Pedal Wheelchair Offers Hope for Paralytics

Some years ago, I published a photo collection of life in a physical rehabilitation center. The book centered on two themes, which I saw as keys to such facilities’ success. One was the power of a place to promote healing by bringing together people who would otherwise be isolated. The other was the power of hopes and dreams, even for those who had hit rock bottom.

I returned to the rehab scene recently to see how things had changed in the past 16 years. In the process, I came across a powerful technology that mobilizes both of these forces. It is an innovative wheelchair called the Cogy (from the Japanese verb meaning to row or pedal).

Introducing the Cogy

What first caught my eye in the promotional video was the Cogy’s assertive bright yellow color and stylish design. The mechanism was intriguing as well—why pedals for people who had presumably lost the use of their legs? But what really grabbed me was the expressions on the faces of the people trying out the Cogy for the first time. They brimmed with amazement, joy, and hope. The video captured the moment when they discovered the motive power that had lain dormant within them, and resignation turned to hope. Their radiant smiles spread to those around them and lit up the entire room.

Among the subjects appearing in the video is a man who has been mostly paralyzed from the waist down for 13 years. Using the leg that is still capable of slight movement, he pushes gently on one pedal. To his utter astonishment, the leg he believed to be useless begins to slowly move of its own accord, propelling the chair steadily forward. “What’s going on?” he asks uncomprehendingly. The exercise is exhausting, “but it feels really good!” Responding to his light touch, the Cogy has awakened his sleeping muscles and shown him the latent power that he still possesses. It has given him hope for the future.

But how is it possible?

The newest Cogy, released in the summer of 2024, is available in blue as well as the original yellow and red. (© Ōnishi Naruaki)

Birth of the Pedal Chair

The Cogy grew out of the work of a research team under Professor Handa Yasunobu of the Tōhoku University School of Medicine. The team was investigating the possibility of restoring movement to paralyzed limbs through electrical stimulation of the spinal cord, and for purposes of study, it had built a pedal-operated wheelchair sensitive to the lightest thrust. One day, to the team’s astonishment, a paralyzed subject began propelling the wheelchair forward continuously even before the electric stimulus was applied.

After rigorous study, the team found that when various parameters, such as the distance between the pedal and the seat, were exactly right, the movement produced by even a slight push from one leg would send a stimulus to the spinal cord, awakening the primitive “stepping reflex,” which causes the opposing leg to move. After numerous modifications and refinements, they were able to design a pedal-operated wheelchair based on that reflex response. The Cogy prototype was unveiled in 2009.

The Cogy is extremely simple to operate. A small amount of pressure on the pedals is enough to propel the chair forward. A handle wired to the back wheels is used for turning and braking. (© Ōnishi Naruaki)

The Cogy is powered by the primitive “stepping reflex” seen in infants. When the sole of one foot touches the floor, the other leg involuntarily moves. This reflex recedes as the brain develops. (© Ōnishi Naruaki)

Test-Driving the Cogy

Uebayashi, who can “barely take one step,” successfully pedals a bright red Cogy at a test-driving event. (© Ōnishi Naruaki)

A recent Cogy test-driving event at Harmony Nursing Home in the city of Sakai attracted paralytics and nursing-care professionals alike. Among the former is an 84-year-old by the name of Uebayashi, who blames his loss of mobility on a long hospitalization following a fall. “I want to improve my QOL [quality of life],” he says simply.

Coaching Uebayashi is Itō Akira. Having experienced life in a wheelchair following an auto accident, Itō is now busy helping promote the use of pedal-powered chairs for the partially paralyzed.

“Okay, now, sit back, close your eyes, relax your shoulders,” says Itō. “Don’t think of the Cogy as a chair you’re sitting in. Think of the equipment as an extension of your body_—just like in the martial arts.”

Before long, Uebayashi has completed several circuits of the meeting room, working up a good sweat. “It might take a while before I’m comfortable operating it all by myself out on the city streets,” he says, “but once I get used to it, I think it could be great fun.”

“Wow, this is a breeze!” exclaims test-driver Yokotani, who suffers paralysis on his right side as a result of a stroke about six months earlier. (© Ōnishi Naruaki)

Spreading the Good News

Squatting next to a wheelchair in need of adjustment is Suzuki Kenji, a former elementary school teacher who now runs the company that manufactures and sells the Cogy.

About 20 years ago, Suzuki was inspired by a TV segment about a pedal-powered wheelchair developed at Tōhoku University. He watched with astonishment as an elderly woman, previously bedridden, was placed in the chair and immediately began pedaling it about. He wondered if the device could help a student of his who relied on a wheelchair to get around.

Seized by a desire to broaden access to the technology, Suzuki quit teaching to work for a medical venture firm that was handling the pedal-powered chair. The company folded, but Suzuki persevered. At the age of 34, he launched his own firm, Tess Co. (headquartered in Sendai), to manufacture and sell the Cogy under license from Tōhoku University. In the 16 years since then, Tess has sold more than 10,000 of the devices at a price of about ¥500,000 per chair.

In recent years, the Cogy has attracted attention overseas as an example of Japanese innovation and ingenuity. In Vietnam, “pedal wheelchair therapy” has won official approval as a medical procedure. Suzuki is considering renting the wheelchairs out on a monthly basis to give more people a chance to try the device.

“The most important thing is for satisfied users to spread the word to others. Once pedal-powered wheelchairs are established as an accepted option, I believe society will change. I’d like the Cogy to become a symbol of society’s support for forward-looking people who refuse to give up on life despite their disabilities.”

Tess Co. President Suzuki Kenji travels all over Japan attending test-driving events, where he can often be seen squatting beside a wheelchair with his toolbox open. He says that ideas for improvements often come from tinkering with the mechanism. (© Ōnishi Naruaki)

Attending my first Cogy test-driving event, I was deeply moved by Suzuki’s passionate determination to help as many people as possible experience this amazing invention. I was also struck by the infectious energy of devoted Cogy users from around the country.

Prominent among these is Tomono Hideki, representative director of the nonprofit Synchro-Plus. In addition to helping out with promotional events, Tomono has launched a Facebook group where Cogy users can network with others with similar conditions and share information on ways to make optimal use of the device. He also works to spread the technology nationwide from his hometown in the southern island chain of Amami Ōshima.

Suzuki and Tomono (right) entertain event participants with a friendly Cogy race. (© Ōnishi Naruaki)

Making Rehab Fun

Daycare Hikari 2, a rehab facility in Shikokuchūō, Ehime Prefecture, offers outpatient therapy with the help of about 80 Cogy wheelchairs. The building is hard to miss, with its vivid multi-story mural displaying the copy “Stop aging and start pedaling!” The large recreational vehicle the center uses also sports a picture of a Cogy, along with the slogan “Have Fun and Get Healthy!!”

Daycare Hikari’s colorful RV promises fun and good health. (© Ōnishi Naruaki)

Two friends from Daycare Hikari 2, aged 94 and 83, take the air around Lake Kinsha in their Cogy wheelchairs, which they have been using for about six years. “I used to have to go to the doctor twice a week to get shots for knee pain,” says one. “Now I don’t go at all. The Cogy has made me so much better.” (© Ōnishi Naruaki)

Patients take part in physical therapy on the facility’s spacious roof. “I come here because pedaling is fun,” says one. A cooling mist keeps the roof comfortable on hot days. (© Ōnishi Naruaki)

On Sports Day, patients compete in a Pedaling Olympics held on the grounds of the rehab center. Those pedal-powered chairs can really move! (© Ōnishi Naruaki)

The chairman of the corporation that manages Daycare Hikari 2 is 87-year-old Kuri Mitsuhiro, who has contributed to community healthcare for many years as an orthopedist. He first incorporated the Cogy in his rehab services 13 years ago, and the fleet has expanded rapidly since then to meet popular demand. Signs posted here and there around the building express the group’s basic philosophy: Rehab will only last if it’s fun!

Dr. Kuri knows and understands his elderly patients on a personal level. (© Ōnishi Naruaki)

“Elderly people are apt to reject anything that’s a hassle,” says Kuri. “So staff members are on hand to get them into the chairs, encourage them, praise them, and scold them as necessary. It’s not sufficient just to provide the Cogy. You also need to provide a safe place to operate them and staff to supervise. And if you really want people to get into pedaling, you need to put them together with friends so they can all have a good time. Competition is great. Winning, losing—that gets people excited. Sports Day is hugely popular here.

“Of course, I think it would be great if pedaling could be adopted more widely,” Kuri adds with a winning smile. “After all, I want everyone to be happy.”

Proven effective in enhancing lower limb motor function, the Cogy is used as a physical therapy device in a growing number of settings. (© Ōnishi Naruaki)

The Romance of Rehabilitation

Among the qualified professionals working at the rehab facility are several of Kuri’s grandchildren, who have embraced his philosophy and followed in his footsteps. I spoke to one of them, physical therapist Murakami Ryō, who has founded a nonprofit dedicated to promoting the use of pedal wheelchairs. “For people who have trouble walking, Cogy isn’t just a mobility aid,” he explains. “It also helps restore muscular strength.”

As explained by Murakami, the pink charts on the monitor display the results of electromyography measuring electrical activity in the muscles of a patient’s paralyzed left leg. The light shades of pink on the left side indicate the low level of activity generated by simple flexion and extension of the knee, without the Cogy, while the dark shades on the right show the much stronger electrical activity that accompanies Cogy pedaling. (© Ōnishi Naruaki)

A few patients at the facility have even formed a Cogy dance team, and I was able to sit in on a rehearsal.

“The best part of Cogy dancing is spinning in a circle,” says dancer Aya. Her dazzling smile never fades, even as she talks about the cerebral hemorrhage that struck in 2014, leaving her with paralysis on the left side and a lingering speech impairment. Fortunately, in Shikokuchūō, long-term care insurance covers much of the cost of renting her Cogy, leaving Aya with a bill of just ¥1,500 per month.

The rehab facility’s Cogy dance team rehearses for the fall recital, dancing to the original song “Yuke yuke Cogy” (Go, Go, Cogy). (© Ōnishi Naruaki)

Baku, age 81, lost the use of his legs two decades ago. He tried virtually every treatment available but saw little improvement until two years ago, when he began Cogy therapy. “For a long time, I got around in a motorized scooter, but since transferring to a Cogy, I’ve been able to build up my muscles. I’m so happy to have this opportunity to dance, because it turns on my motivation switch!”

The team leader is Cogy dance choreographer and artist, Yufuki Rei. “Right now, I’m able to stand and walk on two feet, but it’s still important to me to know that the Cogy’s there when I need it. It would be great to have Cogy dance troupes spring up all over Japan. I’d like to be on stage with about a hundred dancers, maybe even performing in the Paralympics opening ceremony. I dream big!”

From left, Yufuki Rei, Aya, and Baku of Daycare Hikari’s Cogy Dancers. (© Ōnishi Naruaki)

A Cogy user cruises around town in his cheerful yellow wheelchair. The Cogy’s backers hope such sights will become commonplace. (© Ōnishi Naruaki)

Naturally, I was eager to test-drive a Cogy myself. It was quite exhilarating to gather speed and feel the wind in my face as I pumped my feet faster and faster. Like a small child riding a tricycle for the first time, I could almost imagine myself lifting off and taking flight.

The title of the photo collection I mentioned at the beginning of the article was The Romance of Rehabilitation. I used the word “romance” to describe the quest for deeper knowledge of the unseen world, driven by a boundless curiosity about the mysteries of human existence. Surely the same description applies to a wheelchair that operates by using a mysterious dormant reflex to awaken motor function in paralyzed limbs. I, for one, will continue to follow the “romance of the Cogy” with the greatest interest.

(Originally published in Japanese. Banner photo: A Cogy in action. © Ōnishi Naruaki.)