Can I learn to Cycle? Opportunities for all children to achieve cycling- voices from research and practice

Child’s World- Next Steps, International Conference Aberystwyth

University Gabriela Todd and Dawn Pickering

26th June 2014

Objectives

• Context of practice and research– Cycling, Race running

• Children’s voices

• Future

United Nations Convention on the Rights of the Child

• 23 Children with disabilities • 28 Right to Education

• 29 Goals of Education

• 31 Leisure play and culture

Background

• Physiotherapy clinical practice with Cerebral Palsy (CP)

Lack of participation opportunities for CPFowler et al, 2009;Fauconnier et al, 2009;McConachie et al, 2006;Mihaylovat et al 2004

Choice of activities limited- requires some adaptation and support

Cerebral Palsy- consensus definition

Rosenbaum et al 2007‘….describes a group of permanent disorders of thedevelopment of movement and posture causingactivity limitations that are attributed to non-progressivedisturbances that occurred in the developing fetal orinfant brain. The motor disorders of cerebral palsy areoften accompanied by disturbances of sensation,perception, cognition, communication and behaviour, byepilepsy and by secondary musculoskeletal problems.’

Palisano et al, 1997; Reid et al, 2011

Adapted cycling research 2009-2012(Nancie Finnie Charitable Trust )

• Diane’s drawing aged 10 Muscle strength and length

Participation opportunities2 groups: Cycling (17), non cycling (18)

Diary of physical activities

Interview adapting Mosaic methods

Cycle route

What did physiotherapists understand participation meant? Pickering et al, 2012

Medical model

Non cycling group analysis- physical activities + cycling Pickering et al in press 2014

Wheel of Participation

Social model

Voice

AspirationsPeter’s Mum: “Gabriela put him on the

Tom Cat trike, strapped his feet in and it was the first time ever he pedalled and he couldn’t stop it. Everybody got so emotional, fantastic. It just shows if you’ve got the tools for the job, the right equipment, you can do it…This year we cycled from Bristol towards Windsor because we could hire the special trike….I think completely independently he cycled not far off 40 miles…”

“I did cycling

and it was wicked!”

Peter aged 7 years Diplegia, High tone, GMFCS I

Diane’sDiary entry-

cycling skills

Andrew’s cycling skillsAndrew was able to describe his cycling experiences: ‘…when I pedal it’s like I’mthere and I am enjoying it…we cycle inthe park and I go down the slope…and then I change it…. you know… I put into 3(gears) and it makes me fast…’

Dad describes his progress ‘…he lovesbiking, obviously it gives him that independence…they’ve taken the footplates away..’

Andrew progressed to going cycling with a carer (Bethan)

Dad: ‘…Bethan actually cycles with Andrew and they now do four circuits rather than the one or two he did before….’

Andrew 17 years and GMFCS level II with diplegia, athetosis and autism

Recumbent Trike steered from side

Children unable to self report

Julia, 14 years, GMFCS IV Rachel, 8 years, GMFCS IV

“You can just see the joy in her face when she’s on her bike yeah!....Um, I mean if it’s straight, you know, you can virtually sort of let go and she’ll just go by herself until she starts veering off course……she definitely enjoys it…”

“Throughout the cycling sessions I feel that Rachel’s confidence hasimproved. She is so happy when she is cycling and it gives her the freedom and independence she

needs…..”

Fatigue

Cycling at school

• Becky (GMFCS III) attended mainstream school• Diary entry, written by mum: “…It’s bike day at

school. All of the children are taking their bikes…Apparently she had another good session, cycling enthusiastically and proudly on her bike ( not sure how long-should think it was a good hour)….”

May’s diary entryMay is GMFCS II and has underdeveloped organs, dystonia and hemiplegia due to prematurity and having a stroke

May’s Cycling AmbitionsMay ‘s own Diary entry (aged 10 years)

Today I had a 20 mins bike ride with mysister and brother to RK secondaryschool car park there are loads of bends,curbs, bays and car spaces. I have comeon really well considering me and myfamily all thought I wouldn’t be able toachieve such a brilliant opertinity, wealso thought I am going to be doing abike prefishinsiy test after easter so wehave been practising weving in and outand signalling left and right the right isreally easy for me but the left is what Ifind tricky. and I am also learning that Ihave to ride on the left on the road.

May

Interview: Int:… So assuming you pass your cycling proficiency test, what do you hope to do with your cycling?M:..to get better and better at it.Int: Where would you like to go with your bike?M: H ForestInt: Have you been there already?M: Yeah but I had to go on a ‘stupid tandem’ because my teacher kind of forced me…another Dad pedalled..Mum: …It was sort of an ice cream basket on the back..Int: So you didn’t do any pedalling at all?M: No which was really, really, really disappointing…cos all my other friends were like riding a bike and I was lonely….

Change in behaviour

• 11 of the 18 children started cycling during or after the study was completed

Implications for practice

• Quality of life - The children who participated in adapted cycling told us they enjoyed this experience and it improved their sense of well being, independence, achievement and confidence.

• Some children chose other activities to participate in, fatigue was a factor in this.

• Policy makers should consider offering adapted cycle hire within a 50 mile radius.

Follow on from research

• This research has led to the development of some after school cycling clubs and the exploration of a competitive sport:

• Race running bikes

Imogen on her racerunner

Children were curious

5 pilot sessions in athletic stadium

Great excitement

Physiotherapy Student volunteers keen to help

Requested Funding

Racerunning

• Speed- without worrying about falling• Space is open- freedom to move - • Sociable- being with others is fun• Spring-loaded - easy to turn or to keep

straight • Sporty- fun to race my friends• Stand- I can just stand still and stretch, chat or

rest!

• Beginning

• OUTCOME

What Gareth did

Parents want their children to have a go

invite an expert speaker

Assessment arranged at

cycle charity

Cycle together session

follow-up

Funding for 4 after

school sessions

Imogen on her bike

Kissing gates were created to keep animals in, not children out

Radar key

Making leisure activities accessible for all

• Accessible space• Opportunities • Personal adjustments • Adult services cannot simply be made “smaller”• Cost of bespoke anything is high- seek funding

6 week after school cycling club

• Help children to be physically active for one hour after school (well-being)

• Work on pre-cycling skills• Progress children or let them try out different

cycles and chose what they like- if safe• Help children focus as routine builds up• Reduce the burden for parents to go out again

after school when they are tired

Department of Education June 2013

• Evidence on physical education and sport in schools:

• “The barriers include: inaccessible facilities and equipment; staff without adequate training; and inadequate, non-compliant or otherwise inaccessible programs and curricula

(Auxter, et al, 2010; Rimmer, 2008; Rimmer and Rowland, 2007; Stanish, 2010)”

Imogen’s digital story

• Consent obtained 28th April 2014:• Imogen now aged 8 years reported that she

“enjoys horse riding- especially when I’m trotting, bike riding and Brownies”

Three ‘E’s we need to flourish

Expectations

Equality

Empathy

Wheelchairs

Medical prognosis

Treatments

The sky is the limit

How do those words make me feel?

Hours in the day

Whole family aspirations, constraints and challenges

Children have rights too

“Yes, we can!”

School of Healthcare SciencesYsgol Gwyddorau Gofal Iechyd

Questions ?Dawn Pickering, Senior Lecturer,

Cardiff University’s School of Healthcare Sciences; pickeringdm@cf.ac.uk

Twitter: @DawnMPickering

Gabriela Todd, Community Children’s Physiotherapist, NHS; and BBC Children in Need funded @ Cardiff Pedal Power

gabriela.todd@yahoo.co.uk; physio@cardiffpedalpower.org