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Playfulness and new technologies in hand therapy for children with cerebral palsy: A Scoping Review

Background: Innovative technologies such as game consoles and smart toys used with games or playful approaches have proven to be successful and attractive in providing effective and motivating hand therapy for children with cerebral palsy (CP). Thus, there is an increased interest in designing and implementing interventions that can improve the well-being of these children. However, to understand how and why these interventions are motivating children, we need a better understanding of the playful elements of technology-supported hand therapy.Objective: This scoping review aims to identify the playful elements and the innovative technologies currently used in hand therapy for children with CP.Methods: We included studies that design or evaluate interventions for children with CP that use innovative technologies with game or play strategies. Data were extracted and analyzed based on the type of technology, description of the system, and playful elements according to the Lenses of Play, a play design toolkit. A total of 31 studies were included in the analysis.Results: Overall, 54 papers were included in the analysis. The results showed high use of consumer technologies in hand therapy for children with CP. Although several studies have used a combination of consumer technologies with therapeutic-specific technologies, only a few studies focused on the exclusive use of therapeutic-specific technologies. To analyze the playfulness of these interventions that make use of innovative technologies, we focused our review on 3 lenses of play: Open-ended Play, where it was found that the characteristics of ludus, such as a structured form of play and defined goals and rules, were the most common, whereas strategies that relate to paidia were less common. The most commonly used Forms of Play were physical or active form and games with rules. Finally, the most popular Playful experiences were control, challenge, and competition.Conclusions: The inventory and analysis of innovative technology and playful elements provided in this study can be a starting point for new developments of fun and engaging tools to assist hand therapy for children with CP.

Exercise-induced muscle fatigue leads to changes in gait-related parameters among older adults: a systematic review and meta-analysis

Effectiveness and cost-effectiveness of an optimized process of providing assistive technology for impaired upper extremity function

Background: Impaired upper extremity function due to muscle paresis or paralysis has a major impact on independent living and quality of life (QoL). Assistive technology (AT) for upper extremity function (i.e. dynamic arm supports and robotic arms) can increase a client’s independence. Previous studies revealed that clients often use AT not to their full potential, due to suboptimal provision of these devices in usual care. Objective: To optimize the process of providing AT for impaired upper extremity function and to evaluate its (cost-)effectiveness compared with care as usual. Methods: Development of a protocol to guide the AT provision process in an optimized way according to generic Dutch guidelines; a quasi-experimental study with non-randomized, consecutive inclusion of a control group (n = 48) receiving care as usual and of an intervention group (optimized provision process) (n = 48); and a cost-effectiveness and cost-utility analysis from societal perspective will be performed. The primary outcome is clients’ satisfaction with the AT and related services, measured with the Quebec User Evaluation of Satisfaction with AT (Dutch version; D-QUEST). Secondary outcomes comprise complaints of the upper extremity, restrictions in activities, QoL, medical consumption and societal cost. Measurements are taken at baseline and at 3, 6 and 9 months follow-up.

Towards a global quality framework for assistive technology service delivery

Assistive technology supports maintenance or improvement of an individual’s functioning and independence, though for people in need the access to assistive products is not always guaranteed. This paper presents a generic quality framework for assistive technology service delivery that can be used independent of the setting, context, legislative framework, or type of technology. Based on available literature and a series of discussions among the authors, a framework was developed. It consists of 7 general quality criteria and four indicators for each of these criteria. The criteria are: accessibility; competence; coordination; efficiency; flexibility; user centeredness, and infrastructure. This framework can be used at a micro level (processes around individual users), meso level (the service delivery scheme or programme) or at a macro level (the whole country). It aims to help identify in an easy way the main strengths and weaknesses of a system or process, and thus guide possible improvements. As a next step in the development of this quality framework the authors propose to organise a global consultancy process to obtain responses from stakeholders across the world and to plan a number of case studies in which the framework is applied to different service delivery systems and processes in different countries.

Creative Motor Actions As Emerging from Movement Variability

In cognitive science, creative ideas are defined as original and feasible solutions in response to problems. A common proposal is that creative ideas are generated across dedicated cognitive pathways. Only after creative ideas have emerged, they can be enacted to solve the problem. We present an alternative viewpoint, based upon the dynamic systems approach to perception and action, that creative solutions emerge in the act rather than before. Creative actions, thus, are as much a product of individual constraints as they are of the task and environment constraints. Accordingly, we understand creative motor actions as functional movement patterns that are new to the individual and/or group and adapted to satisfy the constraints on the motor problem at hand. We argue that creative motor actions are promoted by practice interventions that promote exploration by manipulating constraints. Exploration enhances variability of functional movement patterns in terms of either coordination or control solutions. At both levels, creative motor actions can emerge from finding new and degenerate adaptive motor solutions. Generally speaking, we anticipate that in most cases, when exposed to variation in constraints, people are not looking for creative motor actions, but discover them while doing an effort to satisfy constraints. For future research, this paper achieves two important aspects: it delineates how adaptive (movement) variability is at the heart of (motor) creativity, and it sets out methodologies toward stimulating adaptive variability.

Haptics for the Development of Fundamental Rhythm Skills, Including Multi-limb Coordination

This chapter considers the use of haptics for learning fundamental rhythm skills, including skills that depend on multi-limb coordination. Different sensory modalities have different strengths and weaknesses for the development of skills related to rhythm. For example, vision has low temporal resolution and performs poorly for tracking rhythms in real time, whereas hearing is highly accurate. However, in the case of multi-limbed rhythms, neither hearing nor sight is particularly well suited to communicating exactly which limb does what and when, or how the limbs coordinate. By contrast, haptics can work especially well in this area, by applying haptic signals independently to each limb. We review relevant theories, including embodied interaction and biological entrainment. We present a range of applications of the Haptic Bracelets, which are computer-controlled wireless vibrotactile devices, one attached to each wrist and ankle. Haptic pulses are used to guide users in playing rhythmic patterns that require multi-limb coordination. One immediate aim of the system is to support the development of practical rhythm skills and multi-limb coordination. A longer-term goal is to aid the development of a wider range of fundamental rhythm skills including recognising, identifying, memorising, retaining, analysing, reproducing, coordinating, modifying and creating rhythms—particularly multi-stream (i.e. polyphonic) rhythmic sequences. Empirical results are presented. We reflect on related work and discuss design issues for using haptics to support rhythm skills. Skills of this kind are essential not just to drummers and percussionists but also to keyboards’ players and more generally to all musicians who need a firm grasp of rhythm.