A Single-Button Mobility Platform for Cause-Effect Learning in Children with Cerebral Palsy: A Pilot Study

Background: Mobility plays a fundamental role in causal reasoning (causal inference or cause-effect learning), which is essential for brain development at early ages. Children naturally develop causal reasoning through interaction with their environment. Therefore, children with severe motor disabilities (GMFCS levels IV-V), who face limited opportunities for interaction, often show delays in causal reasoning. Objective: This study investigates how a wheelchair-mounted, semi-autonomous mobility platform operated via a simple switch may enhance causal learning in children with severe disabilities, compared with traditional therapies. However, due to the scarcity of participants who meet the inclusion criteria and the need for long-term evaluation, recruitment poses a significant challenge. This study aims to provide an initial assessment of the platform and collect preliminary data to estimate the required sample size and number of sessions for future studies. Methods: We conducted a pilot randomized controlled trial (RCT) to assess platform usability and its effect on reaction time and keystroke accuracy. Four children, aged 8.5 ± 2.38, participated in seven 30 min sessions. They were randomly assigned in equal numbers, with two participants in the intervention group (using the platform) and two in the control group (receiving standard therapy). Usability was evaluated through a questionnaire completed by two therapists. Key outcome measures included the System Usability Scale (SUS), reaction time (RT), and keystroke accuracy (NIS). Results: Despite the small sample size and recruitment challenges, the data allowed for preliminary estimates of the sample size and number of sessions required for future studies. Therapists reported positive usability scores. Children using the platform showed promising trends in RT and NIS, suggesting improved engagement with cause-effect tasks. Conclusions: The findings support the feasibility and usability of the mobility platform by therapists, although some improvements should be implemented in the future. No conclusive evidence was found regarding the platform's effectiveness on causal learning, despite a positive trend over time. This pilot study also provides valuable insights for designing larger, statistically powered trials, particularly focused on NIS.