Cerebral palsy (CB) is the most common physical disability in children that affects movement and posture, impacting daily activities such as eating, writing, dressing and playing.
It is a neurodevelopmental disorder that causes abnormalities in muscle tone, movement and motor skills (Gulati & Sondhi, 2018). It is non-progressive, whereby its clinical expression develops over time as the brain matures.
CP is the leading cause of serious physical disability in childhood, having an overall prevalence of 1.6 per 1,000 live births in Europe (Arnaud, et al., 2023) and affects around 17 million people worldwide.
Occupational therapists working with children with CP use strength-based approaches to enable children to achieve competence in their daily childhood occupations, thus enabling them to participate in the home, school and community to the greatest extent possible.
Technological devices are becoming more important and available in the 21st century, especially in health-related fields. However, to date, most technological devices for children with CP do not provide a customisable experience for children’s individuality.
Within this context, the Smartclap project research team developed Digiclap, a customisable device that increases the motivation of a child to use their hands.
A holistic user-centred design approach was adopted to deliver a product-service system that provides a high-quality user experience. In fact, the team sought the views of the children and their parents in developing various aspects of the device, including the comfort of the finger rings, the colours of the device, as well as aspects of the game.
Digiclap aims to provide an opportunity for children to engage in therapy through the use of gaming, more specifically using the medium of augmented reality. It is being developed to support children with neuromotor difficulties to use their hands, contributing towards the improvement of their functional hand skills.
The device is worn on the hand and the child interacts with a serious game in an augmented reality environment. The smart wearable makes use of movement sensors located in the glove-like device which connect to a game that children play using an ordinary tablet.
Augmented reality in children with cerebral palsy is advantageous when used in habilitation as it enables them to be more fully immersed in the context and environment in which the therapy is being carried out. This device poses an innovative way of enhancing the therapeutic programme of children with CP and is aimed to be used as a tool for both assessment and intervention during the occupational therapy process.
Digiclap is currently being evaluated in terms of its effectiveness in therapy with occupational therapists, children with CP and their families. Very promising feedback was obtained so far. Hereunder are testimonials from three of the research participants: from a parent, a therapist and children respectively:
“The fact that he managed to do just small movements with his fingers, and we could see the results on the screen, gave us hope and made it quite a success to be honest. Apart from the improved tone and the hand being more flexible, he has realised that he can use his hand,” a mother of a seven-year-old boy with CP, said.
“I see potential in it [Digiclap]. For a lot of children at his age, this is [using gadgets] their mode of play. And although we encourage children to use different kinds of media to develop different skills, in reality, all children end up playing on a gadget and having screen time, so at least we are offering an option for play even for these children,” a paediatric occupational therapist, who participated in the study, said.
“The fact that he managed to do just small movements with his fingers, and we could see the results on the screen, gave us hope”
The children’s main views were that they looked forward to the sessions and were excited and eager to play the game. While most children required elements of physical and verbal prompting to play the game, they were able to feel in control and were capable of using their hands independently, irrespective of their level of success in the game scores. One of the greatest achievements was that children were engaged and had fun.
It is envisaged that with further refinement and development of the device, the target users for Digiclap can be expanded to other potential users, including children with other neuromotor disorders, persons who have sustained a hand injury, as well as persons who have suffered a stroke or traumatic brain injury.
Digiclap is still a work-in-progress and is now being evaluated with more children in another European country in order to obtain further feedback on its potential benefits to children with cerebral palsy and other diagnostic groups.
It is also a promising tool that occupational therapists can use in clinic-based therapy sessions. Finally, it also has potential to be used for home therapy and beyond to support the habilitation of children with CP.
This article is written by Nathalie Buhagiar, resident academic, Occupational Therapy Department, Faculty of Health Sciences, University of Malta, with the contribution of Prof. Ing. Philip Farrugia, Joseph Mercieca and Matthew Bonello. For more information, contact Buhagiar on nathalie. buhagiar@um. edu.mt.
Smartclap is being funded by the Malta Council for Science and Technology (MCST) under the Technology Development Programme (project reference no. R&I-2019-003-T). The project is led by the Department of Industrial and Manufacturing Engineering in collaboration with the Department of Systems and Control Engineering and the Department of Occupational Therapy at the University of Malta. Philip Farrugia is the project lead. Two industrial partners also on board are Invent3D Ltd and HumAIn Ltd. A multidisciplinary team composed of engineers, game developers, artificial intelligence experts, occupational therapists and researchers are part of the project.
For more information, visit www.facebook.com/smartclap.