Poster #77 - Efficacy of a joystick-operated ride-on-car navigation training program in promoting upper extremity (UE) active control and independent use in children with Hemiplegic Cerebral Palsy (HCP).

• In Event: Poster Session 10

Abstract

Introduction: Children with Hemiplegic Cerebral Palsy (HCP) display an array of sensorimotor impairments particularly prominent in their affected upper extremity (UE) that hampers their performance in activities of daily living. Given the significant limitations in daily function that children with HCP face, they frequently required prolonged rehabilitation services. There is therefore a clear need to develop novel, motivating interventions that can address their functional limitations, while promoting sustained adherence with therapy. Our research group has been exploring the use of joystick-operated ride-on-cars (ROC) to promote UE use and function in children with HCP. This study investigated the efficacy of a novel behavioral intervention using dual joystick-operated, ride-on-cars to promote active control and independent use in bilateral UE in children with HCP.
Study Design: Quasi-experimental, single group study
Study Participants: Eleven children with HCP (4-10 years, 4M, 7F, 6 right hemiparesis and 5 left hemiparesis), recruited through convenience sampling, participated in a single-group, pre-post study that was conducted as part of a 3-week summer camp. Children were excluded if they couldn’t sustain supported sitting (<20 minutes), use their arm/body to briefly activate a joystick, exceeded weight limits of the toy, or had other additional comorbidities that limited participation in the study.
Methods: Training involved daily practice (~20-30 min./day for 15 days) of driving a modified joystick-operated ROC using both UE. The training activities promoted bimanual use of UE and involved navigation games requiring the child to skillfully navigate through challenging paths while avoiding obstacles and performing gross and fine motor activities using both UEs. The Quality of Upper Extremity Skills Test (QUEST) which is a standardized motor test was administered at pretest and posttest. We will code for changes in the following variables from early to late training sessions: (a) duration of independent versus assisted mobility, (b) duration of unintentional stops due to immature bilateral coordination skills (c) rates/minute of bumps/crashes into obstacles during navigation and (d) rates/minute and duration of pushing and pulling movement bouts normalized by total driving time.
Expected results: We hypothesize that children will show statistically significant improvements in total and subtest QUEST scores from pretest to posttest. In terms of joystick assistance, we hypothesize that children initially will require greater assistance on the affected side to maneuver the ROC during early sessions with assistance decreasing across weeks. Similarly, children will show a reduction in the time spent in unintentional stops as well as the rates/minute of bumps/ crashes indicative of improved bimanual coordination skills across training weeks. Lastly, we expect that the rates/minute of bouts will decrease with a concurrent increase in bout length across sessions.
Conclusion: If our hypotheses hold true, our pilot study will provide preliminary evidence for use of joystick-operated ROCs as a motivating therapeutic adjunct to promote UE function and use in children with HCP.

Authors

• Nidhi Amonkar

• Vaishnavi Sandeep Shahane, University of Connecticut

• Dev Patel
  Presenting Author

• Amanda Kilyk

• Fiona Xhafi

• Lucinda Carlos

• Michael Sullivan

• Kavya Sajeev

• Patrick Kumavor

• Kristin Morgan

• Sudha M Srinivasan, University of Connecticut