Technology-Enhanced Play for Physical Disabilities

Overseen By Minoo Dabiri Golchin, Ph.D.

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: University of Manitoba

Disqualifiers: Play therapy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 9

20 Participants Needed

Trial Summary

What is the purpose of this trial?

Play is an important activity for children. Almost all children play, but what is play? It is not easy to define play. In the past, people believed that children played to burn their energy. Now, it is known that play is important for children's growth. Some kids with disabilities cannot play. Many experts use play to teach children specific skills. People often forget that play is a child's right. It is important to help all children play. The first step is to define play and find what features are important in helping a child with a disability play. There are some models of play. But they are not complete. They do not look at play as a whole. Some models are just about playfulness, and some are about playing with others. Having a model that defines play helps researchers and clinicians think about play and the different parts of it. Then, when a child cannot play, experts can fix the part that is not working. Investigators want to introduce a model of play in this project. Investigators want to edit and complete it in three steps. First, Investigators will ask parents and children with disabilities about things that help or do not help them play; then, investigators will give Lego robots to kids that they will build with help and play with them for a few weeks. And at the end, investigators will ask therapists and other experts about our model of play. This model will be edited during the study.

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

What data supports the effectiveness of the treatment The Dice Model of Play for physical disabilities?

Research shows that play, especially when enhanced with technology, can be a powerful tool in therapy for children with physical disabilities. For example, virtual reality play-based interventions have been shown to improve self-efficacy (belief in one's ability to succeed) in children with cerebral palsy, suggesting that similar play-based treatments could be beneficial. ^{1 2 3 4 5}

Is Technology-Enhanced Play for Physical Disabilities safe for humans?

The research on technology-enhanced play, such as powered mobility devices and switch-adapted toys, suggests these interventions are generally safe for children with disabilities. They are designed to improve play and mobility without significant safety concerns, although specific safety evaluations for each device may vary. ^{1 6 7 8 9}

How does the treatment 'The Dice Model of Play' differ from other treatments for physical disabilities?

The Dice Model of Play is unique because it uses technology-enhanced play, such as robots and information and communication technology (ICT), to support play in children with physical disabilities. This approach focuses on making play accessible and engaging, which is different from traditional therapies that may not prioritize playfulness and the child's intrinsic motivation to play. ^{1 10 11 12 13}

Eligibility Criteria

This trial is for children aged 3 to 8 with physical disabilities, living in Winnipeg, who speak and understand English. It aims to help them play, which is vital for their growth but often difficult due to their conditions.

Inclusion Criteria

Speaking and understanding English

Living in Winnipeg

I have a physical disability.

Exclusion Criteria

I have not been diagnosed with Autism or received play therapy recently.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Phase 1: Interviews

Exploring the alignment of the Dice Model of Play with the experiences of children and their guardians through semi-structured interviews and content analysis

4 weeks

1 visit (in-person)

Phase 2: Practical Application

Children build and play with LEGO robots or conventional toys in a cross-over design, with assessments conducted at the start, switching point, and last session

8 weeks

8 visits (in-person)

Phase 3: Expert Opinions

Online focus groups with professionals to seek expert opinions on the revised Dice Model of Play's clarity, relevance, and applicability

4 weeks

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• The Dice Model of Play

Trial Overview The study tests a new model of play using Lego robots versus conventional methods. Kids will build and interact with the robots over several weeks while researchers refine a comprehensive model of play based on observations.

Participant Groups

Group I: robots Experimental Treatment 1 Intervention

Participants will be randomly allocated to groups A or B. Those in group A will co-design and build their LEGO™ robot, using the researcher's assistance, as led by the child. A go-along interview will be conducted during the co-design with the child . The co-design session will be video recorded to provide context, visual data, and to inform the qualitative analysis. Videos will be deleted right after analysis. A research assistant (RA) will visit the participant's home twice a week for 30 to 45 minutes (after school or on the weekend) to play with the child and their built LEGO™ robots for four weeks (4 sessions total).

Group II: conventional toys Experimental Treatment 1 Intervention

Group B will engage in the same process of 4 play intervention sessions over four weeks with the research assistant; however, they will receive conventional play tools. The RA will carry a prepared play pack for the play intervention session.

Who Is Running the Clinical Trial?

University of Manitoba

Lead Sponsor

Trials

628

Recruited

209,000+

Rehabilitation Centre for Children, Canada

Collaborator

Trials

3

Recruited

50+

Findings from Research

In-depth interviews with 8 children with cerebral palsy and their families revealed that understanding the subjective experiences of users is crucial for the design of assistive/rehabilitative gamebots like PedBotHome, which were trialed for 28 days.

The study highlighted the need to balance therapeutic intensity with the enjoyment of gameplay, as well as the importance of considering both children's and parents' perspectives in evaluating the effectiveness of these technologies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Toward Evaluation of the Subjective Experience of a General Class of User-Controlled, Robot-Mediated Rehabilitation Technologies for Children with Neuromotor Disability. Schladen, MM., Cleary, K., Koumpouros, Y., et al.[2021]

A pilot study involving three school-aged children with cerebral palsy showed that a virtual reality play-based intervention significantly improved self-efficacy, as measured by the Canadian Occupational Performance Measure (COPM).

Participants reported increased motivation and engagement in play activities, indicating that this innovative approach could be a valuable addition to rehabilitation for children with cerebral palsy, warranting further investigation in larger trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Benefits of a virtual play rehabilitation environment for children with cerebral palsy on perceptions of self-efficacy: a pilot study. Reid, DT.[2019]

A systematic review identified 8 play instruments relevant to pediatric occupational therapy, highlighting the need for better measurement tools in evaluating children's play, with only 30 out of 1,098 articles meeting the criteria for analysis.

The Revised Knox Preschool Play Scale and the Test of Playfulness + Test of Environmental Supportiveness Unifying Measure were noted as the most comprehensive tools for assessing play, but the overall development of play instruments in this field is still evolving, requiring therapists to use clinical judgment when selecting them.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Systematic Review on Clinimetric Properties of Play Instruments for Occupational Therapy Practice. Romli, MH., Wan Yunus, F.[2020]

Play is essential for everyone, especially for individuals with disabilities, as it fulfills important needs and contributes to their rehabilitation.

The paper emphasizes the optimum arousal theory of play as crucial for enhancing the rehabilitation process, and offers practical suggestions to engage patients meaningfully in play activities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Play as occupation: implications for the handicapped. Gunn, SL.[2012]

The Test of Playfulness (ToP) is a valuable assessment tool for occupational therapists working with children with disabilities, as it effectively highlights the child's strengths in play and the interactions between the child, activity, and environment.

While therapists found the ToP easy to administer, some faced challenges in interpreting the results, indicating a need for further education and research to enhance its application in therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The clinical utility of the test of playfulness. Cameron, D., Leslie, M., Teplicky, R., et al.[2022]

The study identified 19 potential hazards related to the use of pedal extensions in tractors, highlighting the need for safety evaluations of modified equipment used by farmers with disabilities.

Using a hazard self-assessment worksheet, the research found that custom-fabricated pedal extensions tailored to specific tractors are likely to provide the safest working environment, as some existing designs blocked access to exit paths.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of mechanical tractor pedal extensions. Kelso, SA., Stangherlin, AM., Mann, DD.[2008]

The article highlights a significant shift in pediatric powered mobility technology (PMT) that aims to enhance early exploration and participation for children with disabilities, aligning their experiences with those of their non-disabled peers.

To achieve this shift, it is crucial to address barriers to access, promote user-driven design, and advocate for policies that support the widespread use of PMT, emphasizing the importance of family and community involvement in the process.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Why the time is right for a radical paradigm shift in early powered mobility: the role of powered mobility technology devices, policy and stakeholders. Feldner, HA., Logan, SW., Galloway, JC.[2022]

The study demonstrated that modified ride-on cars are a feasible intervention for children with mobility-related disabilities, as evidenced by good attendance and successful use during an inclusive playgroup with 13 participants.

While overall play behaviors did not show significant changes, some children with disabilities experienced decreased solitary play and increased parallel play and peer interactions, suggesting potential benefits in social engagement.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility of a Modified Ride-on Car Intervention on Play Behaviors during an Inclusive Playgroup. Ross, SM., Catena, M., Twardzik, E., et al.[2019]

Providing switch-adapted toys to children with complex medical conditions significantly increased the variety and number of independently accessible and cognitively appropriate toys, as reported by their caregivers.

However, this increase in toy accessibility did not lead to a statistically significant increase in total or active play time, suggesting that simply having more toys may not be enough to enhance play experiences for these children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Caregiver-reported impact of access to switch-adapted toys on play for children with complex medical conditions. Rasmussen, KM., Chole, DM., Hughes, R., et al.[2023]

A systematic review identified 27 technologies, including robots, virtual reality systems, and computer systems, designed to support play in children with severe physical disabilities, highlighting the growing role of innovative technology in enhancing play opportunities.

Among these technologies, robots were particularly noted for their potential to facilitate 'play for play's sake', indicating a focus on enjoyment and engagement rather than solely therapeutic or educational outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Robots and ICT to support play in children with severe physical disabilities: a systematic review. van den Heuvel, RJF., Lexis, MAS., Gelderblom, GJ., et al.[2019]

The SIVA research team is developing new methods to select and implement assistive technology that enables children with motor disabilities to play with toys, promoting equal play opportunities.

Providing children with motor disabilities the chance to play like their peers is crucial for enhancing their cognitive and social development, as highlighted by the literature review included in the study.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An Italian research project to study the play of children with motor disabilities: the first year of activity. Besio, S.[2019]

Children with cerebral palsy (CP) showed high levels of intrinsic motivation to engage in play when using mainstream robotic toys, as indicated by their high scores on the Test of Playfulness (ToP).

The study highlights the importance of adult partners in facilitating play, suggesting that their role as 'scaffolders' is crucial for helping children with CP interact effectively with both the toys and their environment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Children With Cerebral Palsy Playing With Mainstream Robotic Toys: Playfulness and Environmental Supportiveness. Bulgarelli, D., Bianquin, N., Besio, S., et al.[2020]

The development of Button Bash, a switch-accessible game, aims to promote inclusive play between disabled and non-disabled children, addressing the barriers that often exclude disabled children from play.

The study highlights a challenge in game design: while making games more accessible for disabled players, it can inadvertently reduce their playfulness, suggesting a complex relationship between accessibility and the enjoyment of play.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Designing Out the Play: Accessibility and Playfulness in Inclusive Play. Holt, R., Beckett, A.[2018]

References

1. Switzerland pubmed.ncbi.nlm.nih.gov

Toward Evaluation of the Subjective Experience of a General Class of User-Controlled, Robot-Mediated Rehabilitation Technologies for Children with Neuromotor Disability. [2021]

2. England pubmed.ncbi.nlm.nih.gov

Benefits of a virtual play rehabilitation environment for children with cerebral palsy on perceptions of self-efficacy: a pilot study. [2019]

3. England pubmed.ncbi.nlm.nih.gov

A Systematic Review on Clinimetric Properties of Play Instruments for Occupational Therapy Practice. [2020]

4. United States pubmed.ncbi.nlm.nih.gov

Play as occupation: implications for the handicapped. [2012]

5. United States pubmed.ncbi.nlm.nih.gov

The clinical utility of the test of playfulness. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Evaluation of mechanical tractor pedal extensions. [2008]

7. England pubmed.ncbi.nlm.nih.gov

Why the time is right for a radical paradigm shift in early powered mobility: the role of powered mobility technology devices, policy and stakeholders. [2022]

8. England pubmed.ncbi.nlm.nih.gov

Feasibility of a Modified Ride-on Car Intervention on Play Behaviors during an Inclusive Playgroup. [2019]

9. England pubmed.ncbi.nlm.nih.gov

Caregiver-reported impact of access to switch-adapted toys on play for children with complex medical conditions. [2023]

10. England pubmed.ncbi.nlm.nih.gov

Robots and ICT to support play in children with severe physical disabilities: a systematic review. [2019]

11. England pubmed.ncbi.nlm.nih.gov

An Italian research project to study the play of children with motor disabilities: the first year of activity. [2019]

12. Switzerland pubmed.ncbi.nlm.nih.gov

Children With Cerebral Palsy Playing With Mainstream Robotic Toys: Playfulness and Environmental Supportiveness. [2020]

13. Netherlands pubmed.ncbi.nlm.nih.gov

Designing Out the Play: Accessibility and Playfulness in Inclusive Play. [2018]