Our physiotherapy intensives are fantastic fun, and a great way improve bike riding skills over the school holidays. I spoke at the Australian Physiotherapy Association's Paediatric group about the way we are setting goals and measuring change.
Image description: young boy excitedly riding an orange bike with training wheels
In physiotherapy, understanding the child and family priorities is the first step. Then getting to know the child and their individual learning needs is key. Then we see what they can currently do, and what they could learn next, in moving towards their goals. Then we develop goals together.
This is all part of the assessment process. It allows us to develop physio approaches that are specific to this child at this moment in time. This is different to a generalised program, where children all complete similar tasks, and we hope that their goal areas are targeted, and that their learning needs are met.
In physiotherapy, we are constantly monitoring how the child is going, moment to moment. We adjust our approach on the spot as needed. That is how we can individualise our sessions to see wonderful outcomes!
I spoke about the Cycling Skills Checklist, which is an outcome measure for bike riding. It goes from beginner skills (like picking up your bike and climbing on) through to advanced skills (like riding on the road). In this way, it can be used over time to see skills develop.
While it hasn't been researched itself, it is the major outcome measure used in bike riding physiotherapy research. It is used by bike riding physiotherapy programs at both the Royal Children's Hospital with children, and at the Epworth with adults.
It is designed for use with two wheeled bikes, and the programs mentioned work with people on two wheeled bike riding skills who are close to achieving this goal.
At Splash, we are happy to work with children at different stages of skill development. We have done intensives with children using:
custom made tricycles with additional postural supports, who use a walking frame to walk short distances and otherwise use a wheelchair. Examples of changes in their goals are: BEFORE pedal four times after a push start while going down an incline; AFTER: on flat ground pedal to get started and do 20 pedals in a row
Image description: a child sits smiling in a custom tricycle with postural supports, assisted by a physio
tricycles, in either preschool or older child sizes: this can be useful for developing pedalling and steering skills. Some of these children will progress towards two wheeled bike riding. For other children, using a tricycle will give them independence into their adulthood
two wheeled bikes with training wheels: this is used when we anticipate a child will be soon moving on to two wheeled bike riding. Training wheels are quite unsteady and do not have a long life span, compared to tricycles. They can be useful when we are working on pedalling and steering and getting ready to take the training wheels off. Sometimes families have tried to take the training wheels off but it hasn't worked out, and children sometimes come to us very anxious about this next step, and are well supported by our physios in developing skills to successfully work through this.
balance bikes: balance bikes can be great for working in steering and balancing. Sometimes we use these with younger children, or balance bikes can be bought for older children. We have been known to take the pedals off a 2 wheeled bike for an older child to 'create' a balance bike
two wheeled bikes: are used when we have assessed that a child has enough of the required skill components to begin to put it all together in this very complex task. We take children from learning to get on and off a bike through to riding on different surfaces and keeping left on narrow bike paths, depending on their ability and age.
Image description: child getting his balance riding down a grassy slope on a green bicycle
The Cycling Skills Checklist is designed to be used with two wheeled bicycles. As we are not doing research, we can use the outcome measure for the other bike types as long as we are clearly marking the measure. This means that if a child does an intensive with us using a tricycle and sees great improvement on the measure, we would not be comparing against that score when we move to a bike. We would start fresh with a new measure.
Image description: a child is assisted practise pedalling while two adults help with bike balance and steering
Outcome measures help us identify strengths and goals. They help us to provide targeted physiotherapy towards children's goals. They help us to track change and check that we are making a difference through our physiotherapy sessions. And they help us communicate this change, and celebrate small and big achievements that children make!
Shayna Gavin is a physiotherapist who is passionate about helping babies, children and young people learn functional skills so they can participate in life at home, school and in their community. Recognising that children do best in their own environments, she visits homes, schools, and leisure activities from football fields to ballet classes. She also has daily aquatic physiotherapy sessions available at two private swimming schools in Moonee Ponds and Greensborough, Melbourne. She combines principles of paediatric physiotherapy, Contemporary Neuro Developmental Treatment, motor learning, and swimming teaching to address the individual needs of each child and their family. She loves providing professional development to physiotherapists, allied health and education professionals, allied health assistants and swimming teachers.