Wheeling à petit pas: Parkinsonism detected by observation of wheelchair propulsion.

We present a man with parkinsonism detected by the observation of wheelchair propulsion. His manual wheelchair propulsion technique was observed to include rapid, brief, low-power strokes resembling the marche à petit pas (walking with tiny steps) phenomenon of parkinsonism. We videotaped his wheelchair propulsion and compared him with ten age-, gender-, and diagnosis-matched controls. The patient had a propulsion velocity of 0.14 m/sec compared with a mean (+/- standard deviation) of 0.73 (+/- 0.16) m/sec for the controls, a cadence of 209 strokes/min vs. 60 (+/- 12) strokes/min for the controls, and a mechanical efficiency of 0.04 m/stroke compared with 0.75 (+/- 0.25) m/stroke for the controls. This observation shifted the course of his medical investigations and management as well as his rehabilitation care. This is the first detailed report of how parkinsonian features may affect manual wheelchair propulsion. It suggests that observation of wheelchair mobility should be a routine component of the physical examination of wheelchair users.