Learning to cycle is one of the milestones of childhood. Children of all ages love to ride a bike, and children with hemiplegia are no different. Cycling helps develop self-confidence and can increase independence. It can also have a therapeutic role, strengthening muscles and improving balance. And it is great fun!
Ask your child's therapist for advice about when and how best to start. They may even be able to lend you a special trike. Generally, of course, children prefer to learn to ride a bike than a trike. There is no reason why your child should not start with a bike, provided their hemiplegia is not too severe and not complicated by other medical conditions that might affect ability to balance, steer etc.
What to wear
For safety your child must always wear a helmet, since they are much more likely than other children to bump their heads if they fall, and the slightest bump to the head can be dangerous. Long trousers, long sleeved tops and gloves help cut down on grazes, as do knee and elbow pads.
Stabilisers and balance bikes
Most young children start with stabilisers, but children with hemiplegia will probably need them for much longer. You may need to buy adjustable stabilisers, which will grow with your child and which you can raise slightly as they gain confidence.
For children who have particular problems with balance (or lack the confidence to try without stabilisers), a father designed special adjustable stabilisers that can be moved inwards gradually so that the child hardly realises that they are managing more and more on their own. These stabilisers are available from www.gooddesigns.eu.
Balance bikes are another option. These do not have pedals or stabilisers. Instead, the child puts both feet on the ground from the saddle. Balance bikes allow children to gradually build up their balance before moving straight onto a bike without stabilisers.
Choosing a bike
Some parents have found that it helps to have a bike that is exactly the right size or even slightly small, so that the child can have their feet firmly on the ground whilst sitting on the saddle. It may be better to buy a series of second-hand bikes than to spend a lot of money on a new one that is too big.
The crossbar on boys' bikes should not be too high - fortunately, fashionable BMX and mountain bikes have lower crossbars than traditionally framed models.
How to begin
Practice areas should be as flat and even as possible. You could try a sandy beach, which is firm enough for the wheels to turn but soft enough to cushion falls.
Some children need to learn in stages. They may, for example, find it difficult to think about balancing and pedalling at the same time. It can be useful to remove the bike's pedals and let your child try 'scooting' along, getting a feel for balancing, before attempting pedalling.
If your child does not get the hang of pedalling immediately, you may need to push their feet round in the pedalling motion until they get used to it.
If your child has a left hemiplegia, the back brake will be on the side of their weaker hand. Any good cycle shop will swap the brakes over, as it is more important to have the back brake functioning. This may be enough when your child is learning, but once they are riding properly we strongly recommend that you have the bike adapted so that both brakes are operated by the stronger hand.
If the bike has gears, the gear lever/changer should also be moved to your child's stronger side. Alternatively, you could buy a bike with back pedalling brakes.
Children with hemiplegia vary enormously in the extent to which they can grip with their weaker hand and stretch their arm.
Some may need adaptations to their handlebars to help with holding. This can be as simple as sticky Dycem to improve grip, or you can fit an additional steering socket or knob (similar to those used for driving a car one-handed). Some children find an old-fashioned 'sit up and beg' type of bike, where the handlebars curve towards the body, easier to ride than a mountain bike or racer.
Some children have trouble keeping their foot or feet on the pedals. Here are some ideas tried by families (note that some of them should be used only with bikes with stabilisers or trikes. On an unstabilised bike you need to be able to remove your foot from the pedal if falling sideways):
- Sticky Dycem attached to the pedal is sometimes sufficient to hold the foot in place.
- Toe clips of the type used on racing bikes can be fitted to the pedal. These can be used with unstabilised bikes since they allow the foot to slip out sideways in a fall.
- On a stabilised bike you can use additional elastic or Velcro around the heel. If the pedals have slots, try threading through Velcro strips or nylon straps with quick-release buckles, which can be fastened round the foot.
- Footplates, with a cord and pulley to keep feet horizontal, are available from specialist suppliers
- You can attach an adult shoe to the pedal, which will accommodate foot and shoe, or use plastic moulded into a 'shoe' shape and attached to the pedal.
- Bolt an old fashioned metal roller skate to the pedal, minus the wheels but still with its leather straps.
Trikes, trailers, tandems and other bikes
Children with hemiplegia usually take longer to learn to ride a two-wheeler, but with persistence many of them make it in the end. And if not, there are plenty of alternatives in the shape of interesting trikes, recumbents and tandems. These are usually expensive, but many families have had help with buying them from local Rotary Clubs etc. or from Whizz-Kidz).
Trikes come in all shapes and sizes (and some have loads of street cred as well)! Some have double wheels at the front, which can help children with perceptual problems to judge width more easily.
One model, designed for older teenagers, has a small engine to help in hilly areas. Some trikes have fixed wheels i.e. the pedals move with the wheels. The benefit of this is that the child does not have to get off to get out of an awkward position but can just reverse. For a child with more complex needs, a side-by-side or tandem may be the answer.
A good way to prepare your child for riding a two-wheeler is to use a 'trailer bike'. These are attached to an adult bike by a tow-bar and the child can do as much or as little pedalling as they like whilst getting a feel for balance. It also helps teach the child road skills.
Another similar idea is a device which allows you to attach the child's bike, minus front wheel, to the back of an adult bike. The extra wheel can be carried on a special bracket, so the child can start riding alone but hitch a lift when they get tired. Tandems are also a good way of building up a child's strength and balance, but are more expensive and less flexible than trailer attachments.
Safety and signalling
The best way to ensure that your child is safe on a bicycle is for them to take part in a cycling training scheme.
The old Cycle Proficiency Scheme has been replaced by a set of National Standards, and the main provider for training is Bikeability www.bikeability.org.uk, which has developed a three stage programme. Your child's school may already be taking part in this, otherwise contact your local authority. The Bikeability website states that the scheme is suitable for children with additional needs, who will be given extra training to reach the required level if necessary.
One safety concern is the ability to signal, which, depending on which way they are turning, involves either steering with their affected hand while indicating with their stronger hand, or using the affected hand to indicate. If turning right at a busy junction it may be better to dismount and walk across. If your child is taking part in a training scheme, this is something to discuss with their instructor.
You can also visit the Disabled Living Foundation at www.dlf.org.uk. They have a list of suppliers of specialised bikes/trikes and also of accessories such as back supports, footplates, special handlebars etc.
Charlotte's Tandems - www.charlottestandems.co.uk - is a charity that lends tandems to disabled people or people with additional needs for free.
CTC - www.ctc.org.uk - is the UK's national cyclists' organization. Go to: Go Cycling> Cycling hints and tips> All ability cycling for information and links.
GetKidsGoing - www.getkidsgoing.com - is a charity that promotes sports for disabled children and young people by providing them with mobility equipment, mostly wheelchairs but also trikes. It also supports their training, travel etc.
London Cycling Campaign - www.lcc.org.uk - has an excellent downloadable 'All Ability Cycling for Greater London' with information on the various types of bike suitable for riders with disabilities, and a useful names and addresses list which covers the whole country, not just London.
Reach - www.reach.org.uk - is a national charity providing support and advice for children with hand or arm deficiencies, and their parents. The website has a downloadable guide to cycling, which is out of date in some details but generally useful.
Tandem Club - www.tandem-club.org.uk, 01908 282485 - organises rides, pairing sighted and visually impaired riders. Also useful if you are anxious about someone with epilepsy cycling alone.
Whizz Kids - www.whizz-kidz.org.uk - is a charity which provides mobility equipment, including trikes.
Cycling as a disabled sport