Poster #103 - Effects of a dual joystick-operated ride-on-car training program on bimanual function and spontaneous affected arm use in children with hemiplegic Cerebral Palsy

• In Event: Poster Session 01

Abstract

Background & Objectives: Children with Hemiplegic Cerebral Palsy (HCP) develop a ‘developmental disuse’ phenomenon on the more affected side, where they tend to not use their weaker upper extremity (UE). Instead, children learn strategies to compensate with their unaffected UE. These impairments lead to significant difficulties in bimanual coordination with implications for children’s independence in activities of daily living. We propose an innovative, enjoyable way of improving upper extremity (UE) use and function through purposeful, joystick-controlled navigation of ride-on-cars (ROCs). This study aims to assess the effects of a dual joystick-operated ride-on-car navigation training program to improve unimanual and bimanual UE function 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) with clear asymmetry in UE were recruited using convenience sampling. Children were excluded if they couldn’t maintain 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 their participation in the study.
Methods: The training was incorporated as part of an existing summer camp for children with HCP. Children were provided training on a dual joystick-operated ROC for 20-30 minutes/day for 15 days. Children needed to coordinate use of both hands to control the joysticks to drive the ROC. Training activities involved navigation along progressively challenging paths (e.g. straight, arc, and slalom paths) while performing UE tasks at intermediate stations. Tasks promoted functional use of the UE for reach, grasp, and manipulation including pulling, picking, throwing, catching objects, etc. We assessed changes in children’s ability to use both hands for functional activities from pretest to posttest using the standardized Shriners Hospital Upper Extremity Evaluation (SHUEE) test and the parent-rated ABILHAND-Kids questionnaire. In addition, video data collected during training sessions will be coded to assess changes from early to late training sessions in the use of the affected arm for navigation (percent duration of time of use of only unaffected, only affected, and both arm use during navigation) and affected arm control (assessed by rates and duration of unintentional stops during navigation reflective of poor and jerky motor control).
Expected Results: From pretest to posttest, we hypothesize that children will significantly increase spontaneous use of the affected arm and demonstrate improvements in spatiotemporal positioning of their affected UE while performing functional activities on the SHUEE. Caregivers will also indicate increased use of their affected UE during bimanual tasks on the ABILHAND-Kids questionnaire. From early to late training sessions, we expect to see an increase in coordinated bimanual activity during navigation, with a concurrent decrease in rates of and time spent in unintentional stops due to fatigue or poor endurance of the UE.
Conclusion & Significance: If the above-mentioned hypotheses hold true, we will provide preliminary evidence in support of the use of joystick-operated ride-on-toys as highly motivating and playful tools to promote child-initiated movement practice of using their affected arm during goal-directed activities.

Authors

• Vaishnavi Sandeep Shahane, University of Connecticut

• Nidhi Amonkar

• Aparna Athreya
  Presenting Author

• Natasha Sattar

• Emily Tully

• Aarthi Tippireddy

• Rylee Dooney

• Kavita Srirangam

• Kristin Morgan

• Patrick Kumavor

• Sudha M Srinivasan, University of Connecticut