On our Invacare® Top End® Force™ RX Handcycle we offer elbow-activated brakes which are easy to access using brake levers mounted on the side frame of the handcycle. There are two options for shifting. The most popular one is the wrist-driven double tap shifting which is available with the QuadGrips handpedal option. The QuadGrips handpedals feature power plates on the top and bottom of the handpedal to secure the hand throughout the full pedal stroke plus tri-pins to stabilize the wrist. A QuadWrap is included to prevent chaffing. Another option is to mount a double tap shifter near the elbow brake lever so that the athlete can use his/her elbow to shift the front wheel cassette.
To change the upper chain rings there is no special option needed since it is easy to activate with limited hand function.