Toys And Technology For Rehabilitation In Cerebral Palsy Patients

CP is a disorder that affects the development of the brain and the motor system, often causing muscle weakness and paralysis. Physical and occupational therapy have been shown to be effective treatments in improving function, however, Karen Kerman, M.D., director of the pediatric rehabilitation center at Hasbro Children's Hospital, wanted to find a way to incorporate physical therapy into the normal activity of children -- play.

Kerman noted that while there are currently toys that address the cognitive realm, nothing existed to address the unique needs of CP patients -- more than 800 in Rhode Island and nationally, between 750,000 and one million.

Kerman approached the CVS Caremark Charitable Trust and explained her idea -- to create toys that would allow children with CP to obtain vital therapy in a fun way. Kerman says, "The CVS Caremark Charitable Trust was wonderful, immediately seeing the advantages of such a project, and their support allowed us to go ahead with our idea."

With funding available, she approached her colleague, Joseph (Trey) Crisco, Ph.D., director of the bioengineering lab in the department of orthopedics at Rhode Island Hospital and a professor of orthopedics at The Warren Alpert Medical School of Brown University. Crisco was teaching an engineering course that combined industrial science students from Rhode Island School of Design (RISD) and engineering studies students at Brown University.

The pair believed this was a perfect forum to bring creative minds together to create some prototypes for new therapeutic toys. Thus, Toys and Technology for Rehabilitation was formed. Kerman says the project "has the power to harness the benefits of play, and may have many implications in the future."

They approached Khipra Nichols, B.I.D., professor of industrial design at RISD, and in the fall of 2006, the students in Crisco's class were challenged to design therapeutic toys. At the end of the course they then applied to the Rhode Island Science and Advisory Technology Council (STAC) and obtained a grant providing additional funding for the project. Specifically, they were hoping to develop toy controls for games that would rely on the use of the wrist and forearms for children with CP who lack the fine motor skills normally required of hand-held game controllers.

The team collaborated with Susan D'Andrea, Ph.D., of Afferent Corporation, David Durfee, Ph.D., of Bay Computer Associates to further develop the ideas born out of the students' assignment, and then worked with Cornerstone Prototype Development.

Crisco says, "There were a lot of design iterations, but in the end, there were about 15 prototypes and concepts that came out of the class." The efforts were then focused on designing a hand-held control that could be used by the CP patients as both fun and therapeutic and would increase the use of the affected limb, helping to strengthen the muscles. At the same time, the researchers wanted to be able to obtain information from the use of the toys. So the controls are equipped with data logging capabilities that allow the researchers to study the extent of use and the arm movements and also measure the outcome.

The project has now reached its study phase, during which 20 children with CP between ages 5 and 12 will be enrolled. Each child in the study will be provided with a toy to be used at home as part of their normal play. Once a month, their progress will be charted, looking at markers for functional gain.

"We are proud to be able to support the innovative work done by Hasbro Children's Hospital to develop interactive toys that can actually serve as rehabilitative therapy for children with cerebral palsy," said Eileen Howard Dunn, Vice President, CVS Caremark Charitable Trust. "CVS Caremark All Kids Can focuses on the need for children to Learn, Play and Succeed. The therapeutic robotic toys currently being studied at Hasbro Children's Hospital are in line with our mission as they can engage children with CP in a fun and stimulating play experience that also provides them with positive physical therapy benefits."

Kerman and Crisco believe that this is a big step in physical therapy for CP patients, however, they also believe that the information obtained for this study may even have future implications for other patients, including those who have suffered a stroke. Kerman says, "Our goal is not only to provide rehabilitation, but to reshape the brain after injury to improve function. We believe we can do that."

The toys were unveiled during an open house event on Monday, June 16, showing controllers for slot car racing, remote control toys, and moving stuffed animals, all manipulated by the new rehabilitation controllers. Children with and without CP were able to play alongside each other at the unveiling.