Feasibility and perceived impact of a clinician-led bimanual training program using joystick-operated ride-on toys incorporated into an intensive task-oriented hybrid summer camp for children with unilateral cerebral palsy.

backgroundChildren with Unilateral Cerebral Palsy (UCP) have significant limitations in upper extremity (UE) function impacting their independence and quality of life. Our study objectives were to assess (a) the feasibility and acceptability of incorporating a novel, bimanual ride-on-toy navigation (RNT) training program within a 3-week intensive, hybrid UE training camp (modified constraint induced movement therapy + bimanual training) and (b) the combined benefits of the comprehensive camp training model as perceived by clinicians. METHODOLOGY: We employed a single-group, pretest-posttest design. Ten children with UCP (M(SD): 6.99(2.13) years) and 6 clinicians/camp staff were recruited through convenience sampling from an annually held intensive therapy camp for children with UCP. In the 3-week camp, children practiced goal-oriented and task-focused activities for 6 h/day (5 h of UE practice with a constraint on the less-affected arm and 1-h of bimanual practice without the constraint). Following an initial training session, camp staff delivered fourteen RNT sessions (~ 20 min/session) per child over the 3 weeks as part of the bimanual portion of the camp. Feasibility and acceptability of the RNT program were assessed by monitoring adherence, through child and camp staff exit questionnaires, the Physical Activity Enjoyment Scale, and video-based behavioral coding. Clinician-perceived benefits of the overall camp programming, inclusive of RNT, was assessed using an exit questionnaire administered with camp staff and the ABILHAND-Kids Questionnaire. Given the pilot nature of this study and the small sample size, we report descriptive data, effect sizes, and 95% confidence intervals around the effect sizes.

resultsAll 10 participants completed the study (Adherence: Mean(SD): 90.7% (13.5%)). Staff were able to successfully deliver RNT with minimal issues and wanted to repeat it in subsequent camp iterations. Children found RNT enjoyable and were highly engaged across sessions. In combination with other camp programming, RNT led to clinician-perceived improvements in children's bimanual function and spontaneous affected UE use during daily activities.

conclusionsOur work suggests that RNT is an engaging, versatile, and easy-to-implement therapy adjunct that clinicians may use to incentivize affected UE use and motor practice in children with UCP.