Advancing Mobility and Socialization in Toddlers with Disabilities---A Randomized Controlled Trial to Assess the Effects of Modified Toy Cars Training with Different Postures

The three purposes of this study are: 1) to examine the feasibility and effects of ride-on car training with two different postures on mobility and socialization in toddlers with disabilities; 2) to quantify whether toddlers with disabilities are able to have more exploratory behaviors and social interactions with ride-on car training through observation and wrist-worn accelerometers; 3) to determine the critical factors of using the different modes of modified ride-on toy car on family perceptions and participation. Independent mobility is believed to be essential for perceptual-motor, cognition, language and social skill development. 1,2 It is important to increase independent mobility in toddlers with disabilities and further enhance their development, especially socialization. Assistive and power mobility devices allow toddlers with disabilities to move independently within their environment and may increase the opportunities to explore environment and interact with people. 3 However, issues to consider before prescribing an assistive device include factors such as age, accessibly to community environments, cost, social acceptance of the device and the adaptability of the device to growth.4 To address these limitations and meet toddlers5 needs, the concept of using modified ride-on toy cars (ROC) in therapy becomes a novel application. 5 Studies have demonstrated the use of toy cars enhanced a child’s motivation, socialization and family participation (Figures A & B).6,7 Our preliminary results of the group study showed significantly increased mobility, socialization and decreased parenting stress level after the toy car training in toddlers with disabilities. More percentages of participants in the treatment group had clinical meaningful improvements on mobility and social function than the control group. Evidence supported that specificity of psychological changes associated with different modes of locomotion, particularly the locomotor experience involving motor activity, e.g., postural control; the perceptual information (e.g., periphery optical flow) and action experience affect psychological development. 8,9 Therefore, this study is further to examine the effects of ride-on toy car training with two different postures, i.e., sitting and standing (Figures C & D), on independent mobility, exploration and socialization through low-cost, family-centered approach. It will also improve family’s understanding of children’s capabilities, which improves their development. Based on the power analysis from the preliminary results of our group study, we will recruit 60 children with disabilities who are between 1 to 3 years old and diagnosed as motor delay (＞1.5 sd). They will be randomly assigned to one of the following three groups: ROC-Sit group, ROC-Stand group and regular therapy group. The whole study duration will be 24 weeks, including 12-week intervention and 12-week follow-up; the total amount of treatment will be equal for three groups. Standardized assessments are provided for a total of three times during the study, including the time before and after the intervention and in the end of the follow-up phase. The ROC-Sit and ROC-Stand programs will be administered by the therapist and include 120 minutes/per session, 2 sessions/per week. The research team will visit the hospital once/per week to provide 60 minutes videotaping and let participants wear wrist-worn accelerometers. The regular therapy group will continue their regular therapy without any additional car driving training. The research team will visit them once/per week for the assessments. The assessments include standardized measurements and behavioral codings from the videotapes and accelerometers. The findings of this study will provide a novel therapeutic tool (i.e., combining the low-tech modified ride-on cars with different postures) on advancing children’s mobility, socialization, family participation and development.

Project ID:PC10408-1722
External Project ID:MOST104-2314-B182-023-MY3