Project summary/Abstract
Hemiplegia is a very common pediatric developmental condition in the United States with roughly 4000 babies
diagnosed every year. Children with hemiplegia have impaired upper extremity (UE) function, presenting
significant challenges during self-care, play, and school work. Current guidelines for evidence-based
rehabilitation recommend intensive, repetitive, goal-directed practice of at least 30-40 hours to produce
meaningful improvements in UE function; however, in practice, children receive < 15 hours of physical and
occupational therapy per month due to issues associated with access to services, therapist availability, as well
as time-related and financial constraints of families. This critical service gap needs to be addressed by
designing child- and family-centric interventions that can be easily implemented by families and can help boost
the dosing of conventional therapy. We propose that a training program that uses modified, commercially-
available joystick-operated ride-on-toys will be enjoyable, feasible, acceptable, and easy-to-implement for
families, and will also be effective in serving as an adjunct to conventional therapy to improve UE motor
function in children with hemiplegia. Thirty children with hemiplegia between 3 and 8 years will be matched on
age, gender, ability level, and therapies received and then randomly assigned to either an experimental group
(will receive a home program involving ride-on-toy navigation training) or a control group (will receive a home
program involving activities modeled on conventional physical and occupational therapy). Children in both
groups will receive training co-delivered by researchers and caregivers for 6 weeks @ 4 sessions/week (2
sessions by researchers and 2 sessions by caregivers). Both groups will continue to receive treatment-as-
usual outside study settings. Primary outcome measures (assessed at pretest, posttest, and 1 month follow-
up) associated with project specific aims include: (a) feasibility and satisfaction-related metrics using child and
caregiver questionnaires and (b) objective and subjective measures of preliminary efficacy of the training
program using standardized motor tests, accelerometry, and movement kinematics. Our work is highly
innovative in merging the interdisciplinary fields of healthcare and biomedical engineering to develop child-
friendly therapeutic aids/toys and effective family-centric training programs to promote self-initiated UE use,
motor function, and participation in children with hemiplegia. Our findings have implications for the use of
intrinsically rewarding, age-appropriate, ride-on-toys by caregivers and clinicians to incentivize spontaneous
UE use and promote sensorimotor, problem solving, and motor planning skills in children with hemiplegia. By
expanding hours of therapy beyond clinic/school settings, involving caregivers as interventionists, and
increasing goal-oriented practice as part of children's play routines in their naturalistic environments, we aim to
improve UE function and independence, while reducing future complications of non-use/disuse in children with
hemiplegia.
