The bed cycling test: a new bedside test to detect mild unilateral cerebral dysfunction of the lower limb (P6.021)

Objective: Analogously to the forearm rolling test to detect unilateral upper limb dysfunction a so-called bed cycling test (BCT) was developed and evaluated to detect mild to moderate unilateral lower limb dysfunction and compared to the leg holding test (LHT). Background: In recent years the sensitivity and specificity of different clinical tests was systematically investigated. In clinical practice, it is important to make a fast clinical decision whether the patients suffers from paresis. Methods: In a prospective examiner-blinded study 60 patients with MRI or CT proven acute focal cerebral hemisphere lesions and a mild to moderate unilateral paresis of the lower limb (graduated 3 or 4 of 5 on MRC scale) and 60 control persons with normal imaging and without obvious focal signs were examined using a battery of clinical tests including the filmed BCT and LHT. Nine examiners, who were blinded to the diagnosis, evaluated these tests presented to them on videos. The sensitivity, specificity as well as positive and negative predictive values of each test were analyzed. Results: The BCT was rated right positive in 35.5 [percnt] compared to LHT in 26.0 [percnt]. On the other hand, examiners had false negative results in 29.1 [percnt] of cases using BCT and 44.7 [percnt] using LHT. In 36.7 [percnt] of patients only BCT was pathological while leg holding test was unremarkable, In conclusion the BCT is more sensitive (64.3 [percnt]) than LHT (46.2 [percnt]) while the specificity of leg holding test (85.6 [percnt]) is higher than of BCT (70.1 [percnt]) to detect a cerebral lesion affecting the lower limb. Conclusions: The BCT test is a useful additional clinical bedside test to detectsubtle unilateral cerebral lesions, especially when regular neurological examination is unremarkable. The BCT is easy to perform and can be added to the neurological routine examination. Disclosure: Dr. Feil has nothing to disclose. Dr. Boettcher has nothing to disclose. Dr. Lezius has nothing to disclose. Dr. Hoegen has nothing to disclose. Dr. Huettemann has nothing to disclose. Dr. Muth has nothing to disclose. Dr. Eren has nothing to disclose. Dr. Schoeberl has nothing to disclose. Dr. Zwergal has nothing to disclose. Dr. Bayer has nothing to disclose. Dr. Strupp has received personal compensation in an editorial capacity for the Journal of Neurology as Joint Chief Editor, Frontiers of Neuro-otology as Editor in Chief, and of F1000 as Section Editor.