VCU news

By Frances Dumenci

Aaron Nalle had a wish. He wanted to ride a bike just like his big brothers. But for Aaron, riding a bike was complicated. The 7-year-old was born with arthrogryposis, a congenital, nonprogressive condition that severely limits movements of joints, including the knees, hips, ankles, elbows, wrists and hands.

What started with the personal project of a Virginia Commonwealth University physical therapy Ph.D. student transformed into a service-learning project that soon involved a number of VCU students and faculty from across campuses and disciplines.

J. Cortney Bradford, then a Ph.D. student in the Rehabilitation and Movement Science (REMS) program at VCU, read about Aaron on his mother’s blog. Born in Eastern Europe and abandoned by his parents, Aaron was adopted by Julia and Robert Nalle of Palmyra, Va., who brought him home when he was 5 to join their sons, Ben and Elijah.

Aaron’s story stuck with Bradford, and she decided to get involved.

“I’m not sure what pushed me to send Julia that first email. I was finishing up my Ph.D. and didn’t really have the time or money to take on such a project,” said Bradford, who has since received her doctorate and is working on her post doctorate in the Department of Physical Therapy at VCU. “This kid had the most awesome smile and zest for life, shouldn’t he be able to ride a bike like any other kid?”

This kid had the most awesome smile and zest for life, shouldn’t he be able to ride a bike like any other kid?

Bradford took it upon herself to find a recumbent bicycle that might be modified to fit Aaron’s unique needs.

“The first modification was pretty simple, but paramount to getting Aaron pedaling. His knees don’t bend as much as most others do. The crank, the part that the pedals connect to, was too long for Aaron, meaning his knees couldn’t bend enough to pedal all the way around,” Bradford said.

With help from her brother, Bradford made the initial adjustments, and it was clear that Aaron was thrilled at the prospect of getting his very own bike.

“I was so nervous taking the bike to Aaron after the first modifications,” said Bradford. “Aaron’s English was still hard to understand at the time, but it was clear when we got there that he was very excited about his bike. Before we could get out of the car, he was exclaiming, ‘My bike, my bike!’”

The bike was left with Aaron for a couple of months so he could practice pedaling and to see if he could steer without further modification. After several months, Bradford knew other changes to the bike were needed, including a pedal-braking system since Aaron was unable to use hand brakes due to limited grip function. This is the point when VCU faculty and other students became involved.

“Julia and Rob were going to drop the bike off at my house so I could make further modifications. I mentioned the project to my professor, Dr. Pidcoe, and his interest was piqued,” said Bradford. “It was Dr. Pidcoe’s vision to involve students, both physical therapy and bioengineering students. Both types of students spend time in his lab, and this project involved the skills of each. The physical therapy students were able to assess Aaron’s abilities and needs, while the bioengineering students came up with the ideas for the modifications.”

Part of the physical therapy program at VCU involves students participating in a service-learning project. Peter Pidcoe, PT, DPT, Ph.D., associate professor in the Department of Physical Therapy, viewed Aaron’s bike project as unique because it was the first service-learning project that would help cross-train bioengineering and physical therapy students.

“This project represented a true marriage of physical therapy and bioengineering,” said Pidcoe. “It was interdisciplinary, blending the expertise of these two groups of students. I loved the process. It was different than any other project we’ve done.”

The students completed a comprehensive evaluation, listing further modifications needed to the bike. The group met each week during most of the fall 2011 semester to brainstorm and then implement solutions. At the end of the project, the students put together a case report describing the project titled, “Adapting Assistive Technology.”

“Our goal was to give Aaron a safe, reliable way to brake, while still allowing him to use the bike completely independently. Another feature was to figure out how to allow Aaron to shift gears,” said Bradford. “It was definitely a team effort. We found the bike parts that we needed and made sure they would work with our bike frame. Gearing ratios also had to be considered. We had to custom-modify sprockets to attain a gearing ratio that we knew would work for Aaron.”

This second set of changes took several months. Finally, the bike was ready to go back to Aaron, who was very excited to see his bike again.

“One of the first things he told me was that this time, the bike was going to stay with him for a long time. I laughed. Then he studied everything that was different, and he noticed everything!” Bradford said.

Aaron was off riding within minutes and was pedaling, breaking and steering all in a very short time.

And what does Aaron’s mom, Julia, think about all this? She describes Aaron as an extremely creative, happy child that keeps himself entertained and stimulated.

When he was in Europe, after he was transferred from his baby house orphanage to a mental institute because he was disabled, he stopped speaking his native language. This has made learning English rather difficult for him. He is currently in speech therapy and is both homeschooled and attends public school part-time. He’s had several surgeries to correct some of the joints and will have more in the future.

“He just blows everybody away with his joy. He wraps himself around people’s hearts,” said Nalle. “His favorite thing is to ride his bike. This boy was made for biking! It’s huge therapy that gets him using his legs, which makes them stronger. There are so many things he can’t do, so riding his bike makes him feel normal. He loves to zoom around our circle driveway. We appreciate everything that Cortney did and everyone at VCU, they were all such a godsend.”

The Nalles plan to visit Pidcoe at VCU for further evaluation in terms of his physical therapy. But for now, Aaron continues to zoom around on his bike.

“Seeing Aaron ride the finished bike makes everything worth it and then some,” said Bradford. “We spent many frustrating hours trying to get the modifications to work. None of that matters once you see how happy Aaron is. Aaron’s story helps keep things in perspective for me.”

 

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