Editor's note: A version of this story ran in the May 2022 issue of BRAIN.
IRVINE, Calif. (BRAIN) — Don DiCostanzo has heard the stories. The 14-year-old with bone cancer regenerated leg movement riding an e-bike after having surgery. A woman who began e-biking to recover from a heart transplant. Another battling a muscular disease now is able to maintain mobility with the help of an e-bike.
The Pedego Electric Bikes CEO knows e-bikes and e-trikes are beneficial for more than leisure and/or transportation. They also can be a rehabilitation tool for mobility and mental health. Research shows that outdoor motor-assisted, non-stationary exercise can help stroke, spinal cord injury survivors, Multiple Sclerosis patients, and people born with motor function disorders.
"We call it 'Love Stories,'" DiCostanzo said. "And chronicling that has been a huge part of our success."
Bosch eBike Systems also sees this added value. It published on its website an interview with physiotherapist Philipp Hausser, who noted among the benefits of e-bikes is that stress can be "regulated and adapted to suit the stamina and state of health of the rider. As a result, the e-bike is perfect for patients who have just had a joint replacement — it's an ideal means of remaining active. In this way, they can step up the stress levels in a series of stages. For patients who are less fit, the power assistance enables them to make up for any physical deficit."
Paul Boland, a research support team member with the Faculty of Health and Wellbeing at the University of Central Lancashire in the United Kingdom published a paper exploring factors that influence e-bike usage by stroke survivors.
The study said e-bikes have the potential to overcome some of the physical activity barriers that stroke survivors face and concluded that e-bike use was a positive factor in enabling some of the participants in the case study to cycle outdoors.
But "due to the small sample size and the number of participants who were able to loan an e-bike, further research is required to determine whether e-bikes are a feasible and effective intervention to increase physical activity for stroke survivors."
A potential market
Boland told BRAIN that marketing e-bikes and e-trikes for rehabilitation could be a wise business decision for dealers. "It may encourage people in rehab to take up cycling, post-rehab, as a form of long-term physical activity and increase independence," Boland said.
Chris Nolte, the founder of Propel Electric Bikes, knows this well. As a U.S. Army Reservist, Nolte returned from the Iraq war a disabled veteran. Discovering the benefits of the e-bike helped him regain his active lifestyle — and later in 2011 — emerge as a successful e-bike dealer.
"As a disabled vet, I think of the possibilities of e-bikes offering more mobility and rehabilitation to vets and others suffering both physical and mental challenges," Nolte said.
The Sea Otter Classic Foundation understood such possibilities when it began a program last year to donate e-bikes to the Veterans Transition Center of Monterey County. The center helps veterans dealing with homelessness to substance abuse.
"It provides them that sense of freedom that they're yearning to get back," Rep. Jimmy Panetta (D-Calif.), a Center board member, told BRAIN in October.
While e-bikes and e-trikes can benefit rehab patients and those dealing with limited mobility, DiCostanzo emphasized Pedego's decision to equip their models with both throttle and pedal assist so the rider has an option on how much to pedal.
"I think the missing thing here is that the retailers that are selling Class 1 (pedal-assist) bikes only do not understand that these customers might have an ailment that doesn't allow them to pedal all the time," DiCostanzo said. "They can pedal some of the time, but they might be diabetic; they might have emphysema; they might have a hip problem or back problem, and they want to know that they can get home in case they're not able to pedal. The pedal (assist) system doesn't allow for that. It's that simple."
E-trikes another rehabilitation option
E-trikes are popular with older folks at rehab centers who have balance issues, and DiCostanzo said Pedego has been sold-out of its models with supply chain issues keeping them scarce. "We've been chasing our tail getting three-wheeled vehicles for a long time. Our supply is starting to loosen up a little, but we're still away from that. So it's hard to go to these rehab centers with a bike and they really need a three-wheeled bike."
Pat Phillips has an e-trike success story to tell about her husband, Ted, who's recovering from a stroke. Riding a Van Raam Easy Rider for rehab, Ted has a cognitive deficit that accompanies aphasia. "So cognitively, he needs to get back to making judgments," Pat Phillips said in a Van Raam video. "And when you're on the road, he has to decide to stay on the right or make sure he's not drifting to the left, so that's a judgment he has to make in real time in real life. That becomes important. Plus, the actual event of riding the bike and getting oxygen to the brain. We all know how important that is, and the more you can do that, the better it is for stimulating the cells. ... And then the emotional part of being outside, to be in the fresh air ... Fresh air, sunshine, and light is important for recovery and healing."
Pat told BRAIN in mid-April that her husband continues to improve. "He becomes stronger each day and looks forward to when he is fully recovered," she said.
The Phillips' story is part of Van Raam's DNA as an adaptive e-bike brand based in Varsseveld, Netherlands. It was founded by Piet Boezel, a stroke survivor whose desire for rehabilitation with a bike took the company in the direction of manufacturing e-trikes for those with disabilities.
"Suffice it to say that Van Raam and Spinov8 Distribution have at their core the mission of making it possible for people to experience the health and rehabilitative benefits of cycling," said Dan Pellett, Spinov8 CEO, Van Raam's North American distributor. The partnership between Spinov8 and Van Raam came naturally as Spinov8's founder, Scott Pellett, suffered a spinal cord injury at the age of 14 and had been a champion for adaptive cycling since the early 90s.
North American sales have continued to grow 10-15%, Pellett said, with plans to recruit up to 10 new dealers this year to add to a current 14-dealer network.
"All dealers will be actively marketing the Van Raam bikes to organizations and institutions serving clients and residents with mobility challenges caused by injuries and chronic illness, especially ones that are age-related such as Alzheimer's, Parkinson's and other diseases that have proven benefits from physical exercise, cognition improving activities and outdoor stimulation," he said.
At last month's Sea Otter Classic, Bosch displayed a new e-assist off-road hand cycle, the RX, manufactured by Bowhead Design Corp., an adaptive cycle brand founded in 2018. Bosch helped integrate its technology and Performance Line CX motor to work with the three-wheeled RX.
Bowhead, primarily a consumer-direct brand with some dealers overseas, was co-founded by Christian Bagg, who broke his back in 1996 in a snowboarding competition. He was a designer and machinist and began to build equipment to suit his needs, because at that time, adaptive equipment was in its infancy.
"The RX is a great bike for rehabilitation due to the wide variety of options it has," said Sally Stanier, Bowhead community relations manager. "The Bosch system gives you four different modes — Eco, Tour+, eMTB, and Turbo — so riders can completely customize their ride and have as much or as little e-assist as they require."
Doctor's orders: Ride an e-bike?
Could the day come when doctors might prescribe an e-bike or e-trike as a rehab modality with insurance paying a portion of the cost?
"It would require some changes to the way insurance is handled if they could be prescribed as medical devices for rehab or mobility, but in theory, doctors could finance them on their own dime and offer the devices on loan as an off-site therapy," Nolte said. "The HIPPA compliant transfer of data is what's essential here as the doctor can state they are monitoring the therapy even if it's from afar. This could extend to many fields for sure.
"Currently, I don't believe e-bikes are considered a medical device or a mobility device, which changes the implications of how the insurance companies can reimburse for. It seems to be a lot about that even if the studies prove it's good, paying for them is the challenge."
Pellett said Spinov8 knows some medical professionals who embrace Van Raam e-bikes, "especially those in the field of rehabilitation and geriatrics. The brand is so new that we are depending upon our growing network of dealers to expose more doctors to the medical and rehabilitative power of these bikes, as they sell into rehab hospitals, nursing homes, VA hospitals, geriatric institutions and senior care communities."
Boland said in his study, one participant's doctor refused to grant permission because of liability concerns if the patient had an accident. "Also, I think the e-bike/e-trikes would have to be heavily discounted before some patients would even consider purchasing one. With an average cost of above £1,000 ($1,300), that's something some families just can't afford in the current economic climate."
However, Steven Sheffield, Bosch's marketing director, wondered if sometime in the future doctors will prescribe e-bikes, "or at least get to the point where you could use your HSA account" to help purchase one, he told BRAIN at the Sea Otter Classic.
Espin Electric Bikes published a blog post in February about how e-bikes can be used for sports rehabilitation. "In sports where endurance is an essential part of the game, electric bikes can help players recover faster and get back on the field again. By using an electric bike, an athlete could extend their endurance by about 20%, thus allowing them to perform better."
However, an Espin spokesperson told BRAIN the brand hasn't yet experienced demand from rehab and/or physical therapy users. "It is a potential growth area, as most of our demographic is (age) 55-plus riders."
Or, as Boland's paper noted in its final "Implications for Rehabilitation" bullet point:
"Social support, the belief that e-bike was an enjoyable mode of physical activity that was good for their health were reported by the participants as important factors for using the e-bike/e-trike."
