Poster #24 - Joystick-operated ride-on-cars as motivating tools to promote upper extremity function in children with hemiplegic Cerebral Palsy: Comparing training effects of single vs. dual joystick controls on child engagement and functional hand use.

• In Event: Poster Session 17

Abstract

Introduction: Improvements in upper extremity (UE) function in children with hemiplegic Cerebral Palsy (HCP) requires intense practice of goal-directed activities with the affected side. Frequently, therapists find it challenging to maintain motivation and child engagement in therapy. Our team is assessing the utility of joystick-operated ride-on-cars (ROCs) as child-friendly tools to encourage children to use their affected UE for navigation and thereby improve UE control and strength.
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. Children were excluded if they were unable to sustain supported sitting for around 20 minutes, use their arm/body to briefly activate a joystick, exceeded weight limits (100 lbs.) of the device, or had other additional medical/surgical co-morbidities.
Methods: Children received training for 25-30 minutes/day for 15 days involving navigational games and practice of gross and fine motor UE tasks. In Year 1, participants drove the ROC with single joystick controls provided on their affected side. In Year 2, participants used dual joystick-controlled ROC that required bilateral coordination skills. We will compare changes in bimanual coordination and affected UE use from pretest to posttest across single vs. dual joystick ROC training using the clinician-delivered, Shriner Hospital Upper Extremity Evaluation (SHUEE), and the parent-rated, ABILHAND-Kids questionnaire. We will also compare children’s UE movement control skills during navigation by coding early and late training videos across both years for rates/minute and duration of unintentional stops due to muscle fatigue or lack of endurance. Finally, across single and dual joystick ROC training, we will compare children’s level of enjoyment/engagement during early and late sessions. We will code children’s affective states (percent duration of positive, interested, and negative affect) and attentional focus (percent duration of attention directed towards task-related targets, device/joystick, social partners, and task-inappropriate targets).
Results/ Expected results: In Year 1, 91-100% children improved performance on the SHUEE from pretest to posttest, with small improvements also reported on the ABILHAND-Kids questionnaire. Children displayed high-levels of positive affect across sessions. With training, children decreased device-directed and task-inappropriate attention, with concurrent increases in task-appropriate and socially-directed attention. We expect similar results from Year 2 data analysis. We hypothesize that use of the affected side for functional navigation will improve from early to late sessions. Moreover, we expect to see larger improvements on the SHUEE in year 2 due to the predominantly bimanual nature of the training program. We hypothesize consistently high levels of positive affect and task-appropriate attention across all training sessions.
Conclusion: Our findings have implications for the use of joystick-operated ROCs as playful adjuncts to motivate children to use their affected arm for meaningful, task-oriented activities.

Authors

• Vaishnavi Sandeep Shahane, University of Connecticut

• Nidhi Amonkar

• Natasha Sattar
  Presenting Author

• Aparna Athreya

• Patharapa (Candy) Promprasert, University of Connecticut

• Megha Tirumali, University of Connecticut

• Sarah Sullivan

• Pari Patel

• Patrick Kumavor

• Kristin Morgan

• Deborah Bubela

• Sudha M Srinivasan, University of Connecticut