Outcomes Associated with a Single Joystick-Operated Ride-on-Toy Navigation Training Incorporated into a Constraint-Induced Movement Therapy Program: A Pilot Feasibility Study

Abstract

Our research aims to evaluate the utility of joystick-operated ride-on-toys (ROTs) as therapeutic adjuncts to improve upper extremity (UE) function in children with hemiplegic cerebral palsy (HCP). This study assessed changes in affected UE use and function following a three-week ROT navigation training incorporated into an existing constraint-induced movement therapy (CIMT) camp in 11 children (3–14 years old) with HCP. We report changes in scores on the standardized Shriners Hospital Upper Extremity Evaluation (SHUEE) from pretest-to-posttest and changes from early-to-late sessions in percent time spent by the affected arm in: (a) “moderate-to-vigorous activity”, “light activity” and “no activity” bouts based on accelerometer data and (b) “independent”, “assisted”, and “no activity” bouts based on video data. We also explored relationships between standardized measures and training-specific measures of affected UE activity. We found small-to-medium improvements in the SHUEE scores. Between 90 and 100% of children also showed medium-to-large improvements in affected UE activity from early-to-late sessions using accelerometers and small improvements via video-based assessments. Exploratory analyses suggested trends for relationships between pretest-posttest and training-specific objective and subjective measures of arm use and function. Our pilot data suggest that single joystick-operated ROTs may serve as motivating, child-friendly tools that can augment conventional therapies such as CIMT to boost treatment dosing, promote affected UE movement practice during real-world navigation tasks, and ultimately improve functional outcomes in children with HCP.

A Pilot Feasibility Study on the Use of Dual-Joystick-Operated Ride-on Toys in Upper Extremity Rehabilitation for Children with Unilateral Cerebral Palsy

“…In the past, we demonstrated the feasibility and positive preliminary effects of singlejoystick-operated ride-on toys (controls provided on the child's affected side) implemented within a modified CIMT camp [27,28]. Given the importance of bimanual skills in daily life, in this study, we incorporated ride-on-toy navigation training using dual joystick controls within a hybrid UE training program to promote bimanual coordination.…”

“…We chose ride-on devices because they are popular, intrinsically rewarding, and inclusive toys that promote exploratory play and self-initiated bimanual UE use [47][48][49]. Our training program fostered child autonomy, provided children the "just-right" bimanual motoric challenge and immediate multimodal feedback (visual, auditory, tactile) on their actions, and challenged the children's perceptual, action-related, and motor planning/cognitive skills [27,28,50]. The use of ride-on toys as a therapy adjunct is also aligned with qualitative perspectives shared by children and caregivers that technology and gamification help break the monotony of traditional therapy, fosters greater compliance, promotes sustained engagement during challenging UE activities, and provides a feasible alternative to conventional exercises while fostering repetitive practice [51].…”

“…Our group has been exploring the use of joystick-operated ride-on toys as a technologybased, age appropriate, and child-friendly therapy adjunct that can be used to incentivize use of the affected UE in children with hemiplegia [27][28][29]. This paper reports findings from a pilot study exploring the acceptability and utility of a training program using dual-joystick-operated ride-on toys incorporated as part of a three-week hybrid training camp for children with hemiplegia.…”

A Training Program Using Modified Joystick-Operated Ride-on Toys to Complement Conventional Upper Extremity Rehabilitation in Children with Cerebral Palsy: Results from a Pilot Study

“…Previously, we reported that a training program using modified, single joystick-operated ride-on toys (with controls provided on the child's affected side) was well-received by children, caregivers, and clinicians. The training was feasible for implementation within an intensive mCIMT program, and in combination with mCIMT, it led to improvements in affected UE use and motor functions assessed using standardized motor tests, arm accelerometry, and video-based measures [36,37]. However, given the importance of bimanual coordination for activities in daily living, the present study will explore the effects of an innovative and playful bimanual ride-on-toy training program among children with CP.…”

“…Current evidence on UE rehabilitation approaches in CP suggests that high dose paradigms that foster intensive, task-oriented practice for several hours every day for multiple weeks produce meaningful improvements in function [23,29,30]; however, it is challenging to sustain child engagement and motivation during such intensive paradigms [31][32][33][34]. Over the last several years, our research group has been exploring the use of child-friendly, easy-to-implement, technology-based adjuncts, specifically joystick-operated ride-on toys, to incentivize UE use, boost treatment dosing, and promote task-oriented UE practice through incrementally challenging navigational games [35][36][37]. Previously, we reported that a training program using modified, single joystick-operated ride-on toys (with controls provided on the child's affected side) was well-received by children, caregivers, and clinicians.…”