Playfulness in children with severe cerebral palsy when using a robot

Free play is not only one of the most important means through which children develop and know their world, but also it is the way in which they show their physical, cognitive, social and creative abilities. Children with severe physical disabilities have motor control problems that affect gross and fine motor skills, and in turn, manipulation. Without manipulation, children’s play is less effective for exploring. Thus, it is much more difficult for these children to learn and to develop because they cannot interact easily with the environment. Generally, they are observers of other’s play rather than active participants in play. Consequently, the children’s development is delayed. This study investigated the effect of a robot-based intervention on 1) child’s playfulness; 2) mother’s directiveness, responsiveness, and affect/animation; and 3) child’s play performance and satisfaction with their play. The family’s satisfaction with the robotic intervention was determined. The study’s protocol was tested in a pilot study with a child with cerebral palsy and her mother followed by a partially non-concurrent multiple baseline design with four children with cerebral palsy and their mothers. All children were level IV or V in both the Gross Motor Classification System and the Manual Ability Classification System. The intervention was the availability of a Lego robot during free play at home. Playfulness was measured through the Test of Playfulness version 4, play performance was measured through the Canadian Occupational Performance Measure, and the maternal interactive behavior Maternal Behavior Rating Scale revised. The total length of the study was different for each mother-child dyad with the majority participating about 14 weeks with two sessions per week. Each session was 15 minutes long. The study had three phases; a baseline (5-8 sessions), an intervention (10 sessions) and a one month follow-up (three sessions). During the entire study children played with their mothers at home with their own toys. During the baseline and the follow-up phases the child and mother played without the robot. The robot was available to the mother and child in the free play sessions only during the intervention phase. Children were trained in the use of the switches in order to make the robot move and carry objects according to a protocol before starting the intervention phase. According to the standards for assessing the levels of evidence for single case design, the main findings of this study provided strong evidence that the robotic-based intervention increased playfulness in children with severe motor impairment due to cerebral palsy; moderate evidence that it decreased mother’s directiveness; and no evidence that it increased mothers’ responsiveness during the intervention. The robotic intervention improved the mothers’ perception about their children’s play performance and increased their satisfaction with their children’s play performance. Future research may be oriented towards improving the level of evidence provided by the present study; exploring the impact of robots in other aspects of the play experience of children with CP such as pretend play and play with peers; and comparing traditional interventions for improving mother-child interaction with robotic interventions.

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