Fast and Fun: A Pilot Feasibility Study Using Dual Joystick-Operated Ride-on Toys for Upper Extremity Rehabilitation in Children with Hemiplegia

Abstract

Aim

Our study investigates the feasibility and utility of implementing a dual joystick-operated ride-on-toy navigation training (RNT) program within a 3-week intensive camp based on principles of modified constraint-induced movement therapy and bimanual training, to improve upper extremity (UE) function in children with unilateral cerebral palsy (UCP).

Methods

We employed a single-group pretest posttest, mixed methods study design. Eleven 4-to-10-year-old children with UCP received RNT as part of camp activities. Sessions required children to use both arms together for navigation and completing gross and fine motor UE challenges. We collected exit questionnaires from children, caregivers, and clinicians to assess the feasibility, acceptance, enjoyment, and perceived efficacy of RNT. Videos of training sessions were coded using Datavyu behavioral coding software to assess children’s facial expressions and affective states, indicative of their level of engagement during intervention sessions.

Results

We found high levels of child engagement during RNT sessions based on video data and stakeholder feedback. The RNT program was smoothly integrated into the camp. Stakeholders acknowledged the highly motivating nature of RNT. When combined with other camp activities, the program led to stakeholder-reported improvements in bimanual skills and spontaneous daily use of the affected UE.

Conclusions

Our pilot study provides promising evidence for using joystick-operated ride-on toys as engaging therapy adjuncts. Our findings call for future studies to systematically assess the efficacy of these devices in improving UE function among children with UCP.

Keywords:

• Bimanual training
• child engagement
• feasibility
• joystick-operated novel technologies
• ride-on toys
• unilateral cerebral palsy

Acknowledgments

We thank the children and families who participated in the study. We also thank the staff at the Lefty and Righty camp of Connecticut and the camp director, Cindy Jackson, for her support of this research. We would like to thank Alexander Stiefel for his help with creating the CAD drawings for the 3D printed parts. The authors would like to sincerely thank graduate students, Nidhi Amonkar and Hanna Rakhangi, for their help with data collection and data analyses. We would also like to thank the undergraduate students, Sarah Sullivan and Pari Patel, in the REINVENT-PT Lab at the University of Connecticut for their help with data coding. SS thanks the University of Connecticut for a start-up grant to support this project.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data Availability Statement

Data associated with this study are available upon request from the corresponding author.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article. This study was supported by a start-up grant to the corresponding author through the University of Connecticut.

Notes on contributors

Vaishnavi Shahane

Vaishnavi Shahane is a graduate student pursuing her Master’s degree in Kinesiology at the University of Connecticut. She has a bachelor’s degree in Physical Therapy from India and is interested in areas related to pediatric rehabilitation, physical therapy, kinesiology, and developmental disorders. She was involved in data analyses, interpretation, and dissemination for the current project.

Patrick D. Kumavor

Patrick D. Kumavor is an Associate Professor-in-Residence in the Biomedical Engineering Department at the University of Connecticut. Patrick’s research interests lie in the areas of bioinstrumentation, bioimaging, and biophotonics. Within our research team, he heads efforts directed toward modifying and adapting commercially available ride-on toys for use by children with Cerebral Palsy. For the current project, Patrick was involved in project conception, toy modifications, data analysis, and data dissemination.

Kristin Morgan

Kristin Morgan is an Assistant Professor in the Biomedical Engineering Department at the University of Connecticut. Her expertise lies in human movement biomechanics and computational modeling of human movement. In the present project, Kristin was involved in project conception, devising protocols for capturing quantitative changes in children’s upper extremity movement control following the behavioral intervention, and data dissemination.

Sudha Srinivasan

Sudha Srinivasan is an Assistant Professor in the Physical Therapy program within the Department of Kinesiology at the University of Connecticut. Her research interests lie in the fields of motor development, rehabilitation, and developing novel, playful interventions, and assistive technologies to empower children with disabilities and their families. For this project, she was involved in project conception, data collection, data analyses, data interpretation, and manuscript writing.