Background and purpose: We studied the relationship between wheelchair propulsion and final walking ability in hemiplegic stroke patients who were unable to walk independently 3 or more weeks after stroke.
Methods: Sixty hemiplegic stroke patients unable to walk independently 3 weeks or more after stroke were entered in a study comparing independent walking and wheelchair propulsion. Eight patients were lost to follow-up. Of the remaining 52 patients, 29 were entered 3 weeks and 23 were entered 4 to 10 weeks after stroke. Assessments were performed on admission and 4 and 14 weeks later.
Results: Fifteen of the 17 patients able to propel a wheelchair through a simple course at 3 weeks after stroke learned to walk independently (chi 2 = 9.94, P = .01), but none of the 12 who failed learned to walk (chi 2 = 12, P = .001). At the final assessment, the positive association between wheelchair propulsion and walking had been lost: 21 of 21 walkers and 18 of 31 nonwalkers could propel a wheelchair (chi 2 = 0.23, P = NS). The negative association remained: 13 of 31 nonwalkers failed the wheelchair test, but 0 of 21 walkers failed (chi 2 = 13.0, P = .001). Visual field deficits were significantly more common in patients unable to walk or propel a wheelchair than in walkers (chi 2 = 6.66, P = .01). Laterality had no effect on outcome.
Conclusions: Ability to propel a wheelchair 3 weeks after stroke in hemiplegic patients unable to walk is the most accurate guide to walking potential that has been reported to date.