While working in the sub acute rehabilitation centers in the
United States, I had used the peddler for the geriatric population as a means
to strengthen the lower extremities. Occupational therapists also used it for upper extremity exercises with the patient in either sitting or
standing position. We had separate peddlers for upper and lower extremities for
hygiene purposes. (I can still remember when I got yelled at by an occupational therapist because I
had taken the UE-marked peddler for LE use, albeit in a rush of time!
Personally, despite
the benefits of cycling on a peddler, I viewed it as boring equipment, which I used
for my patients on hectic days. I did
not like it much since it needed to be stabilized with weights so that it would
not glide while being used. To make it interesting and justify its objectivity,
I would tie cuff weights to the patient’s ankles as well as time the minutes of
peddling.
Little did I know then, that it would become crucial
equipment in my private pediatric practice in India. I purchased peddlers for adult treatments, and ended up using them mostly for children!
During the past 3 years, I came across many preschool children
who had difficulty with propelling a tricycle. Not only did they have strength
deficits in the lower body, teaching them to pedal at home was a daunting and frustrating task
for parents. All of these children were
aged 3 to 5 years with various diagnoses such as autism, sensory processing dysfunction, traumatic brain
injury, spastic diplegia and hemiplegia. One child, at the age of 9, was struggling
unsuccessfully to pedal his bike through full revolutions. The demands of strength,
balance, and coordination of two sides of the body were too overwhelming for
these children. Moreover, any effort to pedal caused the bike to move, which
further instilled fear in some of the children who were oversensitive to
movement.
That is when I realized that the peddler would be a perfect, stationary
solution to start learning alternate and reciprocal movements of the extremities. I
had the child sit on a small chair or a regular chair with pillows for support
for pedaling with lower extremities. The child would sit cross-legged on the
floor or stand while using the peddler with upper extremities. Doing so, I had to initially help them push,
and it did take a number of sessions before the child would be able to propel
themselves. Soon I started introducing cuff weights on ankles or arms to
provide them with increased proprioceptive input. And most children soon
started riding the bike at home.
For children who were still non-ambulatory, the peddler
became a useful tool for practicing stepping movements of the lower
extremities. The functional changes in strength and balance led to better
stance and consequently faster ambulation. For some others, peddling helped correct the in-toeing gait by strengthening the hip external rotators.
The peddler is static, light-weight, easy to move as well as
store, and economical to purchase. By practicing on the peddler, I was teaching
the children the sensation of alternate-reciprocal movement of the upper /
lower extremities that is so crucial for body awareness, bilateral coordination,
and facilitating better communication across cerebral hemispheres. Ultimately
it led to the skill of cycling that is so essential for any child’s movement, play
repertoire, confidence, and self-esteem.
As a clinician, I learnt another lesson as to how a simple equipment can become valuable in skill attainment for our clients. This is a reminder that we may easily miss out simple strategies already available to us in our quest for sophisticated solutions.
