Independent manipulation is instrumental for children’s cognitive development, and it enables participation in play and academic activities. It also provides a way for demonstrating acquired skills, which is important because, typically, new opportunities for cognitive development will be available only if adults acknowledge that previous milestones were reached.

Cognitive Development

Children develop cognitive, perceptual, and social skills through motor experience (Flanagan, Bowman, and Johansson 2006; McCarty, Clifton,


Julia is a 10-year-old girl with spinal muscular atrophy that affects all four limbs, leading to severe physical limitations in reaching and grasping. She has a power wheelchair with a custom seating-and-positioning system. She controls her wheelchair using a joystick located at her right hand. Her school desk is customized with a slot for her joystick, so she can drive up to the desk. There are no issues with Julia’s vision and hearing, as reported by her teacher. Julia is verbal. She uses an iPad mini™ attached to her wheelchair and positioned directly in front of her using a Modhose iPad Adjustable Cradle™ mounting system. Julia moves her right finger supported by her left hand to access the iPad. She cannot press hard enough to engage the home button, but she can press the iPad screen if it is positioned within her range of motion.

Julia is in an integrated grade four classroom and studies the same curriculum as her classmates. An educational assistant provides academic and personal assistance to Julia and other students in the classroom. Julia’s education assistant or the other students in class perform most manipulation required in the school activities. Julia’s teacher would like Julia to have hands-on experience manipulating the objects the other students are using to make arrays in order to practice the concept of multiplication.

and Collard 2001). Object manipulation, a critical aspect of motor experience, enables the child to acquire the skills required for learning, emergence of symbols, referential communication, and the understanding of relations between objects (Affolter 2004; Bates 1979; Greenfield 1991; McCarty, Clifton, and Collard 2001; Piaget 1954).

Emerging before locomotion, object manipulation is the first means through which the human infant acts on the world. For the first 9 months of life, human infants rely solely on manipulation for independent interaction with the world (Vauclair 1984). Object manipulation also serves as indication that early milestones of cognitive and perceptual development have been reached (Lockman 2005; Vauclair 1984). Through object manipulation, a child progressively starts to relate to objects, explore their properties, and discover how objects can be used to achieve a goal (i.e., tool use, a landmark cognitive skill in infancy) (Lockman 2000). For example, 18-month-old children can choose which hand to use and how to change their grasp when self-feeding if the spoon is placed in an awkward orientation inside a bowl (Keen 2011; McCarty, Clifton, and Collard 1999). The use of objects as tools extends the capability of the child and enhances the child’s interactions (St. Amant and Horton 2008). Thus, tool use has been studied from several cognitive theory approaches. Among these theories, perhaps one of the most influential in the field of child development research is Piaget’s (1950) genetic epistemology.

Piaget’s observations of children’s behaviors led to the definition of four stages of cognitive development that have been used to further explore and understand cognition in children (Solaz-Portolesa and Sanjoseb 2008). According to Piaget, the relation between motor experience and cognitive development starts with the sensorimotor stage (Piaget and Inhelder 1969). The sensorimotor stage takes place during the first 2 years of life and is critical for the achievement of cognitive milestones, such as object permanence and means-end analysis. During the first 2 years, the child actively manipulates objects, explores them individually and sequentially, and finally realizes that one object can be used as a means to reach the other (Piaget 1954). For example, a child can use a stick (McCarty, Clifton, and Collard 2001) or a string (Chen, Sanchez, and Campbell 1997) to retrieve an object out of reach. Other approaches and contributions to the study of cognitive development differ in how and to what extent they emphasize the influence of cultural and social interactions on development (e.g., Vygotsky [1978], 1997). However, there is widespread agreement regarding the critical role of motor experience on the cognitive development of children.

Because of the strong relationship between motor skills and cognitive development, early studies suggested that a lack of motor experience can result in cognitive and perceptual delays (Bertenthal and Campos 1987). The assessment of cognitive skills throughout childhood relies heavily on the child’s motor and verbal skills as avenues for demonstrating or explaining concepts or engaging in problem solving. Thus, children with physical disabilities can lose opportunities to demonstrate their skills or learn and develop new ones.

Much as powered mobility provides children with physical disabilities with opportunities for independent mobility, robots with adapted interfaces can provide children with motor impairments with opportunities for independent manipulation of objects (Alvarez 2014). Children with disabilities can accomplish manipulative tasks through the use of robots because robots compensate for their functional limitations by decreasing the motor demand of the task (Alvarez 2014). Given that the motor requirements to control the robot can be minimal and can be adapted to a wide range of possible anatomical control sites (Poletz et al. 2010), robots can be used as a tool to explore the cognitive skills of children with disabilities. Through robots, children with severe motor impairments can demonstrate what they know and can further benefit from independent interaction with objects (Alvarez 2014).

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