A novel program including ride-on toys to improve upper extremity function in children with hemiplegia: a randomized controlled trial

Abstract

Objective: This study will assess the feasibility, acceptance, and preliminary efficacy of a novel and engaging task-oriented UE training program, Strength and Power in upper Extremities through Exploratory Driving (SPEED), including joystick-operated ride-on toys, as a therapy adjunct, to advance UE function among children with hemiplegia.

Methods: We will conduct a randomized controlled trial to compare SPEED training to a dose-matched program, Creative Rehabilitation for Arm Function Training (CRAFT), based on standard-of-care. 30 children with hemiplegia between 3 and 9 years will be recruited. Training will last 6 weeks, 4 times/week, 2 sessions by researchers (30-45 min/session) and 2 sessions by caregivers (15-20 min/session). The SPEED group will engage in playful games including ride-on toys and the CRAFT group will complete seated, fine motor activities. The primary outcome measure is treatment adherence. Secondary measures include participant retention, perceived satisfaction, implementation fidelity scores, child engagement, wrist-worn accelerometry, kinematics, scores on the Shriner's Hospital Upper Extremity Evaluation, Quality of Upper Extremity Skills Test, and the ABILHAND-Kids questionnaire, grip strength assessment, and measures of navigational control.

Impact: We propose a community-based, innovative, task-oriented training including modifiedride-on toys to promote self-initiated use of the affected UE in young children with hemiplegia. Study findings have implications for the adoption of the SPEED program by families as an adjunct to conventional therapy to increase children's functional use of their affected arm through playful exploration.

Keywords: Randomized controlled trial; cerebral palsy; hemiplegia; paresis; play and playthings; rehabilitation; upper extremity.