changes in sensori-motor functioning relate to changes in stroke recovery mechanisms associated with peripheral stiffness, interlimb interactions, and cortical inter- and intrahemispheric networks. The present paper describes the design of this single-blinded randomized clinical trial (RCT), which has recently started and will take several years to complete.</p> <p>Methods/Design</p> <p>Sixty patients with a first ever stroke will be recruited. Patients will be stratified in terms of their remaining motor ability at the distal part of the arm (i.e., wrist and finger movements) and randomized over three intervention groups receiving modified CIMT, modified BATRAC, or an equally intensive (i.e., dose-matched) conventional treatment program for 6 weeks. Primary outcome variable is the score on the Action Research Arm test (ARAT), which will be assessed before, directly after, and 6 weeks after the intervention. During those test sessions all patients will also undergo measurements aimed at investigating the associated recovery mechanisms using haptic robots and magneto-encephalography (MEG).</p> <p>Discussion</p> <p>ULTRA-stroke is a 3-year translational research program which aims (1) to assess the relative effectiveness of the three interventions, on a group level but also as a function of patient characteristics, and (2) to delineate the functional and neurophysiological changes that are induced by those interventions.</p> <p>The outcome on the ARAT together with information about changes in the associated mechanisms will provide a better understanding of how specific therapies influence neurobiological changes, and which post-stroke conditions lend themselves to specific treatments.</p> <p>Trial Registration</p> <p>The ULTRA-stroke program is registered at the Netherlands Trial Register (NTR, <url>http://www.trialregister.nl</url>, number NTR1665).</p