Ask the expert!

Choose one of the three forms underneath. Fill it out and exercise physiologist Rik Berkelmans will give you a personal advice.

Form 1

Name:
Address:
Zip code:
Place of residence:
Country:
Email address:
Telephone number:
Health insurance company:
Birth date:
Length (approximately):
Weight (approximately):

When did you get the spinal cord injury?

How did you incur the spinal cord injury?

Beside the spinal cord injury, do you have another physical or mental disability?

At which height is your spinal cord injury?

Do you have any strength in your legs? If yes, which movements can you still make?

Can you feel a pinprick in your upper legs or bottom?

Did you have, since your spinal cord injury, any spasm by which your muscles contracted obviously? It does not matter if it has occurred years ago.

Which medication do you use and for what?

Can you open and close your hands?

Do you still have normal strength in your hands?

Do you have a hand cycle or have you ever ride one and how did it go?

Do you have a wheelchair? What kind: electrical wheelchair, foldable wheelchair, etc.

Where do you want to cycle?
I only want to cycle outside. (Skip next question)
I want to be able to cycle outside and inside, by using my bike easily as a cycle trainer.
I only want to cycle inside on my cycle trainer.

What kind of cycle trainer do you want?
As simple as possible: I want to concentrate on cycling or for instance I want to watch the television.
I enjoy it, when my rollertrack can be connected to the computer and has many possibilities like riding in South Africa with video images or cycling against opponents with virtual reality, where real cycling is imitated.

Did you have contact with somebody of BerkelBike BV before? If yes, in what way?

Do you want to tell anything, you did not get the chance to in the questionnaire?

Form 2

Name:
Address
Zip code:
Place of residence:
Country:
Email address:
Telephone number:
Health insurance company:
Birth date:
Length (approximately):
Weight (approximately):

What is your disability?

When did you incur this disability?

Which medication do you use and for what?

Is your disorder progressive (becomes the disability worse in the course of time)?
Yes
No

How high can you lift your left hand?
Not
Belly button height
Shoulder height
Above the head

How high can you lift your right hand?
Not
Belly button height
Shoulder height
Above the head

Can you grasp a glass of water with your left hand and lift it from the table?
No
Can grasp, not lift
Can lift it, but not up to the mouth
Can lift it up to the mouth

Can you grasp a glass of water with your right hand and lift it from the table?
No
Can grasp, not lift
Can lift it, but not up to the mouth
Can lift it up to the mouth

Can you stretch your left arm completely?
No
Almost
Yes

Can you stretch your right arm completely?
No
Almost
Yes

Does it hurt, when somebody else moves your left arm?
No
A little
Yes

Does it hurt, when somebody else moves your right arm?
No
A little
Yes

Can you walk?
No
With help of a companion
With a walking trolley
With crutches
Yes, without any device, but only inside
Yes, without any device outside, but less than 100 meters
Yes, without any device outside, more than 100 meters

How many strength do you have in your left leg?
None
I can move my leg a little
I can stand on it
Not changed by my disability

How many strength do you have in your right leg?
None
I can move my leg a little
I can stand on it
Not changed by my disability

Can you pull your left leg towards yourself?
No, and if somebody else tries to do it, it hurts or my leg blocks
No, not by myself, but somebody else can bend my leg
Yes, a little myself, with help completely
Yes

Can you pull your right leg towards yourself?
No, and if somebody else tries to do it, it hurts or my leg blocks
No, not by myself, but somebody else can bend my leg
Yes, a little myself, with help completely
Yes

Do see objects on your left of right side equally good?
No, at one side I can (almost) see nothing
No, at one side I see a little bit less
I see objects on my left or right side equally good

Can you have a conversation by phone?
No
Yes, with many difficulties
Yes, but not like before
Yes, without any problems

Where do you want to cycle?
I only want to cycle outside. (Skip next question)
I want to be able to cycle outside and inside, by using my bike easily as a cycle trainer.
I only want to cycle inside on my cycle trainer.

What kind of cycle trainer do you want?
As simple as possible: I want to concentrate on cycling or for instance I want to watch the television.
I enjoy it, when my rollertrack can be connected to the computer and has many possibilities like riding in South Africa with video images or cycling against opponents with virtual reality, where real cycling is imitated.

Did you have contact with somebody of BerkelBike BV before? If yes, in what way?

Do you want to tell anything, you did not get the chance to in the questionnaire?

Form 3

Name:
Address
Zip code:
Place of residence:
Country:
Email address:
Telephone number:
Health insurance company:
Birth date:
Length (approximately):
Weight (approximately):

Where do you want to cycle?
I only want to cycle outside. (Skip next question)
I want to be able to cycle outside and inside, by using my bike easily as a cycle trainer.
I only want to cycle inside on my cycle trainer.

What kind of cycle trainer do you want?
As simple as possible: I want to concentrate on cycling or for instance I want to watch the television.
I enjoy it, when my rollertrack can be connected to the computer and has many possibilities like riding in South Africa with video images or cycling against opponents with virtual reality, where real cycling is imitated.

Did you have contact with somebody of BerkelBike BV before? If yes, in what way?

Do you want to tell anything, you did not get the chance to in the questionnaire?