Improved Technology for Regaining Freedom
By Katie Hawkins
Old and new technology are becoming more popular in providing those who are paralyzed the ability to ride a bicycle. Functional Electronic Stimulation (FES) bicycles are used to stimulate the nerves that connect the spinal cord to muscles, activating movement in the muscles through an electric current running through pads placed on the skin. A computer program allows the muscles to contract in a way that mimics a natural cycling motion. Post-FES therapy, options such as hand cycles and three-wheel adapted mountain bikes are available for riders to get back on the bike, whether for fun or competition.
Active therapy, where muscles are doing work to move on their own, has been increasingly implemented into physical therapy sessions with paraplegic and quadriplegic patients so they can reverse muscle atrophy.
“People with spinal injury or neurological issues who cannot move their legs can use this bike, and a computer program will coordinate the stimulation to simulate motion,” explains Dr. Chester Ho, section chief of Physical Medicine and Rehabilitation and associate professor with the Cumming School of Medicine. “For people with paralysis, they won’t be able to walk or cycle again using their legs if they don’t build the strength.”
FES bikes have four main benefits: building increased muscle mass, which in addition to aiding in strength also helps prevent pressure sores; improving circulation and skin health; increasing range of motion; and improving cardiovascular health. It can also reduce muscle spasms.
Though the technology is about 20 years old, the Canadian Paraplegic Association in Calgary, Alberta, is taking a unique approach to FES therapy. In many areas, people gain access to the bikes in hospital therapy, or if they are lucky, in physical therapy organizations. For the best results, it is recommended to use the machine three times per week for an hour. However, once patients are discharged, they no longer have access to the bikes, which run upwards of $30,000 USD. In Calgary, they now have three bikes available, one in Foothills Medical Centre, another in the Spinal Cord Injury Alberta office, and additional bike that just recently became available for public use at the University of Calgary.
It is a very organized and systematic approach,” explains Dr. Ho. “We are working together in the policies, procedures, and flow of the how the bikes are being used from one place to the next.”
Those who would like to use the FES bikes are required to obtain medical clearance and complete an assessment at a qualified center to ensure the equipment is suitable for their condition. The same bicycle is also used for rehabilitation at the University of Washington Rehabilitation Medical Clinic in Seattle.
“For some, muscles do not respond to electrical stimulation,” expresses Dr. Ho. “Given the neurologic condition of the type of injury, the physicians will have a good idea if the muscles will respond or not, and a therapist can do some testing.”
Vancouver, BC, resident Tara Llanes, a former motocross and mountain bike racer, sustained a devastating injury in 2007 during the Jeep King of the Mountain event in Vail, Colo. Being the 1999 X-Games gold medalist, 2002 Dual Slalom National Champion and 2006 U.S. National Downhill Champion, she was no stranger to technical courses. However, the day of her injury, she describes feeling off.
“I remember being in the gate and not being ready,” recalls Llanes. “My goggles didn’t feel like they were on quite right, and my pedal needed to be in a different spot. But it was a made for TV event, and when they are ready, you go.”
Llanes approached a technical section of three or four double jumps, all of different heights and lengths, in the middle of the course. Hesitating on whether to jump or not, she misjudged the take off and landed on her head, fracturing her neck. With nowhere for her body to go, it curled up behind her like a scorpion tale, breaking her lower back.
She was helicoptered to Denver Health Medical Center where she immediately went into surgery. A few weeks later, she was transferred to Craig Hospital in Englewood, Colo., a world-renowned facility for spinal cord and brain injury rehabilitation. She remained there for three months. Her therapy included bolsters, weights, daily wheelchair class, pool workouts, standing frames, and sessions on the FES bike.
“I was on it all the time,” says Llanes. “Honestly, if I could afford to buy an FES bike, I would. I think they are great for physiotherapy, for getting the nerves firing and regaining muscle.”
In the last few years, Llanes has gotten back on the trails with her three-wheel adapted mountain bike — “The Explorer,” a model built by the company Sport-On.
“We make two adaptive mountain bikes and one high-performance handcycle, [the Skorpion], for road,” explains Llanes. “[The XCR] adaptive mountain bike follow the same concept as handcycle, with two wheels in back and one in front. It’s a hardtail. The Explorer is full suspension with two wheels in front and one in the back, seven feet long and three-feet wide. You lean forward on a chest pad, connected to two front wheels. You pedal with the cranks that are right below you, and lean left or right on the pad to turn. People are nervous about flipping it, but it’s actually quite stable. It’s a really fun bike, and I don’t know of any other bike like it on the market. This one has been great. I’ve heard they’ve started handcycle mountain bike races in Colorado.”
As a sales representative for the company that specializes in adaptive sport equipment, Llanes is advocating for wider trails so that three-foot-wide, three-wheel-adapted mountain bikes can also join in the action. She is currently working with the Trail Adoption Program, North Shore Mountain Bike Association in Vancouver, BC, and the Whistler Adaptive Sports Program (WASP) in making mountain bike trails accessible to everyone. She is also in the process of raising funds to purchase adapted mountain bikes (costing about $9,500 CAD a piece) to be available for rent through (WASP) at Whistler Mountain.
“People want to get out and be active in the woods, and $10,000 is hard to afford,” says Llanes. “Having these bikes available means regaining your independence and getting your health back.”
Another former racer, Barry Wilcox, was an up-and-coming junior from Port Angeles, Wash., who within three years of competing won the national time trial title as a 15-year-old. He claimed the time trial title again at 16, as well as the pursuit crown.
In 1995, 16-year-old Wilcox fell asleep driving home from a concert. He nodded off and hit a tree, breaking his neck. He stayed a month in Harborview Medical Center in Seattle, Wash., spent time at the Children’s Hospital, and then Craig Hospital in Denver, Colo. The FES bike was incorporated into his therapy.
“I used the FES bike every once in awhile,” says Wilcox. “I noticed an increase in muscle mass and circulation. I definitely would recommend the FES for rehab or if the scenario is right. It’s great for circulation, tone, and reducing spasticity short term.”
However, Wilcox expressed that in the 1990s there wasn’t a lot of resources for knowing how to handle quadriplegia. It took four years to get to his state of independence. Wilcox decided to study Exercise Physiology at Oregon State University, and wrote his Masters thesis on spinal cord injuries long-term, incorporating a case study on himself and his progress in regaining function. He is now an Exercise Physiologist in Salt Lake City, Utah.
Wilcox got his first hand bike in 2007 and participated in a few marathons. Since then he mostly has used it for fun and keeping in shape. Just this year he found out that the Union Cycliste Internationale (UCI) revised the category for H1 handcycling, matching his physical ability. [Details on hand cycling classification can be found at ushf.org/index.php/athlete-resources/classification-info.]
“I’ve got limited grip and hand function, limited chest and lats,” explains Wilcox. “Being a quadriplegic is far from easy, but I have learned to maximize my abilities and take advantage of resources to help continue in an upward direction, whether it is taking care of myself by keeping to healthy behaviors, moving career forward, or looking outside the box knowing that ultimately I am in control of what is ahead. I had no idea a category in handcycling would be developed to fit my ability. This truly is my second chance. I am going for gold.”
Wilcox won the 2015 Road Race National Championship in Chattanooga, Tenn., and traveled to Elzach, Germany, to attend the World Cup July 18-August 3, 2015. His goals for 2016 are to gain a spot on the U.S. National Team, repeat a U.S. National Championships win, and attend the World Championships.
Since the ‘90s, technology has improved immensely to help those who have sustained spinal damage. The FES bike is helping to regain muscle strength and toning, so that the body is ready to get back on two feet — or wheels.