Sudha Srinivasan

Objective: This systematic review will critically appraise and summarize the measurement properties of instruments used to measure children’s and adolescents’ engagement during rehabilitation sessions in both clinical and research contexts. A secondary objective will be to assess the suitability of these instruments for clinical and research use. Introduction: Engagement in the therapeutic process is a critical mediator of therapeutic change during rehabilitation interventions. Yet there is little information on valid and reliable measures to holistically assess engagement during rehabilitation. Eligibility criteria: The populations of interest will be children and adolescents ≤21 years, with any diagnosis, in any setting, participating in occupational therapy, physical therapy, or speech-language therapy sessions. Methods: This review will follow the Guideline for Systematic Reviews of Outcome Measurement Instruments. A search strategy will be developed for the following databases: PubMed, CINAHL Complete, Web of Science Core Collection, PsycINFO, and ProQuest Dissertations & Theses Global. Methodological quality of included studies will be assessed through the COSMIN Risk of Bias tool and the COSMIN checklist. The measurement properties of the identified instruments will be graded using the modified GRADE approach and the COSMIN Criteria for Good Measurement Properties. Measurement properties (validity, reliability, and responsiveness), clinical feasibility (ease of administration, training needed, completion time, ease of score calculation, required equipment, and instrument cost), and interpretability (threshold values, floor and ceiling effects, percentage of missing items/scores, distribution of scores in the population, change scores for subgroups of children and adolescents, minimal important change or difference) for each instrument will be described. Review registration: PROSPERO CRD420261277455

Purpose: We assessed potential benefits of an intervention combining ride-on-toy navigation training (RNT) and structured upper extremity play activities (SUPA) added to usual care relative to usual care only on affected upper extremity (UE) function in unilateral cerebral palsy. Methods: Fifteen children (3–8 years) participated in a 19-week, single-arm trial involving baseline testing (T0), 6-week usual care only phase, preintervention testing (T1), 6-week intervention phase (RNT + SUPA plus usual care), postintervention testing (T2), and 4-week retention test (T3). Children received RNT + SUPA 3–4 sessions/week. Outcome measures included the Shriners Hospital Upper Extremity Evaluation, Quality of Upper Extremity Skills Test, ABILHAND-Kids questionnaire, and video-based measures. Results: Compared with Usual Care Only, RNT + SUPA combined with usual care was associated with short-term improvements in spontaneous and independent affected UE use during bimanual tasks on researcher-rated and parent-reported measures. Conclusions: We found preliminary evidence suggesting potential benefit of a community-based, caregiver-supported RNT + SUPA program.

Children with motor disabilities such as Cerebral Palsy (CP) receive rehabilitation services for prolonged periods of time [1]. These services are intensive, with children participating in differen...

Importance: Technology-based adjuncts have been used to incentivize and boost upper extremity (UE) motor rehabilitation among children with unilateral cerebral palsy (UCP). Objective: To evaluate the feasibility and perceived benefit of a clinician-delivered ride-on-toy navigation training (RNT) program. Design: Single-group pretest–posttest design. Setting: Three-week task-oriented UE training camp. Participants: Children with UCP (N = 13) ages 4 to 11 yr. Intervention: Children received 5 hours of unimanual practice and 1 hour of bimanual practice 5 days/wk for 3 wk. As part of daily camp programming, they received 15 to 30 min of RNT delivered by clinicians (two occupational therapists and two physical therapists). Ride-on toys were operated with a single joystick on the child’s affected side. Outcomes and Measures: Feasibility and acceptance of RNT were assessed by tracking session adherence and in-session affected UE use and through a clinician-rated exit questionnaire. Clinicians’ satisfaction with the program was assessed using an exit questionnaire and the ABILHAND-Kids questionnaire. Results: The high degree of session adherence indicated that the RNT program was feasible for clinicians to deliver. Children showed high levels of in-session affected UE use and improved scores on the ABILHAND-Kids questionnaire from pretest to posttest. Clinicians rated program-related satisfaction as high and indicated they had noted benefits from incorporating RNT into camp programming. Conclusions and Relevance: These pilot data suggest that RNT can be successfully delivered by clinicians within an intensive camp and may be used as an engaging technology-based intervention to promote UE motor function in children with UCP. Plain-Language Summary: This pilot study provides evidence that a training program, in which single-joystick–operated ride-on toys are used as therapy adjuncts, can be incorporated into an intensive three-week upper extremity training camp for children with unilateral cerebral palsy. Clinicians were able to successfully deliver the ride-on-toy navigation training program with children with unilateral cerebral palsy as part of a modified constraint-induced movement therapy camp. Children demonstrated high levels of session adherence, the ride-on-toy navigation training program promoted high levels of affected upper extremity use across three weeks, and children improved their bimanual upper extremity use during daily activities after the training program. Clinicians indicated that they were satisfied with the ride-on-toy navigation training program and found it feasible to deliver. Modified ride-on toys can be used in conventional rehabilitation settings, such as intensive camps, as a child-friendly way to promote upper extremity motor function in children with unilateral cerebral palsy.

Children 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. 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. All 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. Our 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.

Background/Objectives: We studied the feasibility of incorporating a play-based bimanual ride-on-toy navigation training (RNT) program into an intensive hybrid training camp based on principles of modified constraint induced movement therapy and bimanual training for children with unilateral cerebral palsy (UCP). The bimanual RNT sessions included theme-based play involving navigational exploration and object-based tasks. Methods: We employed a pretest-posttest, mixed methods design. Ten children between 3 and 11 years participated. Camp was 6 h/day and 5 days/week for 3 weeks. Researchers trained camp staff to provide RNT every day. The feasibility of clinician delivery of RNT was assessed using training logs and staff exit questionnaires. The combined effects of the camp programming, inclusive of bimanual RNT, was measured through a combination of standardized tests (Quality of Upper Extremity Skills Test (QUEST), Shriner’s Hospital Upper Extremity Evaluation (SHUEE), and Box and Blocks Test) and video-coding measures. We report on means (M), standard errors (SE), and effect sizes (ES) with 95% confidence intervals for outcome measures. Results: The average session adherence was 90.7%, and staff were able to successfully deliver RNT, despite initial logistical challenges. In combination with camp programming, RNT led to improvements in the total QUEST score (pretest M (SE): 77.54 (5.11), posttest M (SE): 81.46 (5.22)) and SHUEE spontaneous functional analysis score (pretest M (SE): 41.33 (7.48), posttest M (SE): 50.22 (7.88)). Children increased the use of their affected upper extremity (UE) during late RNT sessions and improved in their navigational abilities. Conclusions: RNT is a fun and easily adaptable therapy adjunct that can complement traditional therapies to incentivize spontaneous use of the affected UE in children with UCP.

Purpose: This case report describes the feasibility, acceptance, and satisfaction associated with community-based implementation of a novel upper extremity (UE) training program using a joystick-operated powered ride-on toy with an 8-year-old male child with unilateral cerebral palsy(UCP). Summary of key points: The 8-session, 1 month training program was feasible to implement in collaboration with the child’s caregiver, was enjoyable and well-accepted by the child and his caregiver and associated with improvements in the child’s affected UE motor function on participant-report and video-based measures. Conclusion and recommendations for clinical practice: Ride-on toys are versatile, easy-to-operate, family-friendly tools that can be used across a variety of naturalistic settings. Intervention programs using joystick-operated ride-on toys may be used to create intrinsically motivating training opportunities to encourage children with UCP to spontaneously use their affected UE for task-oriented sensorimotor exploration of their physical environment and improve movement control in the affected UE.

Background/Objectives: Children with Autism Spectrum Disorder (ASD) experience difficulties with interpersonal synchrony (IPS). While creative movement (CM) interventions have shown benefits for social, cognitive, and motor skills in children with ASD, the neural mechanisms underlying these improvements remain unclear. This pilot randomized control trial examined the behavioral and neural effects of CM, general movement (GM), and sedentary play (SP) interventions. Methods: Twenty-two children with ASD (Mean Age ± SE = 8.7 ± 1.9) participated. Functional Near-Infrared Spectroscopy (fNIRS) was used to measure cortical activation during a drumming synchrony task before and after 8 weeks of intervention. Results: The CM group demonstrated significant improvements in IPS and the most widespread increases in socially enhanced activation across the left middle frontal gyrus (MFG), inferior frontal gyrus (IFG), and superior temporal sulcus (STS). The GM group showed increased activation in the left IFG, while the SP group showed enhanced activation in the left STS. Children with lower baseline adaptive functioning and social responsiveness showed greater IPS improvement. Conclusions: These findings provide preliminary evidence for the efficacy of CM in improving IPS in children with ASD and support the use of fNIRS to capture neural effects following interventions.

Background: Individuals (i.e. children/young adults) with developmental disabilities (DDs) and intellectual disabilities (IDs) often display a variety of physical and motor impairments. It is well known that participation in motor activities can positively impact the development of children's cognitive and social skills. Recently, virtual and digital technologies (e.g. video conferencing applications, virtual reality and video gaming) have been increasingly used to promote better physical/motor outcomes. The efficacy of digital technologies in improving motor outcomes for those with DD/ID varies depending on the technology and population, and the comparative effects of various technologies are unknown. The aim of our study is to conduct a systematic review to comprehensively examine the quantitative and qualitative results of current studies reporting the efficacy of digitally based motor interventions on motor outcomes in individuals with DD/ID.Methods: Literature published from 1900 to 2024 was searched in four health sciences databases: PubMed, PsycINFO, Scopus and CINAHL. Articles that examined the effects of gross motor/physical activity training using technologies such as exergaming (i.e. exercise through video gaming such as the Wii and Xbox Kinect), virtual reality or telehealth video conferencing applications (i.e. Zoom, Webex or mobile health apps) on the standardised or game‐specific gross motor performance of individuals with DD/ID diagnoses that do not typically experience significant walking challenges using experimental or quasi‐experimental study designs were included. Thirty relevant articles were retrieved from a search of the databases PubMed (914), PsycINFO (1201), Scopus (1910) and CINAHL (948).Results: Our quantitative synthesis of this published literature suggests strong and consistent evidence of small‐to‐large improvements in motor skill performance following digital movement interventions.Conclusions: Our review supports the use of digital motor interventions to support motor skill performance in individuals with DD without ID. Digital technologies can provide a more engaging option for therapists to promote motor skill development in individuals with DD or for caregivers to use as an adjunct to skilled therapy.

AimOur study investigates the feasibility and utility of implementing a dual joystick-operated ride-on-toy navigation training (RNT) program within a 3-week intensive camp based on principles of modified constraint-induced movement therapy and bimanual training, to improve upper extremity (UE) function in children with unilateral cerebral palsy (UCP).MethodsWe employed a single-group pretest posttest, mixed methods study design. Eleven 4-to-10-year-old children with UCP received RNT as part of camp activities. Sessions required children to use both arms together for navigation and completing gross and fine motor UE challenges. We collected exit questionnaires from children, caregivers, and clinicians to assess the feasibility, acceptance, enjoyment, and perceived efficacy of RNT. Videos of training sessions were coded using Datavyu behavioral coding software to assess children's facial expressions and affective states, indicative of their level of engagement during intervention sessions.ResultsWe found high levels of child engagement during RNT sessions based on video data and stakeholder feedback. The RNT program was smoothly integrated into the camp. Stakeholders acknowledged the highly motivating nature of RNT. When combined with other camp activities, the program led to stakeholder-reported improvements in bimanual skills and spontaneous daily use of the affected UE.ConclusionsOur pilot study provides promising evidence for using joystick-operated ride-on toys as engaging therapy adjuncts. Our findings call for future studies to systematically assess the efficacy of these devices in improving UE function among children with UCP.