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Aye, Robot

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Andrew Peffley, 3, was born with spina bifida. His mother, Terri (right), enrolled him in the pediatric mobility project of UD’s James C. Galloway (left). Photograph by Jared CastaldiOn a recent trip to Disney World, 4-year-old Will Harp became fascinated with the map stations that directed him to attractions in the Magic Kingdom.

“Every time he saw one, he just had to run right to it and study it,” says his mother, Julianne. “I think we wound up seeing every map in the park.”

Running to anything is a somewhat more complicated process for Will than for many of us. Diagnosed with cerebral palsy at 16 months, Will cannot walk. Julianne and her husband, Gary, still don’t know if he ever will. But Will runs, thanks to a special chair.

So Julianne and Gary chase.

“Parents of children with severe mobility disabilities, such as children born with spina bifida, cerebral palsy or Down syndrome, do not have the experience of having to chase their children when they begin crawling and walking,” says James C. Galloway of the University of Delaware’s Infant Motor Behavior Lab. “Parents of such children don’t get worn out and frazzled like parents of typically developing crawling and walking children do. My goal is to get these parents worn out and frazzled, too.”

So Galloway and a team of researchers from UD’s mechanical engineering-robotics department have developed a mobility robot—a motorized wheelchair with spatial sensors that direct an onboard computer—that allows children as young as six months to explore as if they could crawl or walk on their own.

“Adults love to explore with their cars,” Galloway says. “It’s the same for our kids in the robot chairs.”

The machine has generated much excitement and hope for parents of children with mobility disabilities. Andrew Peffley, age 3, has been “running” in one of Galloway’s robots since he was 6 months old. Andrew was born with spina bifida. His mother, Terri, an occupational therapist, vowed that her son would walk. She had Andrew enrolled in Galloway’s pediatric mobility project and, as a result, he can “commando” crawl now using his arms.

“Today Andrew accompanies his family on walks through Longwood Gardens and accompanies his three siblings on their walk to school,” Galloway says.

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And there’s more to it beyond developing motor skills. “We know that children with mobility issues also have trouble with cognition and social interaction, whether or not there is an accompanying brain disorder,” Galloway says. “But what if, by providing mobility development, you also kick-start their brain activity to improve both cognitive and social skills?”

That may be possible.

Ten years ago, Sunil Agrawal, lead investigator for UD’s mechanical engineering-robotics lab, became interested in mobile robots. “Can I design a machine using computers and sensors to do what humans do?” Agrawal wondered. After six years, he and his team designed several prototypes, but they were too small to be tested by adults.

Four years ago, Agrawal met Galloway. He asked if Galloway had any application for his machines. Galloway was working with infants small enough to fit them, so Agrawal created a seat for the child and a joystick that both drove and directed the young pilots. “We found we could teach these young children to operate the robot within six weeks, with only two or three training sessions per week of 20 minutes duration each,” says Agrawal.

“The joystick receives feedback from the robot’s sensors and pushes back when the child is heading in the wrong direction. Eventually, the child learns to move in the proper direction on his own, and the resistance that was provided can be eliminated to demonstrate the child is ready to operate the robot safely on his own.”

Several studies were done using children from UD’s Early Learning Center’s daycare program. In 2007 Galloway, Agrawal and another associate published a study countering a common belief that children under 24 months were not candidates for power mobility. By using Agrawal’s robots, children could, beginning as infants, learn power mobility. A university study last year suggested that mobility training also had a positive effect on socialization, overall daily living and driving performance. It concluded that a 20-month-old child with spinal muscular dystrophy improved both cognitive and communication skills that exceeded calendar time. For the six months that the child used the robot, cognition showed a seven-month gain. Communication showed a 13-month gain.

“We’ve known for years that mobility is a causal factor in the cognitive explosion that takes place between the ages of six months and one year,” Galloway says. “Lack of mobility in children with disabilities leads to what is known as learned helplessness. Among other issues, that makes mobility, in my view, a human rights issue.”

Michael Gamel McCormick, former head of UD’s Center for Disability Studies, now the dean of the College of Education and Public Policy, says infant brains “are a mass of neurons making connections through exploration. By crawling and walking, babies can make more complex connections through auditory and visual stimulation, all enhanced by mobility.”

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Lack of mobility in children with disabilities limits emotional development due to the frustration of not being able to move, McCormick says. Learning disabilities “are tied to the ability to interact with environment via mobility,” he says. “Power mobility takes the place of stimulating brain activity that is not activated by typical mobility.”

Debbie Kiser, a physical therapist with The John G. Leach School in New Castle, a public school for children with disabilities, says physical therapists have always believed there was a connection between mobility and cognition, “and I’m happy to see there is research being done showing that to be true.”

Leach’s student population includes children with severe disabilities, which makes mobility a big issue at the school. Though Leach has programs in power chair training, it had nothing like Galloway’s robot. Kiser was most impressed with the sensors equipped on the chair that served to keep the child safe during training.

“[Galloway] will reach a greater population of children with disabilities with his robot than can be reached now,” Kiser says. She is excited about getting one of Galloway’s robots into Leach’s training program.

“Power chair training does improve a child’s abilities,” Kiser says. “And any mobility capacity they are able to build on their own is fantastic for developing self-direction and independence.”

McCormick credits Galloway with getting the idea of mobility and cognitive development into the literature. “Now we can get investment people involved in the commercial development of Galloway’s robot,” he says.

That may already have begun. When Galloway contacted the U.S. offices of Swedish-based Permobil about his robot, he struck a chord with pediatric specialist Amy Meyer. “I clicked with him immediately, since I’ve had the same philosophy about pediatric mobility,” says Meyer.

The market for pediatric power chairs remains undefined, Meyer says. Much of that has to do with the parents of children with disabilities. “Many parents feel that placing their child in a power chair means giving up on their hope that their child will one day walk on their own.” And some therapists fear patients will become lazy and lose their desire to walk, she says. “As a result major power chair manufacturers have shied away from developing chairs for infants.”

Meyer describes Permobil as a small, growing company that seeks niche markets where it can individualize its product line. She sees a future for commercial development of Galloway’s robot. “Really, the market is as ready as it ever will be,” she says.

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Galloway is driven by time and the small window of opportunity for infants with mobility disabilities. “We know our bodies so well that we know automatically how our bodies fit in the world.” That’s not the case for children who obtain power chairs later in life. They need time to adapt to the space limitations of their chairs.

Younger children may have a learning advantage. Andrew Peffley at 2 ½ no longer needed to look left and right to determine if his chair will fit through a doorway, as he did when he started training. “He’s already calculated what his clearance in the chair requires,” Galloway says.

More important, both Andrew and Will Harp are working harder to walk than they would have without robot training, Galloway believes.

The Peffleys were able to obtain a custom Permobil-built chair for home use. Terri Peffley says she had to overcome the feeling that a power chair meant Andrew would never walk. “We have found, though, the power chair has given Andrew the ability to move beyond the commando crawl to crawling using his hips and knees,” she says.

The chair allows Andrew to realize he can do things for himself, Peffley says. He doesn’t have to settle for being a spectator. “He will say to us now ‘Andrew walking’ when he’s in the chair, or, when competing for a toy with his brothers and sisters, cries out, ‘I win!’”

The chair has proven essential to his emotional and personality development, Peffley says. “We’ve noticed an improvement in his cognitive perception, social skills and self-esteem and image,” she says. “And now he has made the connection between mobility and walking.”

Peffley has also noticed that Andrew loves “joyriding.” “He sees the chair as an extension of himself, and not just a toy.”

His 5-year-old brother appears inclined to agree. “Where was my chair when I was Andrew’s age?” he’s asked his mother. Older sister Abbi’s friends think Andrew’s chair is “smart and cool.”

“Abbi’s friends say, ‘That’s awesome’ when they see Andrew in his chair, not something like, ‘Aw, that’s so sad.’ As a result, Andrew is excited to show his chair to strangers,” Peffley says.

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Julianne Harp says Will has always demonstrated cognitive skills above age level, but his social interaction lagged. When Will acquired one of Galloway’s chairs at age three, his social skills began to improve. “He would always talk with the other children” Harp says, “but they would have to come to him and they would have to initiate the conversation.” After a year in the chair, Will started initiating conversations. That was clear when Will began chatting about “Toy Story 3” and the pirate ship his grandmother had given him for his fourth birthday.

“As a family the chair has allowed us to continue the activities we’ve always enjoyed,” Peffley says. “We no longer have to gear our lives around Andrew’s condition. He can have his Terrible Twos now. I’m not pushing or carrying him. I’m looking for him. I have to childproof the house.”

She says Andrew’s quintessential motion is his ability to run away from her. Galloway senses a hint of exhaustion behind that statement and smiles a Cheshire grin.

“It’s what I want to hear from parents of children with mobility issues. It’s my goal to have them experience what all the other parents are experiencing.”

Julianne Harp doesn’t mind that at all. “I can walk alongside Will now and hold his hand,” she says. “I couldn’t do that before.”
 

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