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Tynor Anklet Pair - 0 views

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    Tynor Anklet (Pair) Anklets are tubular supports widely used in orthopedic practice to provide mild compression, warmth & support to the ankle joint, to allay pain and inflammation generally associated with old age, arthritis, sports etc. Four way stretch Two layered fabric Hypoallergenic Uniform compression Simple pull on application Tynor Anklet (Pair) Features Bilayered , cotton on the inside Dermophillic interpahse with the skin Better sweat absorption Better comfort Better patient compliance. No allergies or rash Bilayered, nylon on the outside Ensures long life Excellent aesthetics Color fastness. Two layers enclose air space retains body heat effectively Provides therapeutic warmth and assuring support to the knee. Four-way stretchable seamless tubular fabric Effective compression Enhanced comfort. No vaso constriction. Adjusts compression even on uneven diameters Simple pull on application improves patient compliance. Tynor Anklet (Pair) Measurements Measure circumference approx 2 inches above the ankle joint. Size Chart - Size Inches CM Small 7.2-8.4 18-21 Medium 8.4-9.6 21-24 Large 9.6-10.8 24-27 XL 10.8-12 27-30
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Thigh Support - 0 views

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    Thigh Support Applications Mild support to quadriceps and hamstrings. Relieves inflammation and stiffness. Firm compression and therapeutic warmth. Psychological support to geriatric patients. Sports injury, sprains and strains. Post-surgical rehabilitation. Burn care. Thigh Support Features Strong Compression. Four way stretch. Dermophillic. Durable. Breathable and comfortable. Thigh Support Measurements Measure circumference around mid thigh - approximately 6 inches above knee. Size Chart - Size Inches CM Small 14.8 to 17.2 37 to 43 Medium 17.2 to 19.6 43 to 49 Large 19.6 to 22.0 49 to 55
Nathan Goodyear

Pulse Power: Understanding Pulses In Chinese Medicine - 0 views

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    pulse diagnosis chart
Nathan Goodyear

1506 TESTOSTERONE REPLACEMENT THERAPY AND CANCER RISK - 0 views

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    Testosterone therapy found to not increase cancer risk in men.  This chart review, looked at 722 men over an average of 8.7 years to assess risk of cancer associated with testosterone therapy. This study was presented at the AUA in 2013.
wheelchairindia9

Tynor Knee Cap Comfeel - 0 views

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    Tynor Knee Cap Comfeel Knee cap comfeel is a next generation tubular product knitted on a 3 dimensional computer controlled circular looms to provide mild compression, warmth and support to the knee joint. It is used to allay pain and inflammation, generally associated with old age, arthritis or injury. Soft Patella Fine grip at the edges Four way stretch Uniform compression Simple pull on application. Tynor Knee Cap Comfeel Features Anatomically shaped and reduced compression on patella No Chondromalacia on prolonged use Better compression and grip Easy knee movement Improved comfort Bi-layered, cotton on the inside , a dermophillic interphase Enhanced comfort Better sweat absorption Better patient compliance. Bilayered, nylon on the outside Ensures long life Excellent aesthetics Color fastness. Four-way stretchable fabric Effective compression Enhanced comfort. Two layered with interwoven air space Retains body heat effectively. Speeds up healing Allays pain. Tynor Knee Cap Comfeel Measurements Measure circumference around mid thigh - approx 6 inches above knee Size Chart - Size Inches CM Small 14.8-17.2 37-43 Medium 17.2-19.6 43-49 Large 19.6-22 49-55 XL 22-24.4 55-61
wheelchairindia9

Tynor Ankle Brace - 0 views

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    Tynor Ankle Brace Ankle brace is designed to support, stabilize, and limit the range-of-motion of the ankle joint. In injury, or offer protection to people who are prone to ankle injuries. It uses the triple action of straps, laces and rigid lateral natomical splints to provide optimal ankle stabilization. Rigid Splinting Fits left & right. Easy to wear Controlled compression. Comfortable sung fit. Tynor Ankle Brace Features Triple stabilization Splint ensure strong immobilization Lace offers regional tightening, firm grip and good fitting. "Figure of eight Tynor Ankle Brace Measurements Measure circumference approx 2 inches above the ankle joint. Size Chart- Size Inches CM Small 7.2-8.4 18-21 Medium 8.4-9.6 21-24 Large 9.6-10.8 24-27 XL 10.8-12 27-30
wheelchairindia9

Tynor Ankle Splint - 0 views

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    Ankle Splint Ankle Splint is designed to immobilize, support and stabilize the ankle joint in injury, or offer protection to people prone to ankle injuries. Rigid exoskeleton shell design gives better protection and control of the inversion or aversion of the ankle. Rigid immobilization Foam cushioning One size, that fits all Anatomical Easy to clean. Ankle Splint Features Unique figure of eight gripping Effective control on inversion & eversion movement of ankle Most effective gripping around ankle. Enhances comfort and walking pleasure Large enough room for ankle Unconventional, swollen or distorted ankles can be accommodated No compression hot spots on the ankle , so enhances comfort to injured ankle Reduces chances of sports related injuries in recurrent ankle problems Quick healing and better recovery of the fully immobilized ankle Molded Ethafoam Foam Pad Provides optimal compression and pressure Good cushioning , enhances comfort Skin friendly Ergonomic design Light in weight - enhance compliance Bilateral symmetry - can be used for either ankle Neoprene sleeves - good cushioning ,reduce pressure of gripping straps One size fits all Molded splint with perfect anatomy Pleasing aesthetics Sleek can be used inside the shoe Effective immobilization. Ankle Splint Measurements Measure circumference approx 2 inches above the ankle joint. Size Chart - Size Inches CM Universal 7.2-12 18-30
wheelchairindia9

Tynor Restrainer - 0 views

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    Tynor Restrainer Applications To manage combative or disoriented patient. Manage post anesthesia delirium. Patients with head injuries or recovering from seizures. Schizophrenia, mental illness, dementia, or side effects from their treatment. To limit the body movement. Maintain a particular position. Tynor Restrainer Features Cushiony & comfortable. Easy to tie and open. Strong and durable. Fits left, right, wrist & ankle. Tynor Restrainer Measurements Size Chart - Size Inches CM Universal 5-9.5 12.5-23.8
Nathan Goodyear

clinical presentation and Histologic Findings at Ileocolonoscopy in children with Autis... - 0 views

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    Ileal and colonic inflammation found in children with autism. Prominent GI symptoms were found in this chart review of 143 children with autism and developmental disorders.
Nathan Goodyear

High Estrogen in Men After Injectable Testo... [Am J Mens Health. 2014] - PubMed - NCBI - 0 views

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    Again, Testosterone and here Estradiol are merely there for libido and sex.  What tunnel vision?!  What about hsCRP?  What about fibrinogen?  What about IL-1beta?  What about TNF-alpha?  These inflammatory cytokines have all been reported to elevate as a result of estrogen production in men.   And PSA?  No mention of it here.   This linear, tunnel vision thinking on hormones has got to stop! The study points out that all clients were using AIs and SERMs irregardless of whether they had elevated estrogens or not.  That is not a well designed study.  One group should have had AI's if elevated estrogens were present and another group should not--this would compare the effects of aromatase activity.  Second, this was simply a retrospective chart review.  Third, a 50% conversion of 34,000 + men is very high when you look at the literature.  Fourth, they point to gynecomastia as a means of negative?  The cardiovascular implications are more significant.  These studies just seem to focus on superficial things.  Fifth, did libido problems exist before?  What were the free levels?   This falls in the paucity of data (2 studies) that point to excessive lowering of estradiol effecting libido and sexual performance.
Nathan Goodyear

Full Text: Prevalence of Endocrinopathies in Patients with Beta-Thalassaemia Major - A ... - 0 views

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    Chart review of endocrine abnormalities associated with Beta-Thalassaemia Major in Oman.
Nathan Goodyear

Long-term Exposure to Testosterone Therapy and the Risk of High Grade Prostate Cancer -... - 0 views

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    Not the best of study design (chart review), but study finds Testosterone therapy over 5 years not associated with increased risk of high graded prostate cancer.  Others longitudinal studies have shown no general increase in risk.
wheelchairindia9

Tynor Mallet Finger Splint - 0 views

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    Tynor Mallet Finger Splint Mallet finger Specially design to correct the mallet finger deformity. Designed to support the dip joint in hyper- extension, while permitting unrestricted movement of the PIP joint. Sleek and convenient. Customizable dorsiflexion. Comfortable cushioning. One universal size. Tynor Mallet Finger Splint Features Coated aluminum body Malleable can be bent and customized Strong, provides rigid immobilization Light weight Ergonomic design Highly practical design to maintain the requisite hyper extension of DIP joint Well ventilated and comfortable Sleek and simple -Better compliance Easy application and removal. Ethafoam lining High cushioning Enhanced comfort Easy to clean and maintain. Inbuilt Hook loop fasteners Close fitting and excellent grip Easy application and removal. Tynor Mallet Finger Splint Measurements Length of Fingers Size Chart - Size Inches CM Universal Below 2-4 Below 5-10
wheelchairindia9

Tynor Frog Splint - 0 views

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    Tynor Frog Splint Frog-Splint Provides perfect alignment of the inter-phalangeal joints by maintaining them in optimal functional position. Malleable arms fold to hold the finger in the finger in the desired position. No tapes required. Light weight Softened arms for good grip Comfortable cushioning Hypo allergenic Tynor Frog Splint Features Coated aluminum body Extra malleable arms, can be shaped for good grip Strong, provides rigid immobilization Aesthetically pleasing Light weight Anatomic design Immobilizes both interphalangeal joints in neutral functional position Ensures easy wearing during injury Well ventilated and comfortable Does not restrict the movement of other fingers. Sleek, simple and light in weight Ethafoam lining High cushioning Enhanced comfort Easy to clean and maintain. Hypoallergenic, odorless Tynor Frog Splint Measurements Length of Fingers Size Chart- Size Inches CM Small Below 2 Below 5 Medium 2-3 5-7.5 Large 3-4 7.5-10
wheelchairindia9

Tynor Finger Cot - 0 views

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    Tynor Finger Cot Finger cot Supports, protects and immobilizes the phalanges in case of fractures, injuries or post operative care. Hook and loop bands ensure a snug fit and eliminates the need for taping. Light weight Pleasing aesthetics Comfortable cushioning Hypo allergenic Inbuilt tightening Tynor Finger Cot Features Coated aluminum body Malleable can be bent and customized Strong, provides rigid immobilization Aesthetically pleasing Light weight Ergonomic design U design ensures full protection in injuries and burns. Ensures easy wearing during injury Well ventilated and comfortable Better compliance. Ethafoam lining High cushioning Enhanced comfort Easy to clean and maintain. Inbuilt Hook loop fasteners Close fitting and excellent grip Easy application and removal. Tynor Finger Cot Measurements Length of Fingers Size Chart - Size Inches CM Small Below 2 Below 5 Medium 2-3 5-7.5 Large 3-4 7.5-10
wheelchairindia9

Tynor Pattelar Support - 0 views

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    Tynor Pattelar Support Patellar support is designed to lift the patella and alleviate symptoms of pain, inflammation and discomfort associated with knee degeneration, without restricting circulation. Anatomically shaped Pad Enhanced Propioception Skin-friendly materials Customized compression. Tynor Pattelar Support Features Anatomical pad design Lifts and positions the patella properly Optimal compression of the patellar tendon Ensures strong grip of the product Silicon material of pad. Absorbs all the vibrations around the patella and the patellar tendon. Provides comfortable compression to the patellar tendon. Support the patella. Nodular surface Propioception Provides good massage Enhances blood circulation to the area Enhances healing Reverse buckle design One size fits all Provides customized compression Easy to wear. Tynor Pattelar Support Measurements Size Chart - Size Inches CM Universal 12 to 20 30 to 50
spineneuro

Charting New Horizons: Dr. Vipul Gupta's Vision for Interventional Radiology - 0 views

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    Renowned for his excellence in neurological care, the Patient gives Dr. Vipul Gupta reviews and takes pride in delivering unparalleled neurosurgical care with the highest levels of technological and surgical advancements. Dr. Vipul Gupta interventional radiologist goal is to provide his patients from all over the world with the highest possible quality of life through his commitment to excellence.
wheelchairindia9

Tynor Foot Drop Splint Right-Left - 0 views

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    Tynor Foot Drop Splint Right/Left Applications Prevention and correction of foot drop. Peripheral nerve paralysis. Nerve/Muscle damage. Ankle or Plantar flexion contracture. Functional Alignment of the foot. Post operative care. Burn patients. Tynor Foot Drop Splint Right/Left Features Effective foot lift. Strong leaf spring action. Customizable. Thin walled, worn in a shoe. Tynor Foot Drop Splint Right/Left Measurements Measure shoe size Size Chart - Sizes European American Small 34-36 2.8-4.4 Medium 37-39 5.3-6.8 Large 40-42 7.5-9.0
Nathan Goodyear

Testosterone and the Cardiovascular System: A Comprehensive Review of the Clinical Lite... - 0 views

  • Low endogenous bioavailable testosterone levels have been shown to be associated with higher rates of all‐cause and cardiovascular‐related mortality.39,41,46–47 Patients suffering from CAD,13–18 CHF,137 T2DM,25–26 and obesity27–28
  • have all been shown to have lower levels of endogenous testosterone compared with those in healthy controls. In addition, the severity of CAD15,17,29–30 and CHF137 correlates with the degree of testosterone deficiency
  • In patients with CHF, testosterone replacement therapy has been shown to significantly improve exercise tolerance while having no effect on LVEF
  • ...66 more annotations...
  • testosterone therapy causes a shift in the skeletal muscle of CHF patients toward a higher concentration of type I muscle fibers
  • Testosterone replacement therapy has also been shown to improve the homeostatic model of insulin resistance and hemoglobin A1c in diabetics26,68–69 and to lower the BMI in obese patients.
  • Lower levels of endogenous testosterone have been associated with longer duration of the QTc interval
  • testosterone replacement has been shown to shorten the QTc interval
  • negative correlation has been demonstrated between endogenous testosterone levels and IMT of the carotid arteries, abdominal aorta, and thoracic aorta
  • These findings suggest that men with lower levels of endogenous testosterone may be at a higher risk of developing atherosclerosis.
  • Current guidelines from the Endocrine Society make no recommendations on whether patients with heart disease should be screened for hypogonadism and do not recommend supplementing patients with heart disease to improve survival.
  • The Massachusetts Male Aging Study also projects ≈481 000 new cases of hypogonadism annually in US men within the same age group
  • since 1993 prescriptions for testosterone, regardless of the formulation, have increased nearly 500%
  • Testosterone levels are lower in patients with chronic illnesses such as end‐stage renal disease, human immunodeficiency virus, chronic obstructive pulmonary disease, type 2 diabetes mellitus (T2DM), obesity, and several genetic conditions such as Klinefelter syndrome
  • A growing body of evidence suggests that men with lower levels of endogenous testosterone are more prone to develop CAD during their lifetimes
  • There are 2 major potential confounding factors that the older studies generally failed to account for. These factors are the subfraction of testosterone used to perform the analysis and the method used to account for subclinical CAD.
  • The biologically inactive form of testosterone is tightly bound to SHBG and is therefore unable to bind to androgen receptors
  • The biologically inactive fraction of testosterone comprises nearly 68% of the total testosterone in human serum
  • The biologically active subfraction of testosterone, also referred to as bioavailable testosterone, is either loosely bound to albumin or circulates freely in the blood, the latter referred to as free testosterone
  • It is estimated that ≈30% of total serum testosterone is bound to albumin, whereas the remaining 1% to 3% circulates as free testosterone
  • it can be argued that using the biologically active form of testosterone to evaluate the association with CAD will produce the most reliable results
  • English et al14 found statistically significant lower levels of bioavailable testosterone, free testosterone, and free androgen index in patients with catheterization‐proven CAD compared with controls with normal coronary arteries
  • patients with catheterization‐proven CAD had statistically significant lower levels of bioavailable testosterone
  • In conclusion, existing evidence suggests that men with CAD have lower levels of endogenous testosterone,13–18 and more specifically lower levels of bioavailable testosterone
  • low testosterone levels are associated with risk factors for CAD such as T2DM25–26 and obesity
  • In a meta‐analysis of these 7 population‐based studies, Araujo et al41 showed a trend toward increased cardiovascular mortality associated with lower levels of total testosterone, but statistical significance was not achieved (RR, 1.25
  • the authors showed that a decrease of 2.1 standard deviations in levels of total testosterone was associated with a 25% increase in the risk of cardiovascular mortality
  • the relative risk of all‐cause mortality in men with lower levels of total testosterone was calculated to be 1.35
  • higher risk of cardiovascular mortality is associated with lower levels of bioavailable testosterone
  • Existing evidence seems to suggest that lower levels of endogenous testosterone are associated with higher rates of all‐cause mortality and cardiovascular mortality
  • studies have shown that lower levels of endogenous bioavailable testosterone are associated with higher rates of all‐cause and cardiovascular mortality
  • It may be possible that using bioavailable testosterone to perform mortality analysis will yield more accurate results because it prevents the biologically inactive subfraction of testosterone from playing a potential confounding role in the analysis
  • The earliest published material on this matter dates to the late 1930s
  • the concept that testosterone replacement therapy improves angina has yet to be proven wrong
  • In more recent studies, 3 randomized, placebo‐controlled trials demonstrated that administration of testosterone improves myocardial ischemia in men with CAD
  • The improvement in myocardial ischemia was shown to occur in response to both acute and chronic testosterone therapy and seemed to be independent of whether an intravenous or transdermal formulation of testosterone was used.
  • testosterone had no effect on endothelial nitric oxide activity
  • There is growing evidence from in vivo animal models and in vitro models that testosterone induces coronary vasodilation by modulating the activity of ion channels, such as potassium and calcium channels, on the surface of vascular smooth muscle cells
  • Experimental studies suggest that the most likely mechanism of action for testosterone on vascular smooth muscle cells is via modulation of action of non‐ATP‐sensitive potassium ion channels, calcium‐activated potassium ion channels, voltage‐sensitive potassium ion channels, and finally L‐type calcium ion channels
  • Corona et al confirmed those results by demonstrating that not only total testosterone levels are lower among diabetics, but also the levels of free testosterone and SHBG are lower in diabetic patients
  • Laaksonen et al65 followed 702 Finnish men for 11 years and demonstrated that men in the lowest quartile of total testosterone, free testosterone, and SHBG were more likely to develop T2DM and metabolic syndrome.
  • Vikan et al followed 1454 Swedish men for 11 years and discovered that men in the highest quartile of total testosterone were significantly less likely to develop T2DM
  • authors demonstrated a statistically significant increase in the incidence of T2DM in subjects receiving gonadotropin‐releasing hormone antagonist therapy. In addition, a significant increase in the rate of myocardial infarction, stroke, sudden cardiac death, and development of cardiovascular disease was noted in patients receiving antiandrogen therapy.67
  • Several authors have demonstrated that the administration of testosterone in diabetic men improves the homeostatic model of insulin resistance, hemoglobin A1c, and fasting plasma glucose
  • Existing evidence strongly suggests that the levels of total and free testosterone are lower among diabetic patients compared with those in nondiabetics
  • insulin seems to be acting as a stimulant for the hypothalamus to secret gonadotropin‐releasing hormone, which consequently results in increased testosterone production. It can be argued that decreased stimulation of the hypothalamus in diabetics secondary to insulin deficiency could result in hypogonadotropic hypogonadism
  • BMI has been shown to be inversely associated with testosterone levels
  • This interaction may be a result of the promotion of lipolysis in abdominal adipose tissue by testosterone, which may in turn cause reduced abdominal adiposity. On the other hand, given that adipose tissue has a higher concentration of the enzyme aromatase, it could be that increased adipose tissue results in more testosterone being converted to estrogen, thereby causing hypogonadism. Third, increased abdominal obesity may cause reduced testosterone secretion by negatively affecting the hypothalamus‐pituitary‐testicular axis. Finally, testosterone may be the key factor in activating the enzyme 11‐hydroxysteroid dehydrogenase in adipose tissue, which transforms glucocorticoids into their inactive form.
  • increasing age may alter the association between testosterone and CRP. Another possible explanation for the association between testosterone level and CRP is central obesity and waist circumference
  • Bai et al have provided convincing evidence that testosterone might be able to shorten the QTc interval by augmenting the activity of slowly activating delayed rectifier potassium channels while simultaneously slowing the activity of L‐type calcium channels
  • consistent evidence that supplemental testosterone shortens the QTc interval.
  • Intima‐media thickness (IMT) of the carotid artery is considered a marker for preclinical atherosclerosis
  • Studies have shown that levels of endogenous testosterone are inversely associated with IMT of the carotid artery,126–128,32,129–130 as well as both the thoracic134 and the abdominal aorta
  • 1 study has demonstrated that lower levels of free testosterone are associated with accelerated progression of carotid artery IMT
  • another study has reported that decreased levels of total and bioavailable testosterone are associated with progression of atherosclerosis in the abdominal aorta
  • These findings suggest that normal physiologic testosterone levels may help to protect men from the development of atherosclerosis
  • Czesla et al successfully demonstrated that the muscle specimens that were exposed to metenolone had a significant shift in their composition toward type I muscle fibers
  • Type I muscle fibers, also known as slow‐twitch or oxidative fibers, are associated with enhanced strength and physical capability
  • It has been shown that those with advanced CHF have a higher percentage of type II muscle fibers, based on muscle biopsy
  • Studies have shown that men with CHF suffer from reduced levels of total and free testosterone.137 It has also been shown that reduced testosterone levels in men with CHF portends a poor prognosis and is associated with increased CHF mortality.138 Reduced testosterone has also been shown to correlate negatively with exercise capacity in CHF patients.
  • Testosterone replacement therapy has been shown to significantly improve exercise capacity, without affecting LVEF
  • the results of the 3 meta‐analyses seem to indicate that testosterone replacement therapy does not cause an increase in the rate of adverse cardiovascular events
  • Data from 3 meta‐analyses seem to contradict the commonly held belief that testosterone administration may increase the risk of developing prostate cancer
  • One meta‐analysis reported an increase in all prostate‐related adverse events with testosterone administration.146 However, when each prostate‐related event, including prostate cancer and a rise in PSA, was analyzed separately, no differences were observed between the testosterone group and the placebo group
  • the existing data from the 3 meta‐analyses seem to indicate that testosterone replacement therapy does not increase the risk of adverse cardiovascular events
  • the authors correctly point out the weaknesses of their study which include retrospective study design and lack of randomization, small sample size at extremes of follow‐up, lack of outcome validation by chart review and poor generalizability of the results given that only male veterans with CAD were included in this study
    • Nathan Goodyear
       
      The authors here present Total Testosterone as a "confounding" value
    • Nathan Goodyear
       
      This would be HSD-II
  • the studies that failed to find an association between testosterone and CRP used an older population group
  • low testosterone may influence the severity of CAD by adversely affecting the mediators of the inflammatory response such as high‐sensitivity C‐reactive protein, interleukin‐6, and tumor necrosis factor–α
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    Good review of Testosterone and CHD.  Low T is associated with increased all cause mortality and cardiovascular mortality, CAD, CHF, type II diabetes, obesity, increased IMT,  increased severity of CAD and CHF.  Testosterone replacement in men with low T has been shown to improve exercise tolerance in CHF, improve insulin resistance, improve HgbA1c and lower BMI in the obese.
wheelchairindia9

Tricycle Manufacturers - 0 views

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    Tricycles make cycling accessible to all, whatever personal challenges. There are a wide range of disability cycles that suit people with a variety of learning and physical disabilities, as well as health issues. Tricycles have 3 wheels, which means that the rider does not need to be able to balance. This is particularly useful for people with learning disabilities, such as Dyspraxia, and those recovering from illnesses. Tricycles can be fitted with foot plates to make it easier for riders to rotate the pedals and they come in upright or recumbent (horizontal sitting position). For adults and children with balance issues, stabilisers can also be fitted to standard bikes, which makes them more like tricycles. Tricycles come in a variety of accessible styles for people of all abilities including many persons with spinal cord injury disabilities. Tricycles is a great upper body workout and can provide a great sense of freedom for persons with disabilities. While the high cost prevents many from enjoying Tricycles they are steadily growing in popularity. Tricycle Deluxe Double Hand Drive: Frame : Made by E.R.W. Tubes 38.0 mm-16 G. 25.4 mm & 22.22 mm- 18 G. Seat & Back: M S, C.R.C. Sheet. Seat Size 18"x 16" Wheel Size: Wheel Diameter 24"x 1 1/2" Tyre and Tube Standard Company. Parts: Standard Quality. Color: Black Painted. Brake: Front Wheel liver System Drive: Rear Wheel Right Side. Hand powered cycles work along the same principle as standard cycles. The pedals are replaced with handles that also steer, and riders use their arms to push the handles around to drive the chain and wheels. Most hand cycles have 3 wheels, although some have 4 wheels. 4-wheel cycles may have power assistance instead of the rider turning handles,or they may be built for going down hill, in which case gravity powers the bike. As with tricycles, hand cycles can have upright seats or low down recumbent seats. Specialist 'clip on' cycles are also available that can be attached
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