FORMULA FUN: RESULTS FROM A PILOT FEASIBILITY STUDY TO IMPROVE SPONTANEOUS UPPER EXTREMITY MOTOR FUNCTION IN CHILDREN WITH UNILATERAL CEREBRAL PALSY

Purpose/Hypothesis: Children with Unilateral Cerebral Palsy (UCP) have sensorimotor impairments lateralized to one side of their body. They demonstrate ‘developmental disregard’ due to reduced awareness of and decreased reliance on their affected upper extremity (UE) during daily activities.1 Rehabilitation interventions focused on improving upper extremity function encourage task-oriented practice using the affected UE with the goal to improve strength and awareness on that side that can carry over to children’s daily life.2 Our group conducted a single arm intervention study to assess the utility of an innovative training program using modified, commercially available joystick-operated ride-on toys as an adjunct to conventional therapy to improve spontaneous affected UE use in children with UCP.3

Number of Subjects: 15 children with hemiplegia between 3 and 8 years participated in the study.

Materials/Methods: The study involved: (1) a 6-week control phase, where children received usual care, and (2) a 6-week intervention phase, where in addition to usual care children received community-based ride-on toy navigation training (RNT) 2 times/week, 30-45 minutes/session, with caregivers encouraged to provide 2 more sessions each week. The following tests were conducted before and after the control and intervention phases and at 1 month follow-up (FUP): a standardized test of bimanual function (Shriner’s Hospital Upper Extremity Function; SHUEE)4, bilateral wrist-worn accelerometry (worn for 1 week), and a parent-report questionnaire (ABILHAND-Kids)5. In addition, videos of early and late RNT sessions were coded for the quantity and quality of use of the affected UE during navigation and functional UE tasks.

Results: Children showed a statistically significant increase in the spontaneous use of their affected UE following the intervention phase with gains retained at FUP on the SHUEE. Parents reported that their children increased use of their affected UE during daily bimanual tasks following both control and intervention phases, with the magnitude of improvements being greater following the intervention compared to the control phase. Across early and late training sessions, the RNT program afforded high levels of use of the affected UE during navigation and even when the toy was stationary. With practice, children’s UE strength/endurance improved as indicated by decreased breaks due to muscle fatigue during navigation and increased moderate-to-vigorous activity in the affected UE measured by wrist-worn accelerometers.

Conclusions: Our preliminary findings suggest that a playful training paradigm using ride-on toys in conjunction with usual care can incentivize affected UE use and produce greater improvements in UE motor function compared to usual care alone.

Clinical Relevance: Clinicians and caregivers can use modified ride-on toys as age-appropriate and inclusive tools to encourage children with UCP to use their affected UE outside conventional therapy sessions for goal-oriented play/exploration within a variety of naturalistic community settings.