Marina Petrevska ^1,2* Jennifer L. Ryan ^1,2 Selvi Sert ¹ Sarah Munce ^2,3 F V. Wright ^1,2,4 Elaine Biddiss ^1,2,5*

• ¹ Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
• ² Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
• ³ The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
• ⁴ Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
• ⁵ Institute of Biomedical Engineering, Faculty of Applied Science & Engineering, University of Toronto, Toronto, Ontario, Canada

Introduction: This study explored the extent to which an interactive computer play system, Bootle Blast, supports motor learning in a clinical context, and clinicians’ perceptions of their therapeutic role in its use as an intervention tool. Methods: In this observational sequential explanatory mixed methods study, five children with cerebral palsy, mean age 9.4 years (SD 0.5), GMFCS Levels I-III, used Bootle Blast during a single, video-recorded therapy session with their treating clinicians (physical therapists, occupational therapists, therapy assistants). Children played one Bootle Blast mini game independently (without clinician involvement) before clinicians carried out therapy sessions with the game as per usual care. The type and extent of motor learning strategies (MLS) delivered by Bootle Blast and clinicians were rated from video-recordings by a trained assessor using the 22-item Motor Learning Strategies Rating Instrument. Semi structured interviews with clinicians were conducted to gain insights into MLS use and clinicians’ perceived role during Bootle Blast use. Interviews were audio recorded, transcribed verbatim and analyzed independently by two researchers using thematic analysis. Quantitative and qualitative data were merged and reported using narrative and joint display approaches. Results: Bootle Blast provided eight MLS with clinicians adding or enhancing another eight MLS. Four themes reflect clinicians’ perspectives: 1) Bootle Blast disguises therapy as play, 2) clinicians give Bootle Blast the human touch; 3) home use of Bootle Blast is promising; and 4) Bootle Blast is not always the right fit, but some shortcomings could be addressed. Agreement was found for 9 MLS and disagreement for 4 MLS when quantitative and qualitative findings were merged. Discussion: Bootle Blast delivers several MLS as part of game play and clinicians can enhance and provide additional MLS to suit the child’s needs/abilities. Further game refinements that were identified in this study may optimize its clinical use.