A novel, child-friendly, home-based navigation training program using joystick-operated ride-on-toys to improve upper extremity function in children with hemiplegia: A pilot study

Project summary/Abstract Hemiplegia is a very common pediatric developmental condition in the United States with roughly 4000 babies diagnosed every year. Children with hemiplegia have impaired upper extremity (UE) function, presenting significant challenges during self-care, play, and school work. Current guidelines for evidence-based

rehabilitation recommend intensive, repetitive, goal-directed practice of at least 30-40 hours to produce meaningful improvements in UE function; however, in practice, children receive < 15 hours of physical and occupational therapy per month due to issues associated with access to services, therapist availability, as well

as time-related and financial constraints of families. This critical service gap needs to be addressed by designing child- and family-centric interventions that can be easily implemented by families and can help boost the dosing of conventional therapy. We propose that a training program that uses modified, commercially-

available joystick-operated ride-on-toys will be enjoyable, feasible, acceptable, and easy-to-implement for families, and will also be effective in serving as an adjunct to conventional therapy to improve UE motor function in children with hemiplegia. Thirty children with hemiplegia between 3 and 8-years will be matched on

age, gender, ability level, and therapies received and then randomly assigned to either an experimental group (will receive a home program involving ride-on-toy navigation training) or a control group (will receive a home program involving activities modeled on conventional physical and occupational therapy). Children in both

groups will receive training co-delivered by researchers and caregivers for 6 weeks @ 4 sessions/week (2 sessions by researchers and 2 sessions by caregivers). Both groups will continue to receive treatment-as- usual outside study settings. Primary outcome measures (assessed at pretest, posttest, and 1 month follow-

up) associated with project specific aims include: (a) feasibility and satisfaction-related metrics using child and caregiver questionnaires and (b) objective and subjective measures of preliminary efficacy of the training program using standardized motor tests, accelerometry, and movement kinematics. Our work is highly

innovative in merging the interdisciplinary fields of healthcare and biomedical engineering to develop child- friendly therapeutic aids/toys and effective family-centric training programs to promote self-initiated UE use, motor function, and participation in children with hemiplegia. Our findings have implications for the use of

intrinsically rewarding, age-appropriate, ride-on-toys by caregivers and clinicians to incentivize spontaneous UE use and promote sensorimotor, problem solving, and motor planning skills in children with hemiplegia. By expanding hours of therapy beyond clinic/school settings, involving caregivers as interventionists, and

increasing goal-oriented practice as part of children's play routines in their naturalistic environments, we aim to improve UE function and independence, while reducing future complications of non-use/disuse in children with hemiplegia.