title: Joint-Specific Play Controller for Upper Extremity Therapy: Feasibility Study in Children With Wrist Impairment.
abstract: BACKGROUND
  Challenges with any therapeutic program for children include the level of the child's engagement or adherence. Capitalizing on one of the primary learning avenues of children, play, the approach described in this article is to develop therapeutic toy and game controllers that require specific and repetitive joint movements to trigger toy/game activation.
  
  
  OBJECTIVE
  The goal of this study was to evaluate a specially designed wrist flexion and extension play controller in a cohort of children with upper extremity motor impairments (UEMIs). The aim was to understand the relationship among controller play activity, measures of wrist and forearm range of motion (ROM) and spasticity, and ratings of fun and difficulty.
  
  
  METHODS
  This was a cross-sectional study of 21 children (12 male, 9 female; 4-12 years of age) with UEMIs.
  
  
  METHODS
  All children participated in a structured in-clinic play session during which measurements of spasticity and ROM were collected. The children were fitted with the controller and played with 2 toys and 2 computer games for 5 minutes each. Wrist flexion and extension motion during play was recorded and analyzed. In addition, children rated the fun and difficulty of play.
  
  
  RESULTS
  Flexion and 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 1,700 targeted joint motions per week. Play activity was associated with ROM measures, specifically supination, but toy perception ratings of enjoyment and difficulty were not correlated with clinical measures.
  
  
  CONCLUSIONS
  The reported results may not be representative of children with more severe UEMIs.
  
  
  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.
authors.affiliation: B.J. Wilcox, PhD, Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, 1 Hoppin St, CORO West, Ste 404, Providence, RI 02903 (USA). bethany_wilcox@brown.edu.
authors.forename: Bethany J
authors.initials: BJ
authors.lastname: Wilcox
authors.affiliation: M.M. Wilkins, PT, DPT, Meeting Street, Providence, Rhode Island.
authors.forename: Megan M
authors.initials: MM
authors.lastname: Wilkins
authors.affiliation: B. Basseches, BS, Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Basseches
authors.affiliation: J.B. Schwartz, BS, Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital.
authors.forename: Joel B
authors.initials: JB
authors.lastname: Schwartz
authors.affiliation: K. Kerman, MD, Department of Pediatrics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital.
authors.forename: Karen
authors.initials: K
authors.lastname: Kerman
authors.affiliation: C. Trask, PhD, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, and Department of Psychiatry, Rhode Island Hospital.
authors.forename: Christine
authors.initials: C
authors.lastname: Trask
authors.affiliation: H. Brideau, MS, Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital.
authors.forename: Holly
authors.initials: H
authors.lastname: Brideau
authors.affiliation: J.J. Crisco, PhD, Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Crisco
mesh_terms: D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000209:etiology / Q000503:physiopathology* / Q000534:rehabilitation*; D010988:Play and Playthings; D016059:Range of Motion, Articular / Q000502:physiology; D034941:Upper Extremity / Q000503:physiopathology*; D014955:Wrist Joint / Q000503:physiopathology*