Innovative Research - Trycycle Project Update...

 

Claire Higgins our Physiotherapist has now completed the first stage of her research project using the Trycycle project and our school gym as the basis for innovative research into the potential impact of both.  Claire’s research is summarised below:

 

‘The Willow Dene school team are very supportive and receptive to our partnership initiatives and are open to projects of a Universal and Specialist nature that will support their students.  This collaborative partnership allows innovative thinking and projects are brought in to fruition with support from the school budget.

At the end of 2014, through one such project, a new piece of equipment was sourced for a young man to enable him to exercise his arms and legs. 

The MotoMed bike allowed him to exercise from his wheelchair, with arm and leg trainer functions that passively aided his cycling as required, but allowed him to actively join in with the pedalling as he was able. After the bike was purchased for the school it was agreed that the school team would staff activity sessions for children who would potentially benefit from cycling and there would be overarching support from the Physiotherapy team (Specialist intervention).  This was the advent of the ‘Try-cycle’ project and is the focus of this action research.

Observing children over time it became evident that there were individual examples of children being able to actively pedal the static cycle that we did not anticipate would have had the capacity to do so.  This raised the question how many other children may be able to participate as active partners in their physical exercise and what would this look like?

The basis of the project has been: “Can we demonstrate through case studies that children should be given more opportunity within the school day to participate in exercise in an attempt to combat the physical effects of immobility that are an additional concern for their well- being?”

The Action of formally evaluating the Try-cycle programme has resulted in a development in all aspects of the work.

The specific intention of profiling how our children move and respond to cycling has been achieved.  At the most basic level we have established that 7 of the children were comfortable during cycling, 5 children could actively participate in exercise, 4 children improved their active participation over time and there were no adverse effects on heart rate or breathing.  This has laid the foundation for the work to expand and has justified the on-going evaluation of all children’s cycling profiles.

For the individual child we have progressed from the bike session being an ‘experience’ to an ‘intervention’.  Personal targets have now been set with a focus area for change that reflects their ability to date (i.e. increase time on the bike, increase activity).

We did not have an expectation for the degree of change that would occur and equally we could not have predicted the evolution of the project itself.

By formalising the project as Action research there has been an unexpected shift in the status of the work.  As a joint initiative Try-cycle has always been innovative in its delivery –conceptualised and monitored by Health, but delivered by Education.  However as a direct result of the work Try-cycle, as a package, has organically developed its own identity.

As delivery became embedded in to the curriculum timetable the work became more visible to the wider school community.  Our lead LSA was supported to increase her time dedication to the project and Willow Dene’s ‘ownership’ of their integral role in Try-cycle thrived.

The gym space dedicated to cycling was allocated resources – a new sign for the front door, an office desk, towel rack, photo display board.  Enhancing the space enhances the experience for all participants and visitors are a regular feature in the gym.   From our staff survey thirteen responses were collated which showed that staff positively responded in all domains of the questionnaire.  There were no negative comments and the bikes were seen to be beneficial for the students and school.

A third cycle (smaller size) was purchased for the project to enable our youngest pupils to ride.  As the commitment to the potential of the intervention was becoming clear we agreed we wanted to promote active participation in exercise (where appropriate) from the earliest age.

Similarly Willow Dene has now opened their new secondary site in the borough and our 4th bike has been bought to serve the children through transition.

Sessions on the bike are now being actively sought by teachers across the school, for children with varying diagnoses.  For the purposes of the evaluation we focused on the children with complex motor disorder but there are a wide spread of children who have been identified as potentially benefitting from the intervention;

  • Post-surgery to gently reintroduce exercise and movement
  • Obesity concerns
  • Children with a diagnosis of Autistic Spectrum disorder – some children cannot pedal a bike and this would help to model the activity.  They can also have problems with regulation of behaviour and our teachers have suggested that the rhythmic activity of the bike may have a sensory benefit

This is a positive development but also raises the question of capacity and demand.  In its current format the project is not able to expand and priority criteria are being developed so that we can allocate sessions based on highest need.  This also ensures that we continue to achieve consistency for the students that are on the programme and their experience does not get diluted by introducing too many riders.

To address capacity as an interim measure we have written a competency document for the safe use of the MotoMed bike.  This has allowed staff members to become proficient in the delivery of a session and therefore the bikes can be used outside of Gym time to maximise the resource.  However children with a motor disorder or any other physical concern that would deem them a clinical risk are only seen by our lead LSA and/or Physiotherapy team to ensure safe practice.

The specific development of the TA’s role has been an extremely positive benefit of the programme.  Her vision and commitment to the work has helped embed the project within the school’s core provision.  She has championed the work with our parents, producing communication slips and termly reports to update them on their children’s progress (Appendix 16).  She has also enhanced her clinical reasoning skills in the assessment of the sessions and the necessary adjustments that need to be made for each child’s comfort and safety.  Overall the experience has highlighted how new roles can be created through effective, innovative Education/Health partnerships.

From the case studies shown we can demonstrate that there are positive observations when our children with complex motor disorder are given the opportunity to participate in active exercise.

What is apparent from the small number is that even with the same classification of motor disorder all those observations are very different.  Every child’s profile brought up something unique for discussion.  There are also a number of external variables that need to be further considered.

Due to the nature of our children’s difficulties they are unable to perform exercise as would be advised for the mainstream population.  The children in the evaluation were unable to complete a standard warm-up as they are unable to follow specific instructions (e.g. please let the bike cycle for you for 2 minutes, or cycle at half of your normal speed for the first 2 minutes).  There is also a training deficit as we are unable to determine their actual baseline fitness because we cannot instigate maximal effort exercise assessment.

Perhaps what we can hope to achieve with the continuation of this early profiling is that we will be able to expand on the current guidelines for children with Cerebral Palsy.  The more children we profile over the time, the more we can say with certainty that this cohort of children are able to be active and that this is a safe, positive experience for them.

What is clear from the background literature is that there is a need to look further at intervention for this population as they fall under the radar for conventional research studies.  In the Surveillance of Cerebral Palsy in Europe (2002) it was recorded that overall a third of children with CP were not walking.  In our local Children’s Physiotherapy service evaluation we know that our caseload has had a consistent representation of children with CP each year (our largest single diagnosis) sitting at around 45%.  These two figures combined indicate that there is a significant population of children that need help to facilitate active movement in some way if we are to try and attenuate the disadvantages of a sedentary daily life.

If you would like to know more about our Trycycle project or research please contact us.