Playfulness in Children with Limited Motor Abilities When Using a Robot

Play as Occupation: The State of Our Science and a Research Agenda for the Profession

Occupational therapists view play through a unique lens. Considering play as a human occupation, and one to which all people have a right, places occupational therapists among a special group of professionals championing play. This State of the Science article seeks to increase awareness regarding the occupational therapy profession's contributions and to situate those contributions within the larger body of literature on play while also promoting further study of play as an occupation.

Assistive technology to facilitate children's play: a scoping review

PURPOSE

Play is a fundamental human right and one of the most important occupations in children's lives. Fewer opportunities exist for children with physical disabilities (CWPD) to play. This study aimed to conduct a scoping review of published peer-reviewed literature on using AT to enable "play-for-the-sake-of-play" by CWPD.

METHOD

The review was conducted using a widely accepted scoping review methodology. Literature searches were conducted from January 2000 to March 2022 using MEDLINE, Central, CINAHL, ERIC, Scopus, and EMBASE. Pairs of reviewers used an online systematic review system to manage title, abstract, and full-text screening. Excel was used for data extraction and charting. Data was charted based on type of AT, play types according to LUDI definitions, and level of evidence.

RESULTS

The search yielded 5250 papers after the removal of duplicates. Title and abstract screening identified 58 studies for full-text screening. The final sample included 31 papers. Seven types of AT were identified in studies: power mobility, virtual reality, robots, adaptations for upper limb differences, switch-adapted games, augmentative and alternative communication devices, and mobility aids. Twenty-three papers addressed cognitive play, seven addressed social play, and one addressed both cognitive and social play. Most studies used case study, descriptive, or repeated measures designs.

CONCLUSION

There is limited evidence regarding the use of AT to support play-for-the-sake-of-play in CWPD. Given the importance of play, further research using rigorous methodologies and the development of assistive technology dedicated to promoting play-for-the-sake-of-play is warranted.

Non-Intrusive Maternal Style as a Mediator between Playfulness and Children’s Development for Low-Income Chilean Adolescent Mothers

The aim of this study was to describe the relationship between low-income Chilean adolescent maternal playfulness and mothers’ non-intrusiveness in their children’s development and to analyze whether a mother’s non-intrusiveness mediates the relationship between maternal playfulness and children’s development. The Parental Playfulness Scale and the Subscale of Intrusiveness from the Early Head Start Research and Evaluation Project were used to assess maternal playfulness and mothers’ non-intrusiveness respectively. Ages and Stages Questionnaire 3rd Edition (ASQ-3) was applied to measure the children’s communication, gross and fine motor skills, problem-solving and personal–social development. The sample consisted of 79 mother–child dyads with children aged 10–24 months (M = 15.5, SD = 4.2) and their mothers aged 15–21 years old (M = 19.1, SD = 1.7). A bivariate analysis showed that maternal playfulness was significantly associated with communication, fine motor, problem-solving and personal–social development. Moreover, higher levels of communication, fine motor skills and problem-solving development were observed in the children of less intrusive mothers. Maternal playfulness had a significant effect on children’s development of language, problem-solving and personal–social skills when their mothers showed less intrusiveness during interaction. These findings contribute to the understanding of the interaction between adolescent mothers and their children. Active play and less intrusiveness can enhance child development.

The use of robots for augmentative manipulation during play activities among children with motor impairment: a scoping review

PURPOSE

To describe the extent, type, and quality of studies involving robots for augmentative manipulation during play by children with severe motor impairments (CwSMI), and to explore how they influenced children's cognitive skills and engagement.

METHODS

Web of Science, Scopus, PubMed & EBSCO were systematically searched for articles published until March 2021, that reported cognitive skills and/or engagement outcomes from interventions involving the use of robots in play activities, where participants included CwSMI, and full-text was available. Data extracted comprised characteristics of participants, study design, purpose of the study, outcomes assessed, collection methods, and intervention carried out (robot-environment interaction and robot used).

RESULTS

Eight mobile robots and five robotic arms were reported in the 17 included and reviewed articles. Most of them informed a positive impact on CwSMI's cognitive skills and/or engagement. However, the studies scored poorly on a five-criteria quality assessment, and only one single-case design proved strong evidence of treatment. None of the analysed interventions was an evidence-based practice.

CONCLUSION

The use of manipulative robots during play activities may have a positive impact on the CwSMI's cognitive skills and engagement in activities. However, further studies with higher internal and external validity are needed to support stronger evidence.Implications for rehabilitationThe use of robots for augmentative manipulation during play activities may have a positive influence on the cognitive functions and the engagement in activities of children with severe motor impairments.Through manipulative robots, this population could be able to show the abilities that are hidden due to their motor impairments, and subsequently, receive educational and physical training more aligned with their real capacities and potential.

Artificial Intelligence in Rehabilitation Targeting the Participation of Children and Youth With Disabilities: Scoping Review

BACKGROUND

In the last decade, there has been a rapid increase in research on the use of artificial intelligence (AI) to improve child and youth participation in daily life activities, which is a key rehabilitation outcome. However, existing reviews place variable focus on participation, are narrow in scope, and are restricted to select diagnoses, hindering interpretability regarding the existing scope of AI applications that target the participation of children and youth in a pediatric rehabilitation setting.

OBJECTIVE

The aim of this scoping review is to examine how AI is integrated into pediatric rehabilitation interventions targeting the participation of children and youth with disabilities or other diagnosed health conditions in valued activities.

METHODS

We conducted a comprehensive literature search using established Applied Health Sciences and Computer Science databases. Two independent researchers screened and selected the studies based on a systematic procedure. Inclusion criteria were as follows: participation was an explicit study aim or outcome or the targeted focus of the AI application; AI was applied as part of the provided and tested intervention; children or youth with a disability or other diagnosed health conditions were the focus of either the study or AI application or both; and the study was published in English. Data were mapped according to the types of AI, the mode of delivery, the type of personalization, and whether the intervention addressed individual goal-setting.

RESULTS

The literature search identified 3029 documents, of which 94 met the inclusion criteria. Most of the included studies used multiple applications of AI with the highest prevalence of robotics (72/94, 77%) and human-machine interaction (51/94, 54%). Regarding mode of delivery, most of the included studies described an intervention delivered in-person (84/94, 89%), and only 11% (10/94) were delivered remotely. Most interventions were tailored to groups of individuals (93/94, 99%). Only 1% (1/94) of interventions was tailored to patients' individually reported participation needs, and only one intervention (1/94, 1%) described individual goal-setting as part of their therapy process or intervention planning.

CONCLUSIONS

There is an increasing amount of research on interventions using AI to target the participation of children and youth with disabilities or other diagnosed health conditions, supporting the potential of using AI in pediatric rehabilitation. On the basis of our results, 3 major gaps for further research and development were identified: a lack of remotely delivered participation-focused interventions using AI; a lack of individual goal-setting integrated in interventions; and a lack of interventions tailored to individually reported participation needs of children, youth, or families.

Children’s Imaginaries of Robots for Playing With

Children with severe motor impairment due to cerebral palsy have difficulties engaging in play, although they want to play games that typically developing children play. The barriers imposed by motor impairments against engaging in play can be addressed through the use of robots. We aim to identify how children, who have extensive experience of play, imagine what a robot is and what features would make a robot good to play with. Using a qualitative description design, 19 children from urban and rural settings participated in focus groups to draw and talk about the robots they would like to exist. The data were coded and analyzed using a summative approach to content analysis. The findings revealed that the children imagined that a good robot to play with is one that has an anthropomorphic appearance, is tough and strong, has controls, and that is able to move, grab, speak, and play popular children’s games. In particular, the girls imagined that robots should be able to express positive emotions towards children. Age, gender, culture, and the physical environment in which the children lived influenced what they expected to find in a robot for playing with and how they imagined child–robot interactions.

Social Robots in Special Education: A Systematic Review

In recent years, social robots have become part of a variety of human activities, especially in applications involving children, e.g., entertainment, education, companionship. The interest of this work lies in the interaction of social robots with children in the field of special education. This paper seeks to present a systematic review of the use of robots in special education, with the ultimate goal of highlighting the degree of integration of robots in this field worldwide. This work aims to explore the technologies of robots that are applied according to the impairment type of children. The study showed a large number of attempts to apply social robots to the special education of children with various impairments, especially in recent years, as well as a wide variety of social robots from the market involved in such activities. The main conclusion of this work is the finding that the specific field of application of social robots is at the first development step; however, it is expected to be of great concern to the research community in the coming years.

Using a robotic teleoperation system for haptic exploration

Introduction

When children with physical impairments cannot perform hand movements for haptic exploration, they miss opportunities to learn about object properties. Robotics systems with haptic feedback may better enable object exploration.

Methods

Twenty-four adults and ten children without physical impairments, and one adult with physical impairments, explored tools to mix substances or transport different sized objects. All participants completed the tasks with both a robotic system and manual exploration. Exploratory procedures used to determine object properties were also observed.

Results

Adults and children accurately identified appropriate tools for each task using manual exploration, but they were less accurate using the robotic system. The adult with physical impairment identified appropriate tools for transport in both conditions, however had difficulty identifying tools used for mixing substances. A new exploratory procedure was observed, Tapping, when using the robotic system.

Conclusions

Adults and children could make judgements on tool utility for tasks using both manual exploration and the robotic system, however they experienced limitations in the robotics system that require more study. The adult with disabilities required less assistance to explore tools when using the robotic system. The robotic system may be a feasible way for individuals with physical disabilities to perform haptic exploration.

Nine Degree-of-Freedom Kinematic Modeling of the Upper-Limb Complex for Constrained Workspace Evaluation

The design of rehabilitation devices for patients experiencing musculoskeletal disorders (MSDs) requires a great deal of attention. This article aims to develop a comprehensive model of the upper-limb complex to guide the design of robotic rehabilitation devices that prioritize patient safety, while targeting effective rehabilitative treatment. A 9 degree-of-freedom kinematic model of the upper-limb complex is derived to assess the workspace of a constrained arm as an evaluation method of such devices. Through a novel differential inverse kinematic method accounting for constraints on all joints1820, the model determines the workspaces in which a patient is able to perform rehabilitative tasks and those regions where the patient needs assistance due to joint range limitations resulting from an MSD. Constraints are imposed on each joint by mapping the joint angles to saturation functions, whose joint-space derivative near the physical limitation angles approaches zero. The model Jacobian is reevaluated based on the nonlinearly mapped joint angles, providing a means of compensating for redundancy while guaranteeing feasible inverse kinematic solutions. The method is validated in three scenarios with different constraints on the elbow and palm orientations. By measuring the lengths of arm segments and the range of motion for each joint, the total workspace of a patient experiencing an upper-limb MSD can be compared to a preinjured state. This method determines the locations in which a rehabilitation device must provide assistance to facilitate movement within reachable space that is limited by any joint restrictions resulting from MSDs.

Assessing the environmental quality of an adapted, play-based LEGO® robotics program to achieve optimal outcomes for children with disabilities

Purpose: This study assessed the environmental quality of an adapted, play-based LEGO^® robotics program for children and youth with disabilities to determine the degree to which the activity setting supports the therapeutic goals of the program.Materials and methods: We measured the environmental qualities of a robotics program held at a paediatric rehabilitation hospital. We observed and coded video-recordings of the robotics program, specifically one session from each of five different rooms where the program took place. Using the 32-item Measure of Environmental Qualities of Activity Settings (MEQAS), we described the place- and opportunity-related qualities of these settings.Results: Our observations revealed that, across all five settings, the environments support the therapeutic goals of the program, including providing opportunities for social interaction with peers and adults to a great extent. We also identified several environmental features of the robotics program that support optimal outcomes for children and youth with disabilities.Conclusions: Our findings lend support for the value of examining environmental opportunities and affordances of play-based therapy within rehabilitation.IMPLICATIONS FOR REHABILITATIONAssessing the environmental opportunities and affordances of play-based activities using the Measure of Environmental Qualities of Activity Settings (MEQAS) is valuable for supporting positive outcomes in rehabilitation.The settings of an adapted LEGO^® robotics program offer children with disabilities opportunities to engage in social interactions with peers and adults, to learn a new skill, and to develop a sense of self-identity.Optimal therapeutic outcomes of an adapted LEGO^® robotics program can be supported by environmental features, including: large tables with sufficient space for two youth and one or two adult volunteers to interact at eye-level, arranged separately with enough space to invite movement between tables, in such a way that children may also interact across tables.

A feasibility study of eye gaze with biofeedback in a human-robot interface

Play is a vital activity in which children learn skills and explore the environment through object manipulation. Assistive robots have been used to provide access to play, and Forbidden Region Virtual Fixture (FRVF) guidance at the user interface could help the users make the robot traverse the play environment more efficiently because it behaves like virtual walls to follow. Eye gaze was used to indicate the user's intended target and generate the location of the virtual walls in a card sorting task. We eliminated the typical computer screen required for visual feedback to confirm gaze location, and examined the use of alternative feedback. In this feasibility study, first a group of adults without physical impairment tested the system with auditory and vibrotactile feedback modalities for the gaze fixation and with the virtual walls on and off for robot movement. Then case studies with children and individuals with physical impairments were performed. Even though gaze fixation feedback and the virtual wall did not improve the performance of adult participants without impairment, the feedback increased the speed and accuracy of the gaze fixation and the virtual walls improved the movement efficiency for the participants with impairment and a 6-year-old child without impairment.

Devices and Protocols for Upper Limb Robot-Assisted Rehabilitation of Children with Neuromotor Disorders

Neuromotor disorders negatively affect the sensorimotor system, limiting the ability to perform daily activities autonomously. Rehabilitation of upper limb impairments is therefore essential to improve independence and quality of life. In the last two decades, there has been a growing interest in robot-assisted rehabilitation as a beneficial way to promote children recovery process. However, a common understanding of the best drivers of an effective intervention has not been reached yet. With this aim, the current study reviewed the existing literature on robot-assisted rehabilitation protocols for upper extremities in children, with the goal of examining the effects of robotic therapy on their sensorimotor recovery process. A literature search was conducted in several electronic database to identify the studies related to the application of robotic therapy on upper limbs in the pediatric population. We analyzed three reviews and 35 studies that used 14 different robotic devices, and an overview of their characteristics, applications in the clinical setting and results is provided. Besides, the potential benefits of robot-assisted assessment and therapy are discussed to identify the key factors yielding positive outcomes in children. Finally, this review aim to lay the foundations for more effective neuroplasticity-enhancement protocols and elicit insights into robot-based approaches.

Development and Preliminary Investigation of a Semiautonomous Socially Assistive Robot (SAR) Designed to Elicit Communication, Motor Skills, Emotion, and Visual Regard (Engagement) from Young Children with Complex Cerebral Palsy: A Pilot Comparative Trial

Through play, typically developing children manipulate objects and interact with peers to establish and develop physical, cognitive, language, and social skills. However, children with complex disabilities and/or developmental delays have limited play experiences, thus compromising the quality of play and acquisition of skills. Assistive technologies have been developed to increase opportunities and level of interaction for children with disabilities to facilitate learning and development. One type of technology, Socially Assistive Robotics, is designed to assist the human user through social interaction while creating measurable growth in learning and rehabilitation. The investigators in this study designed, developed, and validated a semiautonomous Socially Assistive Robot to compare with a switch-adapted toy to determine robot effectiveness in quantity of, changes in, and differences in engagement. After interacting with both systems for three sessions each, five of the eight subjects showed a greater level of positive engagement with the robot than the switch-adapted toy, while the remaining three subjects showed slightly higher positive engagement with the toy. The preliminary results of the study suggest that Socially Assistive Robots specifically designed for children with complex cerebral palsy should be further researched and utilized to enrich play interactions and skill development for this population.

Children With Cerebral Palsy Playing With Mainstream Robotic Toys: Playfulness and Environmental Supportiveness

Purpose: Play is a right for every child and has a key role in child development. Play can be analyzed according to the construct of playfulness, which is the child’s disposition to play. Children with cerebral palsy (CP) show difficulties in play and can also experience lower playfulness scores when compared to matched typically developing children. This paper analyses play and playfulness in children with CP using mainstream robotic toys with supporting adult play partners.

Methodology: Five mainstream robotic toys were selected and used in play situations with six children with CP interacting with two adult partners. The play situations were coded through the Test of Playfulness (ToP) and the Test of Environmental Supportiveness (ToES), to analyze the role of robotic toys, adult partners and environment in supporting play and playfulness in children with CP.

Results: The children obtained high ToP scores, showing that they were intrinsically motivated to be engaged in the play situations. The ToP scores weakly correlated with the ToES scores. To discuss this result, different features of each robot, the role of adults as scaffolder, and the space characteristics in supporting play are presented and discussed.

Conclusion: This research field is new: to our knowledge, in the literature only one study focused on the use of one type of mainstream robotic toy to support the playfulness of children with CP. The parallel use of the ToP and the ToES was crucial to observe the complexity of the play situations and the role of playmates and toys during the play process. The role of the adult as play scaffolder has been important to mediate between the child with CP and the environment, toys included: the adult should be strongly aware of this role to better support the child in being in charge of the play situation. Further research is needed.

Robotic learning from demonstration of therapist's time-varying assistance to a patient in trajectory-following tasks

The number of people with physical disabilities and impaired motion control is increasing. Consequently, there is a growing demand for intelligent assistive robotic systems to cooperate with people with disability and help them carry out different tasks. To this end, our group has pioneered the use of robot learning from demonstration (RLfD) techniques, which eliminate the need for task-specific robot programming, in robotic rehabilitation and assistive technologies settings. First, in the demonstration phase, the therapist (or in general, a helper) provides an intervention (typically assistance) and cooperatively performs a task with a patient several times. The demonstrated motion is modelled by a statistical RLfD algorithm, which will later be used in the robot controllers to reproduce a similar intervention robotically. In this paper, by proposing a Tangential-Normal Varying-Impedance Controller (TNVIC), the robotic manipulator not only follows the therapist's demonstrated motion, but also mimics his/her interaction impedance during the therapeutic/assistive intervention. The feasibility and efficacy of the proposed framework are evaluated by conducting an experiment involving a healthy adult with cerebral palsy symptoms being induced using transcutaneous electrical nerve stimulation.

What does the literature say about using robots on children with disabilities?

PURPOSE

The purpose of this study is to examine the extent and type of robots used for the rehabilitation and education of children and young people with CP and ASD and the associated outcomes.

METHODS

The scholarly literature was systematically searched and analyzed. Articles were included if they reported the results of robots used or intended to be used for the rehabilitation and education of children and young people with CP and ASD during play and educative and social interaction activities.

RESULTS

We found 15 robotic systems reported in 34 studies that provided a low level of evidence. The outcomes were mainly for children with ASD interaction and who had a reduction in autistic behaviour, and for CP cognitive development, learning, and play.

CONCLUSION

More research is needed in this area using designs that provide higher validity. A centred design approach is needed for developing new low-cost robots for this population. Implications for rehabilitation In spite of the potential of robots to promote development in children with ASD and CP, the limited available evidence requires researchers to conduct studies with higher validity. The low level of evidence plus the need for specialized technical support should be considered critical factors before making the decision to purchase robots for use in treatment for children with CP and ASD. A user-entered design approach would increase the chances of success for robots to improve functional, learning, and educative outcomes in children with ASD and CP. We recommend that developers use this approach. The participation of interdisciplinary teams in the design, development, and implementation of new robotic systems is of extra value. We recommend the design and development of low-cost robotic systems to make robots more affordable.

Exploring types of play in an adapted robotics program for children with disabilities

PURPOSE

Play is an important occupation in a child's development. Children with disabilities often have fewer opportunities to engage in meaningful play than typically developing children. The purpose of this study was to explore the types of play (i.e., solitary, parallel and co-operative) within an adapted robotics program for children with disabilities aged 6-8 years.

METHOD

This study draws on detailed observations of each of the six robotics workshops and interviews with 53 participants (21 children, 21 parents and 11 programme staff).

RESULTS

Our findings showed that four children engaged in solitary play, where all but one showed signs of moving towards parallel play. Six children demonstrated parallel play during all workshops. The remainder of the children had mixed play types play (solitary, parallel and/or co-operative) throughout the robotics workshops. We observed more parallel and co-operative, and less solitary play as the programme progressed. Ten different children displayed co-operative behaviours throughout the workshops. The interviews highlighted how staff supported children's engagement in the programme. Meanwhile, parents reported on their child's development of play skills.

CONCLUSIONS

An adapted LEGO^® robotics program has potential to develop the play skills of children with disabilities in moving from solitary towards more parallel and co-operative play. Implications for rehabilitation Educators and clinicians working with children who have disabilities should consider the potential of LEGO^® robotics programs for developing their play skills. Clinicians should consider how the extent of their involvement in prompting and facilitating children's engagement and play within a robotics program may influence their ability to interact with their peers. Educators and clinicians should incorporate both structured and unstructured free-play elements within a robotics program to facilitate children's social development.

Haptics to improve task performance in people with disabilities: A review of previous studies and a guide to future research with children with disabilities

This review examines the studies most pertinent to the potential of haptics on the functionality of assistive robots in manipulation tasks for use by children with disabilities. Haptics is the fast-emerging science that studies the sense of touch concerning the interaction of a human and his/her environment; this paper particularly studies the human–machine interaction that happens through a haptic interface to enable touch feedback. Haptics-enabled user interfaces for assistive robots can potentially benefit children whose haptic exploration is impaired due to a disability in their infancy and throughout their childhood. A haptic interface can provide touch feedback and potentially contribute to an enhancement in perception of objects and overall ability to perform manipulation tasks. The intention of this paper is to review the research on the applications of haptics, exclusively focusing on attributes affecting task performance. A review of studies will give a retrospective insight into previous research with various disability populations, and inform potential limitations/challenges in research regarding haptic interfaces for assistive robots for use by children with disabilities.