Iryna Babik, Andrea Baraldi Cunha, Michele A. Lobo; Assistive and Rehabilitative Effects of the Playskin LiftTM Exoskeletal Garment on Reaching and Object Exploration in Children With Arthrogryposis. Am J Occup Ther 2020;75(1):7501205110. https://doi.org/10.5014/ajot.2020.040972
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© 2021 American Occupational Therapy Association
Importance: Children with arthrogryposis multiplex congenita are often delayed in their development of reaching and object exploration, which can place them at risk for associated delays in motor and cognitive development.
Objective: To evaluate the longitudinal assistive and rehabilitative effects of the Playskin Lift™ (hereinafter Playskin), a novel exoskeletal garment, on reaching and object exploration abilities in children with arthrogryposis.
Design: Single-case ABA design with a 1-mo baseline, 4-mo intervention, and 1-mo postintervention.
Setting: Home environment.
Participants: Seventeen children with arthrogryposis (ages 6–35 mo at first visit; 5 boys).
Intervention: Participants used the Playskin daily for 30 to 45 min while participating in structured intervention activities to encourage reaching for objects across play spaces larger than they were typically able to.
Outcomes and Measures: Participants were tested biweekly throughout the study with and without the Playskin using a systematic reaching assessment. Coding of reaching and object exploration behavior was performed using OpenSHAPA software; statistical analyses were conducted using Hierarchical Linear and Nonlinear Modeling software. Feasibility of the Playskin for daily home intervention was evaluated with a parent perception questionnaire.
Results: Positive assistive effects (improved performance when wearing the Playskin within sessions) and rehabilitative effects (improved independent performance after the Playskin intervention) were observed with increased active range of motion, expanded reaching space, improved grasping with the ventral side of the open hand, and greater complexity and multimodality and intensity of object exploration.
Conclusions and Relevance: The Playskin may be a feasible, effective assistive and rehabilitative device to advance object interaction and learning in young children with arthrogryposis.
What This Article Adds: The novel exoskeletal Playskin garment improves reaching and object exploration in young children with arthrogryposis.
Unimanual contact: One hand of child contacts the object.
Bimanual contact: Both hands of child contact the object.
Ventral contact: Ventral side of child’s hand contacts the object.
Open-handed contact: Child’s fingers extend more than 50% upon object contact.
Looking at the toy: Child’s eyes focus on the object.
Looking during unimanual contact: Child’s eyes focus on the object while one hand contacts it (multimodal exploration).
Looking during bimanual contact: Child’s eyes focus on the object while both hands contact it (multimodal exploration).
Bouts of exploration: Number of transitions from one behavior to another per minute (behavioral intensity).
Combined behaviors: Child uses more than one behavior simultaneously to act on the object (behavioral complexity).
The Playskin can be an effective assistive and rehabilitative device to improve reaching and object exploration behaviors in children with muscular weakness.
By advancing children’s reaching and object exploration behaviors, the Playskin might potentially improve their motor and cognitive development, self-care efficacy, and quality of life (Bornstein et al., 2013; Jouen & Molina, 2005; Nelson, 1999).
Future research should test the Playskin in other populations of children with muscular weakness.
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