TOYS4THERAPY:Designing Playful Smart Toys to Support Home-Based Hand Therapy for Children with Cerebral Palsy

Children with cerebral palsy (CP), particularly those with spastic hemiplegia, require long-term hand therapy to maintain and improve motor function. While evidence-based interventions such as Constraint-Induced Movement Therapy and Bimanual Training are effective in clinical settings, sustaining therapy at home remains challenging. Home-based therapy is often characterised by repetitive exercises, limited adaptability, and high reliance on parental enforcement, which can decrease children’s motivation, agency, and long-term adherence. This thesis addresses the gap between clinically designed therapy and the lived realities of family life by investigating how playful, adaptive smart toys can support motivating and meaningful hand therapy at home. Adopting a Research through Design (RtD) approach, this work positions smart toys as mediators between clinical goals, children’s intrinsic motivation to play, and the constraints of the home environment. The research integrates insights from play theory, motivation theory, rehabilitation science, and human–computer interaction. Across six interrelated, paper-based chapters, the thesis progresses from understanding the problem space to developing and evaluating design solutions, and finally to synthesising transferable design knowledge. Empirical studies include a scoping review of playful technology-supported hand therapies, co-creation sessions with children, analyses of clinic-to-home therapy translation, and the design and longitudinal field evaluation of the Magic Monster: a smart therapeutic toy that transforms prescribed hand movements into playful interaction. Central to this design is the concept of self-adaptive play complexity, enabled through sensing and machine-learning techniques that identify the correct hand movement to dynamically adjust challenge to the child’s abilities. The thesis culminates in the Smart Toy–CTT (Context–Therapy–Technology) Framework, which synthesises findings into a structured process to guide the design of smart toys for home-based therapy. This thesis reflects on the research journey, answers the two research questions concerning motivation and self-adaptation, and articulates contributions to design research, clinical practice, and interdisciplinary collaboration. Overall, this thesis argues that embedding therapy within playful, adaptive artefacts, designed with sensitivity to family contexts, offers a viable and scalable pathway for supporting children with CP in their everyday therapeutic routines.