Selecting an appropriate tricycle for a child with disability.
The selection of a suitable, adapted tricycle for disabled children presents many challenges. This article explores those challenges and discusses what products and options are available locally. The focus is primarily on foot-propelled tricycles suitable for toddlers, young children and adolescents with cerebral palsy and other neuromuscular disabilities. This excludes recumbent foot-propelled vehicles and hand cycles.
There are many reasons why a tricycle is an ideal piece of mobility equipment for children with disabilities:It provides an opportunity for ‘moving oneself’ for children who cannot walk or self-propel a wheelchair.
Children with a physical disability are often independent on a tricycle before they are independent on their feet.
It enables a child to navigate through passages, along paths, around bends, so developing skills to anticipate problems, plan and execute a motor response e.g. slowing down, turning or braking.
Tricycle riding can be a functional goal and components can be practised during therapy sessions.
Children are able to move around with their peers, participating in activities which are age-appropriate.
It provides for leisure activity, physical exercise and family involvement when a child has a tricycle at home.
Improves head and trunk control as they use balance reactions while reciprocally moving their legs.
Pedalling and getting on and off the tricycle requires motor planning, sequencing, balance and the ability to coordinate arms and legs.
Pedalling provides an opportunity for alternate leg action which benefits ‘stepping’ for gait (while the trunk and upper limbs are stable).
Riding allows for joints and muscles movement, albeit passively when pushed or actively when pedalling, and this promotes the development of the muscular skeletal system.
Riding helps develop the visual-spatial skills of knowing where their body is in space and their environment.
Riding promotes physical activity and improves a child’s exercise tolerance and fitness.
Many schools for children with disabilities have a range of tricycles available for them to use as part of their therapeutic and physiotherapy programmes, for playground amusement, or even for transport around the school. The school’s physiotherapists and occupational therapists are responsible for the selection and ordering of new equipment. A small minority of children have tricycles at home for leisure use.
Sizing for children
Children's tricycle and bicycle sizes are determined by the diameter of the wheel, not the height of seat and size of frame. Most commonly, toddlers under 2Â½ years-old use 25cm or 30cm wheels, and children from 2Â½ to 7 years use 35cm or 40cm wheels. Children from 10 to 15 years will use 50cm wheels. Thereafter, consider small-framed adult bikes with 61cm or 66cm wheels, and which are sized by the length of the seat tube.
When sizing a cycle for the child, a useful guideline is to ensure that the child’s toes can touch the ground when the seat is at its lowest position. This ensures that the child will get several years’ use from it before it needs upsizing.
Toddlers 1 to 3
There are only a few good quality tricycles available in South Africa, and given the small market, these are quite expensive. In my research of tricycles for this age group, I uncovered the Tri-ang tricycle, which is no longer available in South Africa, and some obsolete Panthers, with various modifications. They are almost impossible to repair as the nylon bush in the front wheel where the pedals attach wear out and parts are not available.
Since Tri-angs are no longer manufactured, options include imported models made in the Far East, EU or USA such as Trek and Giant, available from large specialist cycle dealers. Another option is to find second-hand imported tricycles on the eBay or Amazon.com websites. In most cases a bicycle with 30cm wheels is converted into a tricycle for toddlers. (See ‘conversions’.)
Small tricycles normally have a low centre of gravity to prevent tip-overs. The pedals are attached to the front wheel so the child’s leg position when pedalling requires a push forward movement, which does not give much power, but allows for safety. Small tricycles have either plastic wheels or hard plastic “mag” rims with soft EVA foam or rubber tyres. Some models have hand brake levers, but most tricycles have no brake mechanism since small children cannot pedal very fast. Toddlers and small children will need help learning to pedal and steer, and a parent handle is almost always essential. Small Triang tricycle which is now obsolete in South Africa. Modification to raise backrest and adapted pedals shown. (Photos taken at Cape Recife School.)
Some modifications to a tricycle are almost always inevitable, depending on the child’s disability:
Handlebars are turned around or modified to an upright position, so the child can use trunk extension when propelling.
Lengthened axles broaden the tricycle’s base of support, lower its centre-of-gravity, making it less inclined to tip over.
Adaptations such as wooden foot plates with heel-stops and straps are fixed to the pedals to hold the child’s feet. Similarly a universal shoe with laces is fixed to each pedal and holds the child’s in position.
A raised backrest with a brace bar provides back support.
Some children are too flexed in an awkward position to be able to operate the pedals on the front wheel of a tricycle. They can only perform a downward push to achieve motion. In many designs, the turning radius is not limited, so the tricycle can tip over easily.
Tricycles available in SA
L’il Giant Tricycle, 2 sizes (25cm or 30cm scooter type wheels); light alloy frame, with a parent bar sold separately; Price from R700 to R1200 from selected cycle shops.
Reputable tricycles (via internet searches)
Schwinn Roadster, which has 30cm mag wheels, full-steel heavy-duty construction and a sculpted seat. Price from R1200.
Elmo Tricycle, with 25cm mag wheels, moulded plastic saddle, and parent handle. Price from R800.
Kettler Kettrike, with auto-freewheel for comfort and safety, air tires, sturdy rear tipping bucket. Price from R1200.
Radio Flyer Classic Red Dual Deck Tricycle, a 30cm, steel-spoked wheel and rubber tires; sturdy steel design, low centre of gravity. Price from R1200.
Children 3 to 10
When a child outgrows the large tricycle, consider having a small bicycle converted into a tricycle. For this age group, a bicycle with 30cm or 35cm pneumatic wheels can be used. Available from various manufacturers e.g. Raleigh, Giant, Fuji.
Conversion of a bicycle with 12” wheels into a tricycle. This tricycle is fitted with a pushbar, steering limiter, handlebar extensions and special pedals. (Supplier: Grant’s wheelchairs.)
Reputable suppliers who offer this conversion will convert a bicycle into a tricycle with the specific features the therapist or parent requests, or make a purpose-built tricycle. The best known suppliers in South Africa include Koose Tricycles and Grant’s Wheelchairs. There are some Orthotists and Prosthetists who offer this service by outsourcing the making of the axle to an engineer. Only a few suppliers will make purpose-built tricycles, and it is worth asking to see a portfolio of products they have made.
Typically, suppliers use 40cm or 50cm wheels on various Raleigh or Patriot models (Contender, Li’l Honey, Splash, BMX Roost, BMX Havoc). Bicycles of more unusual size with 35cm wheels are available on request. Older children may require 61cm and 66cm diameter wheels on racing or mountain tricycles, with adapted gears and front and rear brakes.
Conversions cost between R1800 for a simple conversion of a small bicycle to R5500 for the high specification racing tricycle with gears.
The single rear wheel is removed and a 66cm axle bar made from mild steel is bolted in its place. Two rear wheels are attached to the axle ends.
The most appropriate cog for the child is fitted, such as a fixed cog, free wheeling or back pedal cog.
Foot straps are added to the pedals.
Dual-caliper hand brakes are fitted to the front wheel with tension adjusted for the child’s level of hand function.
An alternative handlebar or vertical handlebar extensions allow for a more upright cycling position of the trunk.
The plastic seat is replaced with a broader, firmer exercise cycle seat.
A wide-based seat with a metal base which allows fixing of a backrest with or without laterals for trunk support.
A raised backrest with a brace bar providing back support or a front brace to offer trunk support.
Fully-adjustable back support with lateral and spinal support, with or without a harness system.
Specially adapted pedals to strap in the child’s feet, with heel stops and foot straps.
Calf supports to align the lower leg in addition to foot supports.
Height-adjustable steering bar and steering limiter.
Handlebar extensions or raised and upright handlebars with a central axis point or double axis.
Some imported models, like the Vermeulen and Meyra “Sunny” tricycles with either 40cm or 50cm wheels are still available in some schools and offer features like a low-slung cross bar, upright handlebars and larger/broader seats.
Imported from Austria, the Meyra ‘Sunny’ is a well designed purpose-built tricycle with a double upright handlebar, back/trunk support and adapted foot pedals. Very popular choice with the children at Cape Refice School, Port Elizabeth. (Photos taken at Cape Recife School, Port Elizabeth.)
Purpose-built cycles can be ordered from some suppliers, based on the child’s experience on a tricycle and information from websites on imported products that may not be available or that are very expensive to import. Tandem trikes can also be made to order by some suppliers.
Who needs a purpose-built trike?
A child that has difficulty lifting feet high enough to mount an ordinary tricycle or who wishes to do this independently.
A child with minimal hand function to brake.
A child that requires full trunk support.
A child that cannot steer very well and requires a steering limiter.
A child with poor balance or who uncoordinated may need a wider wheel base from 66cm to 77cm. The length of the rear axle is increased making the tricycle wider but more stable.
If a child is still in a flexed position with vertical handlebar extensions, the handlebars may need to be customised and brought closer to the child (special handlebars or a double-handlebar) to get the child more upright.
The main disadvantage of converted tricycles is that the larger the bicycle used, the higher the centre of gravity is raised. The higher the centre of gravity, the more unstable the tricycle and the more demand is placed on the child for balance. The ideal size for a child is a bicycle not too big, with a low-slung cross bar to assist both girl and boy riders to get on and off the bike. The ideal pedalling posture is a 90 degree trunk to hip flexion, but many adolescents prefer recumbent foot-propelled tricycles, as their balance difficulties can be better accommodated. Adolescents may use cycling as a means of transport on public roads, so proper road safety training and protective clothing is important.
Children with athetoid and dystonic cerebral palsy may benefit from a wider base of support from the seat itself and the overall width of the rear wheel base.
Most children with disabilities also require a vertical handlebar extension to correctly align their arms and ensure a better trunk position.
Children with poor hand function cannot operate hand brakes, so a fixed cog prevents rolling back when the child stops propelling action.
Children with visual impairments may need a free-wheeling cog to enable reversing when they bump against objects.
Do not allow passengers to stand on the tricycle’s backboard as this raises the centre of gravity and eventually bends the rear axle causing wheels to “toe out”.
An angle-adjustable seat offers more anterior tilt that may help extend the spine for very flexed children.
Older children with shortened hamstrings or weakness of hip extensors may benefit from a smaller radius on the pedals.
A parent handle allows adult control when the child cannot brake or steer properly. The overall width of the rear axle and wheel assembly should pass through a standard door width of 80cm. Otherwise the tricycle can only be stored in a garage and used outdoors.
When riding outdoors on public roads, attach a 2m whip pole with a small dayglo flag to the tricycle and fit a bell or horn that the child is able to operate.
A chain guard will protect the child’s clothing from damage and dirt.
Mudguards are useful for off-road cycling. Remember too that a child should always wear a well-fitting cycle helmet and be supervised by a responsible adult. Happy cycling!
A special thanks to the therapists, parents and children who shared their experiences with me, for the purposes of writing this article.
Suppliers of adapted tricycles
Koose Tricycles, Worcester. Contact Koos Engelbrecht
Grant’s Cycles, Pretoria. Contact Grant
Presta, Pretoria, Tel.
Freedom Equipment Solutions, Port Elizabeth, Contact Jeff
Orthotists and Prosthetists
Fixed cog – When child stops pedalling the bicycle keeps rolling forward. A fixed cog is useful in environments with sloped corridors and paths. Hand brakes are required to stop the bicycle.
Free-wheeling cog – When the child stops pedalling the bicycle more or less stops; one can reverse by back pedalling. Hand brakes are required for effective braking. If you do not specify you will be supplied with a standard free-wheel cog.
Back pedal cog – When the child pedals backwards the brakes are applied. Hand brakes not fitted.
How do steering push bars and steering limiters work?
The steering limiter is used in conjunction with a parent pushbar, so the front wheel is locked into the forward position while the child in being pushed by the parent. This means the parent controls the direction and the child is often pedalling passively. When child is learning to pedal but may not be able to steer at the same time this is useful. When the child can pedal independently the steering limiter, set at 45 degrees, allows the parent to assist with steering and to ‘save’ the child when he or she gets into trouble. A braking mechanism can be added to the pushbar to ensure that the tricycle remains stationary when stopped. Many parents report how useful this is on tarred roads which are cambered on the sides.