Tricycling as an Aid in Treatment by Movement
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Citation
Martin Siegfried. Tricycling as an Aid in Treatment by Movement. 1900. cyclearchive.com, https://cyclearchive.com/books/tricycling-as-an-aid-in-treatment-by-movement-m-siegfried-1900/
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Contents
- Introduces the tricycle Dr Siegfried devised for patients whose power of walking is suspended, and the cases given to it in the winter of 1898/99 at the Moabit Municipal Hospital, with affections of the spinal cord, nerves and heart. Argues that wheel exercise benefits both central and peripheral conditions.
- Lists the changes needed to adapt an athletic tricycle for patients who cannot walk: a padded springy seat, a back support nearly fifty centimetres high, a body strap, a lever for dorsal and plantar flexion, skate-like foot fastenings, slotted cranks and centimetre graduations. Shows how the pedal positions vary the circles and the force needed.
- A 28-year-old tailoress with compression myelitis, paraplegic after two and a half years in hospital, is given the tricycle from 1 December 1898. The pedal and lever work eases her equinus foot and strengthens the iliopsoas, the ankle clonus fades in the fourth week, and her mood improves. When the three months' treatment ended she stood and walked with two sticks.
- Explains how a tabetic patient in advanced ataxy is strapped to the saddle with the feet fixed to the pedals, since falls and broken feet must be avoided. The author compares the mechanical impulse, which lifts the foot passively as the other pedal falls, to that of the kinetic baths.
- Releases the patient from the iron shoes to a single stirrup strap, so that the patient learns to work the pedals unaided. Advises counting a rhythm while pedalling, with a 3/4 bar at 69 larghetto preferred to 4/4 on Goldscheider's suggestion. A metronome is faulted for its equal clicks, a song is preferred, and a smooth Volkslied is said to round off hasty movements where a military march is too incisive.
- Cites Goldscheider's tabetic patient who warded off attacks of lancinating pain by riding the tricycle, and the author's own observations, including a tricycle with a mechanical handle that helped pain in the brachial plexus. Notes the benefit to the general health and mood of patients kept indoors or in a bath chair.
- Describes the coordination needed to mount: climbing a wooden step 15 to 20 centimetres high, turning the front wheel, turning on the step with the feet together and swinging one leg over the frame, all hard for an ataxic patient. The female myelitis patient of the earlier case mounts over the rear axle after ten weeks, the arm and leg movements raising her weight to the pedal.
- A 40-year-old man with pronounced ataxy from March 1897, who could not stand unaided, starts the tricycle on 1 September 1897. The straps are dropped after fourteen days, he exercises in the open air in the fifth week and buys a tricycle of his own. By 1900 he walks with considerable ability, and his bladder and bowel function has improved.
- A 43-year-old clerk admitted in November 1897 with wasting, pleural exudate and polyneuritis, who by November 1898 could stand only on his toes, with his feet in equinovarus. Tricycle exercise from 22 November 1898 gently stretches the shortened tendons, and by 22 December he walks twenty steps with support. His weight rises from 64.5 to 71.5 kg by 15 March 1899.
- Argues that gentle muscular contraction relieves the heart, citing the Schott brothers, and that a resistance given by weights or levers is more exact than manual resistance. Presents the tricycle as a resistance gymnastic for heart patients, whose exercise must never produce fatigue and should be judged by its effect on the pulse and breathing.
- Sets out the seven columns kept for each heart patient: crank length, pedal rotations a minute, duration, pulse and respiration, rest intervals, and the conditions of exercise. The paths are level, cemented and sheltered from wind, so that friction and air resistance can be treated as constant.
- A 41-year-old chief clerk with a dilated heart, who becomes cyanosed after five steps and has a pulse above 100, is given the tricycle at the bedside on 26 November 1898. The pulse falls by sixteen beats over the first ten days, and by 22 December he gets onto the wheel from behind unaided and walks back to the ward.
- A myocarditis patient under Goldscheider, with a small, frequent pulse, rides a tricycle worked by hands and feet, one hour a day from 21 November 1898 to 13 February 1899. The pulse falls from 90 to 80 in four weeks, and after an hour on 15 February it is 74; the patient is discharged as cured on 14 February.
- Concludes that cycling is a useful modification and supplement to exercise and resistance gymnastics, and that it is named Cyklotherapie for precision, not because it is a new treatment. Heart cases, combined with Nauheim baths in the author's summers at Nauheim, need constant medical control and a physician present at every exercise.