Clinical evaluation of the bed cycling test.

Katharina Feil,Florian Schoeberl,Ozan Eren,Franziska Lezius,Katrin Huettemann,Otmar Bayer,Nicolina Boettcher,Michael Strupp,Carolin Muth,Tobias Hoegen,Andreas Zwergal,Maximilian Habs

doi:10.1002/brb3.445

Abstract

ObjectiveAdditionally 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.MethodsIn 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.ResultsThe 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.ConclusionsThe 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.

Highlights

There is a variety of clinical tests that diagnose a cerebral lesion affecting the upper and lower limb by identifying limb paresis as a sign of unilateral focal cerebral lesion (Anderson et al 2005)
Clinical characteristics of the patients, including the details of the neurological examination are summarized in Tables 2 and 3
Clinical experience did not show a significant effect on the odds of a correct test result. This held true, when the data set was confined to the bed cycling test (BCT) only

Summary

Introduction

There is a variety of clinical tests that diagnose a cerebral lesion affecting the upper and lower limb by identifying limb paresis as a sign of unilateral focal cerebral lesion (Anderson et al 2005). The implementation of two simple bedside tests, namely, the forearm rolling test and the finger rolling test in addition to known clinical tests (e.g., arm holding experiment, wrist extension, tendon reflexes, finger tapping) increased the sensitivity and specificity of the identification of focal cerebral lesions (Sawyer et al 1993; Ko and Verhagen 1994; Yamamoto 1995; Teitelbaum et al 2002; Amer et al 2012). Two variants of the forearm rolling test are the index finger rolling test (Yamamoto 1995) and the thumb rolling test (Nowak 2011) All these additional tests assess rapid alternating movements of more proximal muscles of the arm and shoulder. Based on the distal to proximal gradient of the cortico-spinal system, a test assessing more distal muscles of the hand is assumed to be more sensitive to detect subtle impairments of the cerebral cortico-spinal tract when other clinical tests are normal

Methods

Results

Conclusion