Feil Katharina, Boettcher Nicolina, Lezius Franziska, Habs Maximilian, Hoegen Tobias, Huettemann Katrin, Muth Carolin, Eren Ozan, Schoeberl Florian, Zwergal Andreas, Bayer Otmar, Strupp Michael
Department of Neurology University Hospital Munich Germany; German Center for Vertigo and Balance Disorders University Hospital Munich Germany.
German Center for Vertigo and Balance Disorders University Hospital Munich Germany.
Brain Behav. 2016 Apr 8;6(5):e00445. doi: 10.1002/brb3.445. eCollection 2016 May.
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.
除了用于检测轻度单侧上肢功能障碍的前臂滚动试验外，还开发、评估了用于检测轻度至中度下肢功能障碍的床上蹬车试验（BCT），并将其与腿部支撑试验进行比较。
在一项前瞻性观察者盲法研究中，对60例经MRI/CT证实有局灶性脑半球病变且伴有轻度至中度单侧下肢轻瘫（医学研究委员会肌力分级为3-4/5级）的患者以及60例影像学检查正常的对照者进行检查并拍摄视频。9名对诊断不知情的观察者对这些视频进行评估。分析了各项临床检查的敏感性、特异性以及阳性和阴性预测值。
在所有局灶性脑病变患者中，观察者对BCT的正确评估率为35.5%，而腿部支撑试验的正确评估率为26.0%。另一方面，在BCT检查中，观察者有29.1%的病例出现假阴性结果，在腿部支撑试验中有44.7%的病例出现假阴性结果。在36.7%的患者中，仅BCT检查结果异常，而腿部支撑试验结果正常。两种检查联合使用时的敏感性为0.68（95%可信区间为0.61-0.75）。在检测影响下肢的脑病变方面，BCT的敏感性（64.3%）高于腿部支撑试验（46.2%），而腿部支撑试验的特异性（85.6%）高于BCT（70.1%）。不同评估者之间的变异性较高，不同类型临床经验的评估者之间无差异。
BCT是一种用于检测细微单侧脑病变的有用的床边附加临床检查。BCT操作简便，可纳入常规神经学检查。
