{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T04:27:04Z","timestamp":1772252824291,"version":"3.50.1"},"reference-count":45,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2020,10,19]],"date-time":"2020-10-19T00:00:00Z","timestamp":1603065600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute on Disability, Independent Living and Rehabilitation Research","award":["90REGE004"],"award-info":[{"award-number":["90REGE004"]}]},{"name":"US Department of Health and Human Services (DHHS) Clinical and Translational Sciences Institute (CTSI)","award":["AWD00002531"],"award-info":[{"award-number":["AWD00002531"]}]},{"name":"NIH National Center for Advancing Translational Sciences","award":["UL1TR001876"],"award-info":[{"award-number":["UL1TR001876"]}]},{"name":"American Academy for Cerebral Palsy and Developmental Medicine (AACPDM)","award":["no number"],"award-info":[{"award-number":["no number"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Informatics"],"abstract":"<jats:p>Technological advances in game-mediated robotics provide an opportunity to engage children with cerebral palsy (CP) and other neuromotor disabilities in more frequent and intensive therapy by making personalized, programmed interventions available 24\/7 in children\u2019s homes. Though shown to be clinically effective and feasible to produce, little is known of the subjective factors impacting acceptance of what we term assistive\/rehabilitative (A\/R) gamebots by their target populations. This research describes the conceptualization phase of an effort to develop a valid and reliable instrument to guide the design of A\/R gamebots. We conducted in-depth interviews with 8 children with CP and their families who had trialed an exemplar A\/R gamebot, PedBotHome, for 28 days in their homes. The goal was to understand how existing theories and instruments were either appropriate or inappropriate for measuring the subjective experience of A\/R gamebots. Key findings were the importance of differentiating the use case of therapy from that of assistance in rehabilitative technology assessment, the need to incorporate the differing perspectives of children with CP and those of their parents into A\/R gamebot evaluation, and the potential conflict between the goals of preserving the quality of the experience of game play for the child while also optimizing the intensity and duration of therapy provided during play.<\/jats:p>","DOI":"10.3390\/informatics7040045","type":"journal-article","created":{"date-parts":[[2020,10,19]],"date-time":"2020-10-19T09:36:28Z","timestamp":1603100188000},"page":"45","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Toward Evaluation of the Subjective Experience of a General Class of User-Controlled, Robot-Mediated Rehabilitation Technologies for Children with Neuromotor Disability"],"prefix":"10.3390","volume":"7","author":[{"given":"Manon Maitland","family":"Schladen","sequence":"first","affiliation":[{"name":"MedStar Health Research Institute, Hyattsville, MD 20782, USA"},{"name":"Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC 20057, USA"}]},{"given":"Kevin","family":"Cleary","sequence":"additional","affiliation":[{"name":"Children\u2019s National Medical Center, Washington, DC 20010, USA"}]},{"given":"Yiannis","family":"Koumpouros","sequence":"additional","affiliation":[{"name":"Department of Public and Community Health, University of West Attica, 12243 Aigaleo, Greece"}]},{"given":"Reza","family":"Monfaredi","sequence":"additional","affiliation":[{"name":"Children\u2019s National Medical Center, Washington, DC 20010, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5842-6221","authenticated-orcid":false,"given":"Tyler","family":"Salvador","sequence":"additional","affiliation":[{"name":"Children\u2019s National Medical Center, Washington, DC 20010, USA"}]},{"given":"Hadi Fooladi","family":"Talari","sequence":"additional","affiliation":[{"name":"Children\u2019s National Medical Center, Washington, DC 20010, USA"}]},{"given":"Jacob","family":"Slagle","sequence":"additional","affiliation":[{"name":"Children\u2019s National Medical Center, Washington, DC 20010, USA"}]},{"given":"Catherine","family":"Coley","sequence":"additional","affiliation":[{"name":"Children\u2019s National Medical Center, Washington, DC 20010, USA"}]},{"given":"Staci","family":"Kovelman","sequence":"additional","affiliation":[{"name":"Children\u2019s National Medical Center, Washington, DC 20010, USA"}]},{"given":"Justine","family":"Belschner","sequence":"additional","affiliation":[{"name":"Children\u2019s National Medical Center, Washington, DC 20010, USA"}]},{"given":"Sarah Helen","family":"Evans","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia, Philadelphia, PA 19104, USA"}]}],"member":"1968","published-online":{"date-parts":[[2020,10,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1111\/dmcn.12080","article-title":"An update on the prevalence of cerebral palsy: A systematic review and meta-analysis","volume":"55","author":"Oskoui","year":"2013","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S125","DOI":"10.21037\/tp.2020.01.01","article-title":"Cerebral palsy in children: A clinical overview","volume":"9","author":"Patel","year":"2020","journal-title":"Transl. Pediatr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1136\/adc.83.6.468","article-title":"Effect of severity of disability on survival in north east England cerebral palsy cohort","volume":"83","author":"Hutton","year":"2000","journal-title":"Arch. Dis. Child."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1093\/ptj\/pzy160","article-title":"Developmental Trajectories and Reference Percentiles for Range of Motion, Endurance, and Muscle Strength of Children with Cerebral Palsy","volume":"99","author":"Jeffries","year":"2019","journal-title":"Phys. Ther."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S37","DOI":"10.1097\/PEP.0000000000000383","article-title":"Coupling Timing of Interventions with Dose to Optimize Plasticity and Participation in Pediatric Neurologic Populations","volume":"29","author":"Gannotti","year":"2017","journal-title":"Pediatr. Phys. Ther."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1097\/PEP.0b013e3181728a8c","article-title":"Stretching with children with cerebral palsy: What do we know and where are we going?","volume":"20","author":"Wiart","year":"2008","journal-title":"Pediatr. Phys. Ther."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1111\/j.1469-8749.2006.tb01236.x","article-title":"The effectiveness of passive stretching in children with cerebral palsy","volume":"48","author":"Pin","year":"2006","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1097\/01.pep.0000202099.01653.a9","article-title":"Physical therapy clinical management recommendations for children with cerebral palsy\u2014Spastic diplegia: Achieving functional mobility outcomes","volume":"18","author":"Westcott","year":"2006","journal-title":"Pediatr. Phys. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1053\/apmr.2002.34286","article-title":"A systematic review of the effectiveness of strength-training programs for people with cerebral palsy","volume":"83","author":"Dodd","year":"2002","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/j.rehab.2017.05.004","article-title":"Efficacy of ankle foot orthoses types on walking in children with cerebral palsy: A systematic review","volume":"60","author":"Aboutorabi","year":"2017","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"455","DOI":"10.2147\/JMDH.S88782","article-title":"Multidisciplinary rehabilitation for patients with cerebral palsy: Improving long-term care","volume":"9","author":"Trabacca","year":"2016","journal-title":"J. Multidiscip. Healthc."},{"key":"ref_12","first-page":"691","article-title":"Recommendations for the rehabilitation of children with cerebral palsy","volume":"52","author":"Castelli","year":"2016","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.physio.2003.09.001","article-title":"Factors influencing adherence to a home-based strength-training programme for young people with cerebral palsy","volume":"90","author":"Taylor","year":"2004","journal-title":"J. Physiother."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.jphys.2015.02.014","article-title":"Parents of children with physical disabilities perceive that characteristics of home exercise programs and physiotherapists\u2019 teaching styles influence adherence: A qualitative study","volume":"61","year":"2015","journal-title":"J. Physiother."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1109\/TNSRE.2012.2206055","article-title":"Robotics and Gaming to Improve Ankle Strength, Motor Control, and Function in Children With Cerebral Palsy\u2014A Case Study Series","volume":"21","author":"Burdea","year":"2013","journal-title":"IEEE Trans. Neural Syst. Rehabil. Eng."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Monfaredi, R., Fooladi, H., Tabrizi, P.R., Kovelman, S., Salvador, T., Coley, C., Alyamani, S., Pergami, P., Cleary, K., and Evans, S. (2018, January 12\u201315). PedBot: Robotically assisted ankle robot and video game for children with neuromuscular disorders. Proceedings of the SPIE Medical Imaging Conference 2018, Huston, TX, USA.","DOI":"10.1117\/12.2295031"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1016\/j.apmr.2014.04.010","article-title":"Clinical application of a robotic ankle training program for cerebral palsy compared to the research laboratory application: Does it translate to practice?","volume":"95","author":"Clancy","year":"2014","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_18","unstructured":"Coley, C., Belschner, J., Kovelman, S., Monfaredi, R., Salvador, T., Fooladi, H., Monfaredi, R., Salvador, T., Schladen, M., and Alyamani, S. (2020, January 4\u20139). Use of a robot (PedBotHome) to increase compliance with home exercise program in children with static neurologic injury. Proceedings of the ISPRM World Congress and AAP Annual Meeting, Orlando, FL, USA."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Cleary, K., Monfaredi, R., Salvador, T., Talari, H., Coley, C., Kovelman, S., Belschner, J., Alyamani, S., Schladen, M., and Evans, S.H. (2019, January 24\u201328). PedBotHome: Robotically-assisted ankle rehabilitation system for children with cerebral palsy. Proceedings of the IEEE International Conference on Rehabilitation Robotics, Toronto, ON, Canada.","DOI":"10.1109\/ICORR.2019.8779468"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1016\/j.apmr.2016.01.029","article-title":"Home-Based Versus Laboratory-Based Robotic Ankle Training for Children with Cerebral Palsy: A Pilot Randomized Comparative Trial","volume":"97","author":"Chen","year":"2016","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1712","DOI":"10.3389\/fpsyg.2018.01712","article-title":"Games Used with Serious Purposes: A Systematic Review of Interventions in Patients with Cerebral Palsy","volume":"9","author":"Lopes","year":"2018","journal-title":"Front. Psychol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Falzarano, V., Marini, F., Morasso, P., and Zenzeri, J. (2019). Devices and Protocols for Upper Limb Robot-Assisted Rehabilitation of Children with Neuromotor Disorders. Appl. Sci., 9.","DOI":"10.3390\/app9132689"},{"key":"ref_23","unstructured":"Peiris, V. Personal Communication."},{"key":"ref_24","unstructured":"Cleary, K., Evans, S.H., Salvador, T., Schladen, M.M., Coley, C., Kovelman, S., Belschner, J., and Vinopol, C. (2020). PedBot: A Rehabilitative Ankle Robot [Presentation], Children\u2019s National Medical Center."},{"key":"ref_25","unstructured":"Shelburne, N., Oduye, A., Williams, K., Lou, E., and Litherland, C. (2020). Design Engineering Handbook, InVision."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Koumpouros, Y. (2016). A systematic review on existing measures for the subjective assessment of rehabilitation and assistive Robot Devices. J. Healthc. Eng.","DOI":"10.1155\/2016\/1048964"},{"key":"ref_27","unstructured":"(2020, September 01). What Is AT? Chicago, IL: Assistive Technology Industry Association (ATIA). Available online: https:\/\/www.atia.org\/home\/at-resources\/what-is-at\/."},{"key":"ref_28","unstructured":"Gillen, G. (2016). Rehabilitation Technologies to Promote Upper Limb Recovery after Stroke. Stroke Rehabilitation, Mosby. [4th ed.]."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/17483100600845414","article-title":"A framework for modelling the selection of assistive technology devices (ATDs)","volume":"2","author":"Scherer","year":"2007","journal-title":"Disabil. Rehabil. Assist. Technol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1080\/09638280110066352","article-title":"Reliability, validity, and applicability of the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST 2.0) for adults with multiple sclerosis","volume":"24","author":"Demers","year":"2002","journal-title":"Disabil. Rehabil."},{"key":"ref_31","first-page":"456","article-title":"PYTHEIA: A scale for assessing rehabilitation and assistive robotics","volume":"10","author":"Koumpouros","year":"2016","journal-title":"Int. J. Med. Health Biomed. Bioeng. Pharm. Eng."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Schladen, M.M., Koumpouros, Y., Sandison, M., Casas, R., and Lum, P. (2020). Conceptualization of Hand-TaPS to measure the subjective experience of dynamic hand orthoses in promoting functional recovery at home after stroke. Technol. Disabil., preprint.","DOI":"10.3233\/TAD-200289"},{"key":"ref_33","unstructured":"Brancato, G., Macchia, S., Murgia, M., Signore, M., Simeoni, G., Blanke, K., K\u00f6rner, T., Nimmergut, A., Lima, P., and Paulino, R. (2006). Handbook of Recommended Practices for Questionnaire Development and Testing in the European Statistical System, European Commission."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Pett, M.A., Lackey, N.R., and Sullivan, J.J. (2003). Making Sense of Factor Anaysis: The Use of Factor Analysis for Instrument Development in Health Care Research, SAGE Publications.","DOI":"10.4135\/9781412984898"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"15","DOI":"10.3109\/17518423.2010.533329","article-title":"Using motion interactive games to promote physical activity and enhance motor performance in chldren with cerebral palsy","volume":"14","author":"Sandlund","year":"2011","journal-title":"Dev. Neurorehabilit."},{"key":"ref_36","unstructured":"Whittinghill, D.M., and Brown, J.S. (2014, January 15\u201318). Gamification of physical therapy for treatment of pediatric cerebral palsy: A pilot study examining player preferences. Proceedings of the 121st ASEE Annual Conference & Exposition, Indianapolis, IN, USA."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1089\/g4h.2012.0071","article-title":"Feasibility of computer-based videogame therapy for children with cerebral palsy","volume":"2","author":"Radtka","year":"2013","journal-title":"Games Health J."},{"key":"ref_38","unstructured":"Freitas, D.Q., Da Gama, A.E.F., Figueiredo, L., Chaves, T.M., Marques-Olivera, D., Teichrieb, V., and Cristiano, A. (2012, January 2\u20134). Development and evaluation of a kinect based motor rehabilitation game. Proceedings of the XI SBGames, Brasilia, Brazil."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1089\/cpb.2006.9.123","article-title":"Feasibility, motivation, and selective motor control: Virtual reality compared to conventional home exercise in children with cerebral palsy","volume":"9","author":"Bryanton","year":"2006","journal-title":"Cyberpsychol. Behav."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1111\/j.1469-8749.2008.02045.x","article-title":"Development of the Gross Motor Function Classification System for cerebral palsy","volume":"50","author":"Rosenbaum","year":"2008","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1810","DOI":"10.3389\/fpsyg.2020.01810","article-title":"The Importance of Cursive Handwriting over Typewriting for Learning in the Classroom: A High-Density EEG Study of 12-Year-Old Children and Young Adults","volume":"11","year":"2020","journal-title":"Front. Psychol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"158","DOI":"10.3389\/fpsyg.2020.00158","article-title":"Investigating the \u201cFlow\u201d Experience: Key Conceptual and Operational Issues","volume":"11","author":"Abuhamdeh","year":"2020","journal-title":"Front. Psychol."},{"key":"ref_43","unstructured":"World Health Organization (2002). Towards a Common Language for Functioning, Disability, and Health, World Health Organization."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/1743-0003-9-20","article-title":"Recent trends in assistive technology for mobility","volume":"9","author":"Cowan","year":"2012","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/eci.12380","article-title":"Modern health care as a game theory problem","volume":"45","author":"Djulbegovic","year":"2015","journal-title":"Eur. J. Clin. Investig."}],"container-title":["Informatics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9709\/7\/4\/45\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:23:56Z","timestamp":1760178236000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9709\/7\/4\/45"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,19]]},"references-count":45,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,12]]}},"alternative-id":["informatics7040045"],"URL":"https:\/\/doi.org\/10.3390\/informatics7040045","relation":{"has-preprint":[{"id-type":"doi","id":"10.20944\/preprints202009.0237.v2","asserted-by":"object"},{"id-type":"doi","id":"10.20944\/preprints202009.0237.v1","asserted-by":"object"}]},"ISSN":["2227-9709"],"issn-type":[{"value":"2227-9709","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,19]]}}}