by Sachie Togashiki


I found an interesting article about the development of bicycles for rehabilitation for hemiplegic patients. Sufferers of apoplexy, a percentage of which is overrepresented in mortality rate in Japan, tend to have a secondary disease, which is hemiplegic, after surgery. In order to recover from hemiplegia, rehabilitation is needed, but it usually bores patients or needs someone’s help. To solve this problem, two authors, Hiroshi Shoji and Takeshi Aoki at Chiba Institute of Technology, are trying to develop bicycles for easier and more fun rehabilitation.

How does it work?

The attraction of using bicycles as a rehabilitation tool is its sustainability, non-boringness, and refreshing feeling which comes from outside exercise. Although there is the attraction which the authors can make use of, they also need to cover some anxieties such as safety and uneasiness when pedaling. In order to guarantee safety, a foot which is not paralysed is applied a load to, so that a rider cannot pedal too fast, which results in a stable and low pedaling speed. In addition, a load is applied also to reduce patients’ uneasiness caused by a feeling of unbalanced heaviness depending on feet. The authors used an electrically-powered tricycle made by YAMAHA for an experiment and succeeded in keeping a low pedaling speed by applying a load to a healthy foot. They are going to conduct an experiment to mitigate patients’ uneasiness and to develop a smoothness when pedaling.


The article is crucial because this is an academic article which was published as a documentation of JSME (The Japan Society of Mechanical Engineers) Conference on Robotics and Mechatronics and it shows a new significant way of using bicycles. Because riding on a bicycle is lots of fun and can be done without any permanent help, the authors suggested using bicycles for rehabilitation for the hemiplegic patient, which means bicycles can be used not only for town development and disarmament, which I will report on in two upcoming posts, but for medical uses. The use of bicycles as a rehabilitation tool might enhance patients’ motivation to recover from hemiplegia and contribute to a more positive future.

Additionally, in order to get the article, I paid for it, while most of the Australian articles are available for free. This made me think about freedom for students to research in Japan, which might be a little poorer than Australia.


Shoji, H., & Aoki, T. (2014). Development of rehabilitation bicycle for hemiplegic patients. Proceedings of the JSME Conference on Robotics and Mechatronics, 14(3P2-G03), 3P2-G03(1)-3P2-G03(2) Retrieved from


Sachie Togashiki is our Guest Blogger, unveiling some of Japan’s bicycle culture, from 11th April to 24th April.

What is Fleet Farming?

– A community-driven, low emission distributed urban farming model
– Build home gardens less than .25 acres throughout the community
– Use bike-powered transportation for maintenance and harvest of produce
– Sell produce at local farmers markets, food trucks, and local restaurants

Fleet Farming

The ‘Fleet Farmer’ name refers to ‘Farmers’ on a ‘Fleet’ of bicycles, helping to manage the grow-to-harvest process of urban farming. These Farmers will be made up of members of the surrounding community and members from partnering organizations. Each Farmer will sign-up for a scheduled bike ride once per week, traveling an average of 8-10 miles from the Winter Park Urban Farm to East End Market, and back.

Throughout the ride, the Fleet Farmers will stop at various home gardens participating in the program. Each garden will be regularly maintained, including tilling, watering, removal of weeds and pests, application of organic fertilizer, harvesting of the fruits and vegetables throughout the year, and distribution of the local produce to local venues using pedal power.

In Phase 2, the Fleet Farmers will also help in collecting compost from the restaurants in route that are interested in providing pre and post-consumer food waste to develop the final piece of the closed-loop system.

This remarkable health education initiative really personifies how bicycles can innovate positive social change – in this case, raising awareness about Multiple Sclerosis (MS).

MS Community Education

This initiative brilliantly mixes science, bicycle design, expert collaboration and cyclists to produce a community education campaign where a normal bicycle was augmented in a variety of ways to represent the MS symptoms.

To achieve this, each of the major executive functions on the bike such as the fork, handlebars, seat, frame and gears were altered so that the impact of the disease could be experienced first hand when you try to ride the bike – thus demonstrating the daily challenges that suffers have trying to operate their bodies as this autoimmune disease destroys their nervous system.

Ad Week promoted this ad campaign by giving it international recognition for its ingenuity and creative approach – and very effectively linked this issue to the lived experience of Penelope Conway who is an MS Suffer and informatively and humorously writes about what Multiple Sclerosis really feels like.

The Ad

This bike has Multiple Sclerosis video (2 mins) explains the rationale and research that has gone into the strategic design of this bike.


This community awareness campaign is not only effective in reaching a wide audience and communicating its message, but it is clear and has immediate impact. One of the best aspects is that it is specifically designed to be experiential and engaging for the public.

This campaign is a great example of how a creative approach to presenting a public health issue can generate excitement, consideration and interest about an issue such as MS. In doing so, it is highly successful in prompting public education and discussion about what MS is – and the metaphor of a ‘rider’ trying to ‘control a bike’ as being similar to what an MS suffer experiences to control their body, is a stroke of genius. Most people who have no contact or exposure to MS, will be able to easily relate to how difficult it can be to ride a bike if there are mechanical problems.

If only there were more interactive, dynamic and enterprising projects such as this one that can equally correlate the public’s normative experience (of riding a bike) with a emerging/public issue (MS Awareness).

Want to try riding it?

Those in Melbourne next month (March 2016), will have the opportunity to try to ride this bike for yourself at the MS Melbourne Cycle on March 6, 2016 by registering at

The team

The research I looked at today was how African bicycle ambulances are being used to provide a more effective maternal health services.


This is an area of health services that has a high priority within the UN Millennium Development Goals and in Africa, this is an area of significant concern and where much aid effort is concentrated. One older Transaid project from Zambia, which implemented a number of bicycle ambulance projects in various regions in Africa, stood out for me in particular, so I thought I would share the project highlights with you.


Background to African Bicycle Ambulances

Transaid is a charity organisation established by the Charted Institutes of Logistics and Transport in association with Save the Children Fund. Its primary objective is to address major transportation issues faced by poor rural African health services. This project focuses on maternal health, as these indicators provide a solid representation of the efficiency of the overall health care system in a given area. Rural Africa faces severe patient mobility issues, even for short distances, with access and cost being the most critical factors, especially in emergencies and fistula cases. Additionally, the further demand and requirement for Immediate Modes of Transport (IMT) ‘is significant among maternity cases’ and this is most significant given that ‘one of the biggest reasons for the large number of maternal mortalities in developing countries is the time and distance pregnant women have to travel to the nearest clinic to receive proper care’ (Forster, Simfukwe, & Barber, 2010, pg 13). One example of the seriousness  of this situation comes from an Ethiopian Fistula Hospital, which reports that it takes women in labour an average of 11 hours to reach a health facility that can provide for their needs – and this is in the urban capital city of Addis Ababa!



To increase access to urgent health care services, 40 bicycle ambulances were provided to rural communities in Zambia in 2008, which provided a free bicycle ambulance service for community members. This project was better thought out than a number of others I have read, mainly as the bicycle ambulances were allocated to community-based home carers (personal) and not assigned to be stored and/or work out of a health clinic (location). This is much more appropriate, as location issues such as access to a bike (if they are in a room or shed on location which is locked), or only having one particular staff member who has a key, limited clinic opening hours or collecting oxen to be hitched to a cart from surrounding areas, – have all often hampered response times in similar projects. Additionally, ten local field mechanics were trained to construct and service the ambulances, which was found to be a major success factor.

Bicycle Ambulance Design considerations: Three different bicycle ambulance designs were trialled and assessed. A design with a stretcher, full canopy and a non-flexible hitch was the considered the most comfortable and popular by riders and patients. Other interesting feedback considerations were:
• The bicycle should be permanently attached to the ambulance to extend the life of hitch apparatus.
• Rear wheel post frame hitching made turning more difficult than seat post hitching.
• Provision for a pump, basic maintenance tools and a first aid kit is needed.
• Lights were required for night-time call-outs.
• Bicycles needed to be lighter or adequate gears used for uphill trips.
• Clothing should be provided such as a high visibility vest and a rain jacket.
• The size of local door frames was an issue as the original prototype ambulance was too wide to fit through a standard Namibian door frame – which impacted on patient transference.


• During the whole program, the bicycle ambulances took 251 life-saving journeys – the longest trip being 40 km.
• During the pilot program (first 4 months), the bicycle ambulances were used 82 times to transport patients to health care facilities.
• By having a personal bicycle ambulance, 96% of the recipient caregivers were able to be more effective in their work.
• Travel time was significantly reduced (from 2.5 hours by ox-cart down to 30 minutes) by using bicycle ambulance.
• Patient safety and comfort increased – they could lie down on the bicycle ambulance instead of sit (or ride) on a personal bike.
• The bicycle ambulance canopy provides shelter (rain, mud, sun, animals) and privacy for patients (especially important for women who are nearing birth – i.e. waters breaking etc).
• Having a stretcher attached meant that river crossings were much safer and easier and the bikes were able to take walking paths that oxcart transportation was unable to manage.



There has not been any further monitoring and evaluation data from this particular project – but as it stands, this project seems to be a step in the right direction. It is encouraging to see bicycles being utilised to help address some of the most pressing and urgent health issues that disadvantaged poor African women face. It is incredibly important that such initiatives are investigated, promoted and disseminated. It is also a very humbling reminder for people living elsewhere, (like Australia) who can often forget how significant and urgent basic (community) health services can be.


Source: Transaid

Forster, G., Simfukwe, V., & Barber, C. (2010). Bicycle ambulances have impact. Appropriate Technology, 37(3), 13.