Joint-specific toy and game controllers for upper extremity therapy

Purpose: Challenges with any therapeutic program include the level of the child's engagement o adherence. Capitalizing on one of the primary learning avenues of children, play, our approach is to develop therapeutic toy and game controllers that require specific and repetitive joint movements to trigger toy/game activation. The goal of this study was to evaluate a specially designed wrist flexion-extension play controller in a cohort of children with upper extremity motor impairments (UEMI). We sought to understand the relationship between controller play activity, measures of wrist and forearn range of motion (ROM) and spasticity, and ratings of fun and difficulty. Design: Cross-sectional study of 21 children (12 male, 9 female, 4-12 years) with UEMI. Methods: Our approach was to develop goal-directed, therapeutic toy and game controllers that require specific and repetitive joint movements to trigger toy/game activation. This approach capitalizes on one of the primary learning avenues of children, play, providing intrinsic motivation and maximizing the dose of intervention. These controllers aim to provide an inexpensive home-based therapy to supplement institutional PT/OT. In the present configuration, the controllers enable play with remote controlled toys and computer games using wrist extension and flexion. Play thresholds, or wrist flexion and extension positions that trigger toy/game response, can be adjusted for each child and all wrist motions during play are recorded and stored on the controller. All children participated in a structured in-clinic play session during which measures of spasticity and ROM were collected. Subjects were fitted with the controller and played with two toys and two computer games for 5 minutes each. Wrist flexion-extension motion during play was recorded and analyzed. In addition, children rated the fun and difficulty of play. Results: Flexion-extension goal movements were repeatedly achieved by children during the play session at an average frequency of 0.27 Hz. At this frequency, 15 minutes of play per day would result in approximately 1700 targeted joint motions per week. Play activity was associated with ROM measures, specifically supination (p<;0.001), but toy perception ratings of enjoyment and difficulty were not correlated with clinical measures (p=0.279-0.938). The results reported herein may not be representative of children with more severe UEMI. Conclusions: These outcomes indicate that the therapeutic controllers elicited repetitive goal movements and were adaptable, enjoyable, and challenging for children of varying ages and UEMIs.