No abstract

Technological advances in game-mediated robotics provide an opportunity to engage children with cerebral palsy (CP) and other neuromotor disabilities in more frequent and intensive therapy by making personalized, programmed interventions available 24/7 in children’s homes. Though shown to be clinically effective and feasible to produce, little is known of the subjective factors impacting acceptance of what we term assistive/rehabilitative (A/R) gamebots by their target populations. This research describes the conceptualization phase of an effort to develop a valid and reliable instrument to guide the design of A/R gamebots. We conducted in-depth interviews with 8 children with CP and their families who had trialed an exemplar A/R gamebot, PedBotHome, for 28 days in their homes. The goal was to understand how existing theories and instruments were either appropriate or inappropriate for measuring the subjective experience of A/R gamebots. Key findings were the importance of differentiating the use case of therapy from that of assistance in rehabilitative technology assessment, the need to incorporate the differing perspectives of children with CP and those of their parents into A/R gamebot evaluation, and the potential conflict between the goals of preserving the quality of the experience of game play for the child while also optimizing the intensity and duration of therapy provided during play.

Technological advances in game-mediated robotics provide an opportunity to engage children with CP and other neuromotor disabilities in more frequent and intensive therapy by making personalized, programmed interventions available 24/7 in children’s homes. Though shown to be clinically effective and feasible to produce, little is known of the subjective factors impacting acceptance and of such assistive/rehabilitative gamebots by their target populations and their families. This research describes the conceptualization phase of an effort to develop a valid and reliable instrument to guide the design of A/R gamebots. We conducted in-depth interviews with 8 children with CP and their families who had trialed an A/R gamebot for 28 days in their homes to understand how existing theories and instruments were either appropriate or inappropriate to measuring the subjective experience of A/R gamebots. Key findings were the importance of differentiating the paradigm of rehabilitative from that of assistive technology, the need to incorporate the differing perspectives of children with CP and those of their parents into A/R gamebot evaluation, and the potential conflict between the goals of preserving the quality of the experience of game play for the child while also optimizing the intensity and duration of therapy provided during play.

Purpose: This pilot study assesses the feasibility of using PedBotHome to promote adherence to a home exercise program, the ability of the device to withstand frequent use, and changes in participant ankle mobility. PedBotHome is a robotic ankle device with integrated video game software designed to improve ankle mobility in children with cerebral palsy. Methods: Eight participants enrolled in a 28-day trial of PedBotHome. Ankle strength, range of motion, and plantar flexor spasticity were measured pre-and posttrial. Performance was monitored remotely, and game settings were modified weekly by physical therapists. Results: Four participants met the study goal of 20 days of use. There were statistically significant improvements in ankle strength, spasticity, and range of motion. Conclusions: PedBotHome is a feasible device to engage children with static neurological injuries in ankle home exercise. This pilot study expands the paradigm for future innovative home-based robotic rehabilitation. (Pediatr Phys Ther 2022;34:212-219

Exercise therapy delivered through interactive computer play (ICP) has been shown to be effective for improving gross motor skills, and ultimately gait, in children with cerebral palsy (CP). This chapter provides an overview of CP, its impact on, gait and the current physical therapy (PT) standard of care. The history of the home exercise program (HEP) component of standard PT care is described, along with the potential for using ICP to improve HEP. ICP systems are surveyed, and their defining features discussed. The current therapeutic use of ICP is described and directions for further development to enhance therapeutic utility presented. A theoretical framework to support ICP implementation, self-determination theory (SDT), is outlined, and an example of its exploration in a pilot effort is provided. An example of healthcare system barriers to rapid uptake of ICP is presented along with alternative strategies for deployment and recommendations for further research.