Relationship between wheelchair propulsion and independent walking in hemiplegic stroke.

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.

Deaths in three accident and emergency departments.

A survey of three London hospitals found that approximately 0.45 patients per thousand new attenders die in the accident and emergency department and that there is evidence of poor management in about 10% of these deaths. The commonest faults were excessive delay before starting appropriate treatment and neglect of the basic principles of emergency medicine. These points need to be emphasized in the training of accident and emergency staff.