Peddler in Pediatric Therapy

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.

#pedaling #cycling #bilateral coordination #bilateral integration #body awareness #hand cycle