Jyomi Holland was diagnosed with cerebral palsy when she was about four months old. Her parents noticed she didn’t move the right side of her body; the doctor concluded she most likely had a stroke in her mother’s womb.

Now six, Jyomi does pretty well, said her mom, Maureen Bodden. She appears to be naturally left-handed, like her dad, so she can rely comfortably on her able-bodied side. But that doesn’t mean Jyomi doesn’t need her right side, even if the muscles are stiff and unyielding. Plus even though cerebral palsy is not in itself a progressive disease – the brain damage is permanent, but it doesn’t get worse – if she doesn’t exercise those muscles, they’ll get shorter and tighter and ultimately hurt her bones and joints.

So since she was a baby, Jyomi has gotten physical therapy, and her mom has done exercises with her in their Providence home as well. It’s made a big difference, Bodden said: She can open her fist now, and she can use her right hand to help with tasks like zipping a jacket.

“We see constant improvements with her,” she said.

Yet Jyomi only gets two or three one-hour therapy sessions a week – whether it’s at Flynn Elementary School during the academic year, or at Hasbro Children’s Hospital. Knowing how much that helps her, it’s hard not to ask, what if she got twice as much?

A study at Hasbro and Brown University’s Warren Alpert Medical School is about to try to answer that question, with a twist: Rather than just get traditional therapy, children are going to be sent home with toys that give them therapy as they play.

The project is called Toys and Technology for Rehabilitation, and it has brought together experts in rehabilitative medicine, orthopedics, industrial design, engineering and computing in the nonprofit and for-profit sectors, with public and private financial support.

The ultimate goal is to create toys that can both help children improve their arm and hand function and help measure the impact of therapy. More than 800 children in Rhode Island alone could benefit – and nationwide, between 750,000 and a million.

Cerebral palsy is a neurological disorder caused by damage to the motor control centers in the young developing brain. In the majority of cases, as with Jyomi, the damage occurs before birth, but sometimes it occurs during delivery or in infancy.

There are different types of cerebral palsy, and different levels of severity, but most patients have overly tight and stiff muscles and difficulties controlling their movements; some have trouble walking, standing up straight or speaking, and some are prone to seizures.

At this point, there is no cure for cerebral palsy, but treatment can maximize muscle function and personal independence and help prevent muscle, bone and joint deterioration. Patients tend to get a combination of physical therapy and occupational therapy, and some get drug therapies and whatever assistive technologies they need, from braces to voice synthesizers.

But Dr. Karen Kerman, director of the pediatric rehabilitation center at Hasbro, saw a big need for one more therapeutic tool – toys that children with cerebral palsy could use to improve their muscle function.

The advantages would be many, she said: For starters, if children could get therapy at home or in the community, they’d get more therapy overall. And because going to a hospital or clinic, or even getting therapy at school, reminds disabled children that they’re different from their peers, getting therapy while playing like their peers would be a big plus.

“This is a unique opportunity to have our children who are disabled participate with their normal-able peers in activities which are common to all,” she said.

Kerman took her idea to the CVS Caremark Charitable Trust, which liked the concept and made funds available. Then she approached Joseph “Trey” Crisco, director of the bioengineering lab in the department of orthopedics at Rhode Island Hospital and a professor of orthopedics at Brown, who in turn brought in Khipra Nichols, a professor of industrial design at Rhode Island School of Design.

In the fall of 2006, a class that included both Brown and RISD students took on the task of designing therapeutic toys, and at the end of the term, the team got a grant from the R.I. Science and Advisory Technology Council to pursue a particularly promising set of concepts: toy controls for games that would rely on the use of the wrist and forearms.

Working with Susan D’Andrea, of Afferent Corp., and David Durfee, of Bay Computer Associates, the team developed several prototypes, adding data-logging capabilities that allow researchers to study the extent of use and the arm movements and also measure the outcome.

They tested the toys at the Hasbro rehab center and at the Meeting Street School, and last month, they unveiled the prototypes at an open house event and launched a small-scale study: 20 children ages 5 to 12, including Jyomi, will get toys to take home and play with.

The team is also seeking funding for a full clinical trial, preferably at multiple sites across the country, but if not, at least with a larger number of children in Rhode Island, Crisco said. That will require substantial resources, however, not just to manufacture hundreds of toys but also to document their use and probe two key questions: how well the toys deliver therapy, and how big an impact the extra therapy makes in a child’s strength and skills. A lot of the current measures are subjective, Kerman noted, but these toys could quantify the differences.

As of last week, Jyomi had played with toys at Hasbro, but not yet gotten one to take home. But Bodden, her mom, said she loves to see the girl playing with toys just like her little brother’s, having fun like any other child, and getting therapy without even knowing it.

“They don’t look like therapy tools,” she said. “So she’s thinking this is a toy, and she’s focusing on things like getting the cars to go straight. ... We, as parents, try to get our children to do things as any able-bodied child would, and to be able to have these toys and have therapy incorporated – it’s amazing.” •