@Marney I'm always amazed at the cost of equipment that carries the label ADA or Medical Device, literally astronomical. Instead I like searching for alternative solutions. Check this link & see what you think http://www.sharperimage.com/si/view/product/The-Electronic-Pedaler/200465?trail=I bought an earlier version, w/o power assist about 5 years ago. Sadly I neglect my work out schedule due to lack of space or a rain free environment but still get to it occasionally. Also found these to check out as well:http://www.amazon.com/s/ref=nb_sb_ss_i_3_7?url=search-alias%3Daps&field-keywords=hand+cycle+exercise+equipment&sprefix=hand+cy%2Caps%2C302If these don't appear as links just copy & paste. Good luck to you!