Adaptive Tricycles in Schools: Opportunities for Participation, Motor Learning and Fitness

For a child with a disability such as cerebral palsy, the school therapist’s primary goal is to improve access to education. We have known for some time that encouraging independent mobility helps achieve this. We usually do this by teaching the child to walk through gait training or giving them a wheelchair. The literature on gait training is compelling; No one questions the overwhelming motor and social benefits of gait training.¹ But what about those who are not yet ready for a gait trainer or who can only do short sessions? Without a doubt, a wheelchair is a solution, but this passive seated mobility does not allow the acquisition of motor skills and does not provide the health benefits of physical activity.²

Enter the adaptive tricycle, used to give children the opportunity for independent mobility along with improvements in gross motor skills. When reviewing the literature on adaptive cycling in pediatrics, the conclusion of one study in particular stood out: All children with cerebral palsy (CP) should be provided with an adaptive bicycle instead of a wheelchair to allow independent active movement in community settings while improving their endurance and function..³ Let’s address the use of adaptive tricycles as an alternative form of mobility and participation in the school environment.

The status of the investigation

In a recently published systematic review, Efficacy of cycling interventions to improve function in children and adolescents with cerebral palsy: a systematic review and meta-analysis,⁴ The authors acknowledge the limitations of the research, but underscore what we have known instinctively for a long time: that adaptive cycling produces improvements in muscle strength, cardiovascular fitness, balance, and the ability to stand and walk, as measured by domains D and E of gross motor function. Measurement (GMFM). Although this systematic review focuses on the benefits of adaptive cycling in all pediatric settings, a closer look at each study provides valuable information about how adaptive cycling should be used as an intervention at school and at home.

For example, the first study in the systematic review establishes adaptive cycling as a safe and effective means of mobility for children with significant participation. These children, all GMFCS levels IV and V, showed improvements in their cycling, as well as carryover benefits in standing and walking after the cycling sessions.⁵

Another case report from the review, Pilot evaluation of a school-based program focusing on activity, fitness, and function among children with cerebral palsy at GMFSC level IV. demonstrated better levels of physical fitness and reduced health risks associated with immobility starting with a structured 30-minute routine, which includes transfers on and off the bike.⁶

In a 2013 article, the authors highlight the importance of fun, fitness, family and friendships in childhood. They explain how cycling can promote these”F words in childhood disability”.⁷ Another randomized control trial, using quality of life and outcome questionnaires, showed how children who cycled demonstrated better emotional functioning through a significant decrease in anxiety and anger, and were better able to pay attention in the school.⁸ While this is not surprising, it is good to see these benefits documented in the emerging literature.

Adaptive cycling in schools

Because a child spends most of the day at school, the interventions they receive should benefit them both academically and functionally. He Individuals with Disabilities Education Act,⁹ which defines education standards for students with disabilities, recognizes that educational benefits are not limited to academics. Rather, it directs school professionals to provide all students with an education designed to meet their unique needs and prepare them for “further education, employment, and independent living.” (IDEA 2004)

Cycling is energy efficient and cyclical and is therefore analogous to walking. It could be the bridge that gives a child who otherwise might not be able to walk the opportunity to navigate the school environment, while at the same time building strength and stamina. The long-term health benefits of cycling will help these students improve their mobility skills as they transition to future employment opportunities and independence in a long-term care setting.

According to motor learning theory, practice drives skill acquisition.^{10, 11} It takes practice to generate the rhythmic pattern needed to pedal a tricycle. It takes practice to navigate and drive. It takes repetition and practice to develop endurance. And for lasting benefits, practice must be activity-based, goal-oriented, and contextualized.²

Knowing that frequency of use and repetition leads to better results encourages us to provide frequent opportunities to ride adaptive bicycles throughout a child’s day. The structure of a school day offers countless opportunities for children to use adapted bicycles as an alternative to wheelchairs. Moving to the playground during recess, from the bus to the classroom, or during adaptive physical education are examples.

Takeaway on Adaptive Cycling

Mohanty’s 2015 study is sparking debate about using adaptive bicycles instead of wheelchairs for community mobility. His research shows that children with spastic diplegic cerebral palsy who cycled on an outdoor campus for one hour demonstrated improvements in functional mobility, balance, and cardiovascular fitness compared to their non-cycling counterparts (conventional therapy only ).

Offering alternative forms of mobility in the school environment could increase benefits for students who would otherwise spend much of the day in wheelchairs. Effectively implementing research into practice is part of the school professional’s job. The research we have to date highlights how we can make better use of mobility options throughout a child’s day to improve their physical health and well-being.

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