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AN INTERVIEW-BASED STUDY OF CYCLE TRAINING IN CHILDREN WITH
COGNITIVE IMPAIRMENT
Raissa Barros de Carvalho & Clive D'Souza
University of Michigan
ABSTRACT
This study aimed to identify training components in
a cycle training program for children with cognitive
impairments (CI) with the goal of generating
requirements for potential technology interventions to
support cycling skills acquisition and retention. A
qualitative study was conducted comprising of semi-
structured interviews with cycling trainers (n=4), and
supplemented by a literature review, document
analysis of students logs, and non-participatory
observations of training program development to
identify prominent themes and training components
unique to this student cohort. Key themes identified
relate to training period; importance of baseline cycling
skills assessments to refine the training duration and
goal-setting; role of parental involvement in supporting
the learning process; and the unmet need for long-
term evaluation of knowledge retention, safety
behavior and overall bicycle use.
Importantly, the study identified a lack of valid
measurements instruments to conduct, short- and
long-term objective assessment of cycling skills and
safety performance. The study concluded that
instruments in the form of technology interventions
could greatly improve performance assessment at
multiple points of the training process. These include
at baseline, for instance pre-training to set training
goals and plans, during training to evaluate learning,
and post-training to assess bicycle use and knowledge
retention or skill degradation from disuse. Overall such
technologies can help promote safety, independence,
self-efficacy and overall healthier lifestyle among
children with and without CI.
INTRODUCTION
Active transportation is any self-propelled, human-
powered mode of transportation, such as walking or
bicycling. Bicycling in particular can significantly
expand independent mobility for both adults and
children. In the US, cycling is a popular mode of
independent transportation and recreation among
children (Richmond, 2014). However, bicycling safety
is a reason of significant concern. The Centers for
Disease Control (CDC) estimates that in the year of
2013, 215,751 children between the ages of 05- and
19-years old were injured by cycling pedal related
accidents (71% male), and 114 died (89% male)
(CDC, 2016). Currently in the US, best cycling
practices (e.g., Kimmel & Nagel, 1990; NHTSA, 2013;
Lachapelle et al., 2013) have been incorporated into
bicycle training programs that instruct children in
increasing their knowledge and awareness of safe
cycling and thereby decrease the risk of crashes,
injuries, and accidents in general (Kimmel & Nagel,
1990).
The lack of proper bicycling infrastructure is also a
known contributing factor to crashes, injuries, and
death, in adults and children (Hooshmond et al. 2014;
Lachapelle et al., 2013). Bicycling within the
communities can is perceived as unsafe due to heavy
traffic and a scarcity of sidewalks, crosswalks, and
bicycle facilities (Winters et al, 2010). These factors
emphasize the need for inculcating safe bicycling
practices as a way to encourage safety behavior,
injury prevention, and minimization of health concerns
involving children and young adults (Lachapelle et al.,
2013; Hooshmond et al., 2014; Richmond et al., 2014).
Bicyclists with Cognitive Impairment
The task of cycling places unique demands on
physical strength and cognitive discernment. However,
no predetermined boundaries on physical or cognitive
capabilities exist that preclude individuals with CI from
learning to ride bicycles. Limitations from CI may be
manifested in a persons’ communication, socialization,
attention, memory, focus, logical thinking, dynamic
balance and other higher level cognitive functions. The
consensus is that people with cognitive impairment
generally take longer to learn, but do eventually
succeed in learning it (Michigan Government, n.d.,
National Dissemination Center for Children with
Disabilities, 2011). Medical conditions, either
congenital or adventitious result in cognitive or
impairments affects more than 6.5 million people in the
US (MDE, n.d.). Active transportation modes such as
walking, bicycling, and public transit use can greatly
increase the level of the mobility, independence and
community participant in this cohort.
This study aimed to identify training components in
a cycle training program for children with cognitive
impairments (CI) with the goal of generating
requirements for potential technology interventions to
support cycling skills acquisition and retention.
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METHODS
The study used a multi-method approach
comprising: (1) Literature review on cycling training
and cycling performance assessments in children with
and without CI, (2) Semi-structured interviews with
cycling trainers specialized in active transportation
training of children and young adults with CI, (3)
Observations of training program development, and (4)
Document analysis of cycle training logs. Four cycling
trainers working at a local organization specializing in
active transportation were recruited to participate in
the study. This phase of the research did not involve
participation of individuals with CI. The University’s
Institutional Review Board approved the study.
RESULTS
1) Literature Review
Review of prior research focused on identifying
studies of cycling training programs in children with CI
and examining potential differences in cycle training
programs in children with vs. without CI. A search on
indexed research databases (including ISI Web of
Science, PsycINFO, PUBMed, RESNA Journal, and
TRID) using combinations of search terms as “travel
training”, “cognitive impairment”, “intellectual
disability”, “cycle training”, “cycling” yielded 12 articles
related to either bicycle training or learning in children
with CI, but not related to cycle training in children with
CI. Six of the 12 papers described survey evaluations
conducted pre- and post- cycle training with at most
one week after the end of the training. Two papers
related to long-term evaluation reported significant
retention of knowledge acquired from cycling training
programs in children up to five months (Ducheyne et
al., 2013) and two years (Savill et al., 1996) post-
training.
2) Semi-structured Interviews with Trainers
Multiple one-on-one semi-structured interview
sessions (11 nos. x 30-40 mins each) with the four
trainers were conducted over a two-month period that
matched an on-going cycle training program at two
local area schools. Interviews aimed to identify
features of training program such extent of the
interaction between trainers and students, capabilities
and resource limitations in students and trainers, and
to understand the process of evaluating and logging
student-learning performance. Interviews were
conducted at the organization’s office premises.
Content analysis combined with findings from the
literature review identified that the overall framework
for cycle training sessions were the same for children
with and without CI. In general, training modules and
milestones were set for each student to learn how to
sit on a bicycle, to be acclimated to the bicycle, adjust
the seat to be in a comfortable posture. Next, the
student walks the bike while seated without using the
pedals, walking the bicycle in circles. This was
followed by learning to glide the bicycle with their feet
in the air and cruising; and finally, they will cycle in
specific directions and speed. The trainers
incorporated games to engage and motivate students
during the training. This organization had available 15
bicycles, including an assortment of two-wheel
bicycles, tricycles and tandem bikes.
Trainers also commented on the important role
that parents have in deciding if the child will or will not
learn how to and regularly use a bicycle. Positive
instances mentioned were of parents participating in
the cycling training with the children as
encouragement. Other cases described parents of
children with CI expressing concerns that their child
would be incapable of safe or independent cycling
(e.g., fear of falling, getting lost poor trip planning, and
inadequate cycling infrastructure).
3) Non-participatory Observation
The lead researcher passively observed weekly
meetings during the study period to document and
assess trainer-to-trainer interacts (e.g., questions and
discussion on program improvement), planning and
organization of the following week’s training activities
with special attention to resource constraints such as
time available, and overall goal setting for the class.
Training program duration was noted to span a total of
ten weeks divided in two phases with a few months in
between. The first day of each phase involved
understanding the training needs of the student and
family, along with a subjective assessment of the
student’s skill level and establishing training goals.
Trainers would discuss these topics during meetings
comparing notes and developing a training plan for the
subsequent week.
4) Documentation Analysis
During interviews, the trainers were encouraged to
provide supporting documents that would help provide
an understanding of the formal training process.
Examples of documents shared with the research
team include orientation materials, anonymized
training log sheets, calendars, teaching schedules,
and administrative documents. Training log sheets
were particularly useful as these documents contained
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notes written by the trainers such as their subjective
assessment of student learning. This study analyzed
thirty-five anonymized log-sheets provided by the
interviewees. The log sheet template contained three
blanks for trainers to list higher level training goals
followed by a table with a row devoted to each training
session where the trainers could write notes about the
student after each session. The documentation
analysis helped the researchers understand the
logistics of the cycling training program, such as, how
trainers divide students per instructors how trainers
plan the lessons, to identify what goals do the trainers
set for students, how trainers assess students’ abilities
and limitations, how trainers assess parental needs,
and how they involve the parents in the cycling
program.
Students in special education programs have
different ages and educational levels ranging from
high-school to post-secondary. This wide age range
for students influences the number of students that
can partake in the training, but usually the range is 3-4
students per trainer. The limit imposed is based on the
students’ needs, the greater the need of care and
attention, the smaller the number of the students per
site. Teaching sessions were conducted based on
individual student’s skills and bicycling level, assessed
in the first day of training, by the trainer, by quick
interviews, observation of the child motor abilities and
his or her performance with a bicycle. Each session
itself was based on a predefined goal or set of goals
that the student wants to achieve and their proficiency
at the previous session content.
Analysis of the training logs and documents
identified the following goals:
• Student positioning on a bicycle (sit, feet on
pedals, etc.);
• Stopping skills (smooth stop individual, in group, in
certain area, use of handbrakes, etc.);
• Hold space and use of lanes (predictable space in
line, follow a line, correct space on lanes when
turning, etc.);
• Give signals (hand or spoken);
• Riding skills (ride predictable, straight, in line, in 8
shapes, etc.);
• Follow rules and laws (follow rules of the
neighborhood, of the group, of the road);
• Ride in a group (step into a group, use a gap,
follow leader, use tandem, etc.);
• Being a group leader (i.e., lead a community ride,
lead a group, etc.); and,
• Building cycling endurance.
Lastly, an important component of the bicycle training
program was demonstrating independence. The
training program divided this trait into five levels:
1. Participant cyclist, when the student requires
support from the instructor;
2. Basic skills cyclist, when the student is in the
development process of bike handling skills;
3. Companion cyclist, when the student is mastering
bike handling skills but still requires support of a
companion;
4. Restricted independence cyclist, when the student
can ride and lead; and,
5. Full independence cyclist, when the student can
independently ride on selected routes in
community.
DISCUSSION
This study used a combination of methods to identify
training components in a cycle training program for
children with cognitive impairments (CI). These relate
to training period viz., contact time through more
sessions, longer durations per sessions, and lower
students to trainer ratio; importance of baseline cycling
skills assessments to refine the training duration and
goal-setting; role of parental involvement in supporting
the learning process; and limited resources for long-
term evaluation of knowledge retention, safety
behavior and overall bicycle use. Collectively, the
findings emphasize the need for multiple training
sessions with adequate repetition and assessment in
cycling skills and safety training.
The program considered in this study taught
cycling skills in on-road conditions though without
minimal traffic and correspond to features of bicycle
training environments recommended by Lachapelle et
al. (2013). The program also incorporated,
fundamentals of bike safety such as helmet use and
fit, rules of the road, behaving and riding predictable,
low student to trainer ratio, longer training sessions,
and active parental involvement, which reflect best
practices in learning fundamental cycling skills and
safe behavior (e.g., Hoohmond et al. (2014;
Lachapelle et al., 2013; Macarthur et al., 1998).
Post-training knowledge retention
Prior research on cycle training provides limited
information on methods to assess long-term impacts of
cycling programs in children. It was also observed that
neither the current organization studied nor other
programs described in the literature kept track of
whether students’ maintained or improved in their of
cycling skills and knowledge post-training.
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Furthermore, multiple studies that involved three or
more sessions each indicate retention in children to
last for different durations post-training with at least
one of showing a positive effect up to two years (e.g.,
Ducheyne, 2013; 2014; Hooshmond et al., 2014, and
Nagel, 2003). Regarding effectiveness of bicycle
training programs, Richmond et al. (2014) go as far as
saying “there is no evidence to support that
educational cycle interventions increase knowledge of
safe cycling”.
Parental involvement
The influence of parental support and attitudes on
childrens’ cycling skills, knowledge and safety
behavior emerged as a consistent theme across
trainer interviews and prior research reports on cycle
training in children without impairments (e.g., Kimmel
& Nagel, 1990; Lachapelle et al., 2013; Ducheyne et
al., 2014). Lachapelle et al. (2013) suggest that
parental mistrust or erroneous instructions toward
cycling practices could result from their
misunderstanding or lack of knowledge of safety
behaviors; and hence both children and parents could
benefit from participating in cycling programs
producing a multiplicative effect. It is unclear at this
time if the positive influence of parental involvement is
from a proactive (i.e., how to avoid unsafe actions) or
reactive (i.e., feedback after an unsafe action has
occurred) mechanism or a combination of both
CONCLUSIONS
In terms of bicycle training in children, Ducheyne
et al. (2014) make an important distinction between
improving cycling skills and changing cycling safety
behavior each requiring different approaches. Our
study identified gaps in short- and long-term objective
assessment of cycling skills and safety performance.
Technology interventions developed to provide such
objective performance assessments may be of benefit
to cycling trainers and parents of children with CI
towards promoting safety, independence, self-efficacy
and overall healthier lifestyle among individuals with
and without CI. This study observed one cycling
training program with four trained staff. However,
active transportation programs focusing on children
with CI and with expert trainers are rare. At present,
our methods were limited to studying trainers and
excluded direct observations or involvement of
students i.e., children with CI or their parents.
Nevertheless, the study did reveal important
information about training components pertinent to
cycling program for children with CI, providing
sufficient motivation and need for future work that
might involve individuals with CI.
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