Poster #28 - Comparing effects of single vs. dual joystick-operated ride-on-car (ROC) training programs on unimanual and bimanual function in children with Hemiplegic Cerebral Palsy (HCP).

• In Event: Poster Session 09

Abstract

Introduction: Our team is evaluating the use of ride-on-cars (ROCs) as child-friendly and easy-to-use therapeutic adjuncts to conventional rehabilitation to promote upper extremity (UE) function in children with Hemiplegic Cerebral Palsy (HCP). We recently completed 2 pilot studies in each of which we provided either single or dual joystick-operated ROC navigation training to children. The poster will compare the efficacy of single vs. dual joystick-operated ROC training programs in promoting unimanual and bimanual UE function in children with HCP.
Study Participants: Fourteen children with HCP (range: 3-13 years, 6M, 8F, 9 right hemiparesis, 5 left hemiparesis), participated in the study. In summer of year 1, 11 of these children participated in a single joystick-operated ROC navigation training program. In summer of year 2, 11 children participated in a dual joystick-operated ROC navigation training program. Note that there was an overlap of 8 children across both years, with 3 new children recruited in Year 2. The study was conducted as part of an existing summer camp and children were recruited through convenience sampling. Children were excluded if they were unable to maintain supported sitting for around 20 minutes, use their arm/body to briefly activate a joystick, exceeded device weight limits (100 lbs.), or had other additional medical/surgical co-morbidities.
Methods: Training with the ROC was provided for 25-30 minutes/day for 15 days involving goal-directed navigational games through increasingly challenging paths and gross and fine motor activities requiring children to use their UE for reaching, grasping, in-hand manipulation, and release. In year 1, navigation training was provided using a single joystick-operated ROC, with controls on the child’s affected side, whereas in year 2, training was provided using a dual joystick-operated ROC to promote bilateral UE use. We will compare the magnitude of change in UE motor performance from pretest to posttest across both years using the standardized Quality of Upper Extremity Skills Test (QUEST). Across the 2 types of training paradigms, we will also compare changes in the amount of adult-provided assistance during navigation (percent duration of independent versus assisted mobility) and the frequency of bumps/crashes against obstacles (rates/minute) from early to late sessions.
Results/ Expected results: In Year 1, following single joystick-operated ROC navigation training, children showed significant large improvements in total scores of the QUEST. We hypothesize a similar magnitude of improvement following dual joystick-operated ROC training in Year 2. From early to late training sessions, the single joystick training led to a large increase in independent mobility and a large decrease in rates of bumps/crashes against obstacles. We hypothesize that during dual joystick training, children may initially use the unaffected side more and will require adult assistance to use their affected side for navigation; however, across weeks, the contribution of the affected side will increase. Improvements in bumps/crashes will be similar across both years.
Conclusion: If our hypotheses are upheld, we will provide evidence supporting the use of single and dual- joystick-operated ROCs to promote unimanual and bimanual function in children with HCP.

Authors

• Nidhi Amonkar
  Presenting Author

• Vaishnavi Sandeep Shahane, University of Connecticut

• Dev Patel

• Michael Sullivan

• Kavya Sajeev

• Lucinda Carlos

• Fiona Xhafi

• Amal Ahmed

• Caroline Burkhard

• Andrea Hernandez

• Kristin Morgan

• Patrick Kumavor

• Deborah Bubela

• Sudha M Srinivasan, University of Connecticut