The purpose of this sludy was to compare individual pedal reaclion force components following bicycle training with and without effective force feedback in subjects with unilateral cerebrovascular accident (CVA). Eight ambulatory subjects with CVA were studied on a recumbent bicycle equipped with custom-built pedals, which measure normal and tangential components of the load applied to the pedal surface. Comparisons of normal and tangential pedal reaction forces were made following 1 month of bicycle training (3 times/week for 4 weeks) during retention tests performed without feedback. The ratios of involved to contralateral (I/C ratios) force parameters were used to assess symmetry. Subjects were randomly assigned to 2 groups: (a) a feedback group that received visual/verbal feedback regarding effective force patterns, bilaterally, after each trial; and (b) a no-feedback group dial received no feedback. Two critical results were found: (a) tangential pedal forces were significantly more posteriorly directed bilaterally following training across all subjects, but the change was greater for the no-feedback group relative to the feedback group, and (b) effective force feedback training did not demonstrate improvements in the I/C ratios above that of the control group. A more posteriorly applied tangential pedal force may represent increased dorsiflexion and may suggest that bicycle training facilitated ankle control. The cyclical nature of cycling, however, may allow for natural patterns to develop without feedback or may require less frequent use of feedback based on retention test performance.
K.L. Perell and A.M.E. Scremin is with ihe Physical Medicine & Rehabililaiion Service, VA Greater LA Healthcare System-West LA Healthcare Center, Los Angeles, CA 90073, and the Department ot Medicine, PM&R Division, UCLA School of Medicine, Los Angeles, CA 90024. In addition, K.L. Perell is with the Department of Physical Therapy, Mount St. Mary's College, Los Angeles, CA 90049. R.J. Gregor is with the Department of Health and Performance Sciences. The Georgia Institute of Technology, Atlanta, GA 30332.