# Overcoming barriers to cycling for knee disarticulation and transfemoral prosthesis users: A pilot study in The Netherlands

## TL;DR

This study explores the challenges faced by people with knee disarticulation or transfemoral amputation when cycling and suggests solutions to help them cycle more comfortably and safely.

## Contribution

The study identifies specific physical, psychological, prosthetic, and bicycle-related barriers to cycling for prosthetic users and proposes targeted recommendations to address them.

## Key findings

- Physical barriers include exertion, skin damage, and discomfort, which can be mitigated with electric bicycles and saddle adjustments.
- Psychological barriers like fear of falling can be addressed through task-specific training and improved balance features on bikes.
- Prosthetic and bicycle-related barriers involve socket design and pedal slipping, with recommendations for suspension systems and anti-slip pedals.

## Abstract

Cycling has a number of benefits, especially for individuals with a knee disarticulation or transfemoral prosthesis. However, the barriers they face in cycling are not well understood.

To explore the barriers in cycling experienced by users with a knee disarticulation or transfemoral prosthesis, and to gather solutions to overcome these barriers.

A qualitative research approach was used. In-depth, semi-structured, self-developed interviews were conducted with experienced prosthetic users (N=8) and an adapted version was used for certified prosthetists/orthotists (CPOs) (N=3). The interview included physical, psychological, prosthetic, and bicycle-related items.

Based on the findings from the interviews, the following barriers and corresponding recommendations were identified:

Physical barriers: Exertion, skin damage in the groin area and discomfort in the back and hip.

Recommendation: Use of an electric bicycle and use of a crank shortener or saddle adjustment to overcome asymmetry in cycling.

Psychological barriers: Fear of falling or fear of balance disturbances.

Recommendation: Task- and context-specific training, or graded exposure to cycling during prosthetic training, along with potentially using a more advanced bike with improved balance.

Prosthetic barriers: Problems with switching the knee prosthesis mode for cycling; challenges with prosthetic suspension; and discomfort caused by the socket brim design.

Recommendation: Manufacturers should integrate automatic detection of cycling in microprocessor prosthetic knee joints; use of a total elastic suspension belt (TES-belt); and lowering the ventral edge of the socket.

Bicycle-related barriers: Slipping of the prosthetic foot off the pedal.

Recommendation: Use of anti-slip pedals or a block heel under the shoe.

By addressing the challenges and barriers, we aim to promote greater engagement in cycling, which offers significant physical and psychological benefits for persons with knee disarticulation or transfemoral amputation. Eventually, this can enhance their quality of life and foster greater independence.