Integration of a Bimanual Training Program Using Joystick-Operated Ride-On Toys into an Intensive, Task-Oriented Hybrid Intervention for Children with Unilateral Cerebral Palsy: A Feasibility Study

<b>Background/Objectives</b>: We studied the feasibility of incorporating a play-based bimanual ride-on-toy navigation training (RNT) program into an intensive hybrid training camp based on principles of modified constraint induced movement therapy and bimanual training for children with unilateral cerebral palsy (UCP). The bimanual RNT sessions included theme-based play involving navigational exploration and object-based tasks. <b>Methods</b>: We employed a pretest-posttest, mixed methods design. Ten children between 3 and 11 years participated. Camp was 6 h/day and 5 days/week for 3 weeks. Researchers trained camp staff to provide RNT every day. The feasibility of clinician delivery of RNT was assessed using training logs and staff exit questionnaires. The combined effects of the camp programming, inclusive of bimanual RNT, was measured through a combination of standardized tests (Quality of Upper Extremity Skills Test (QUEST), Shriner's Hospital Upper Extremity Evaluation (SHUEE), and Box and Blocks Test) and video-coding measures. We report on means (M), standard errors (SE), and effect sizes (ES) with 95% confidence intervals for outcome measures. <b>Results</b>: The average session adherence was 90.7%, and staff were able to successfully deliver RNT, despite initial logistical challenges. In combination with camp programming, RNT led to improvements in the total QUEST score (pretest M (SE): 77.54 (5.11), posttest M (SE): 81.46 (5.22)) and SHUEE spontaneous functional analysis score (pretest M (SE): 41.33 (7.48), posttest M (SE): 50.22 (7.88)). Children increased the use of their affected upper extremity (UE) during late RNT sessions and improved in their navigational abilities. <b>Conclusions</b>: RNT is a fun and easily adaptable therapy adjunct that can complement traditional therapies to incentivize spontaneous use of the affected UE in children with UCP.