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Assessing Motivation in Cerebral Palsy During Rehabilitation: A Systematic Review
Daniela De Bartolo1, Marco Iosa1,2, Sara Simigliani3
1SmArt Lab, IRCCS Santa Lucia Foundation, 00179 Rome, Italy.
Insights
Motivation is crucial for children with cerebral palsy (CP) rehabilitation outcomes. This review found motivation assessment in pediatric CP studies is inconsistent, highlighting a need for standardized tools to improve learning and recovery.
Area of Science:
- Pediatric Neurorehabilitation
- Child Psychology
- Rehabilitation Medicine
Background:
- Motivation significantly impacts learning and rehabilitation outcomes in children with cerebral palsy (CP).
- Systematic assessment of motivation is infrequent in pediatric neurorehabilitation.
- There is a lack of consensus on appropriate outcome measures for motivation in this population.
Purpose of the Study:
- To systematically map how motivation-related constructs are assessed in rehabilitation studies for children with CP.
- To identify instruments used for motivation assessment.
- To evaluate the explicit measurement of motivation across diverse rehabilitation settings.
Main Methods:
- Systematic mapping review following PRISMA guidelines, registered in PROSPERO.
- Searched PubMed and Scopus databases for studies published between 2013 and 2025.
- Included studies on rehabilitation interventions for children with CP featuring defined motivation-related outcomes; assessed quality using JBI tools and RoB 2.
Main Results:
- Nine studies with 109 subjects (RCTs, case series) met inclusion criteria, primarily involving children with mild-to-moderate motor impairment (GMFCS/MACS I-II).
- Motivation was assessed using varied approaches: self-efficacy, mastery motivation, participation, adherence, and intrinsic motivation.
- Data collection involved children, parents, therapists, or dyads, indicating heterogeneous assessment methods.
Conclusions:
- Despite recognition of motivation's importance in pediatric CP rehabilitation, its assessment is inconsistent and fragmented.
- The current evidence base is limited and heterogeneous.
- There is a critical need for standardized, validated, and developmentally appropriate tools to measure motivation in pediatric CP rehabilitation.
Abstract:
Background: Motivation is widely recognized as a key factor influencing learning and rehabilitation outcomes in children with cerebral palsy (CP). Despite its acknowledged relevance, motivation is rarely assessed systematically in pediatric neurorehabilitation, and there is limited consensus regarding appropriate outcome measures. Objectives: This systematic mapping review aimed to examine how motivation-related constructs are assessed in rehabilitation studies involving children with CP, identifying the instruments used and evaluating the extent to which motivation is explicitly measured across different rehabilitation contexts. Methods: The review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420250651843). PubMed and Scopus were searched for studies published between 2013 and 2025. Eligible studies included rehabilitation interventions for children with CP that incorporated a clearly defined motivation-related outcome. Study quality and risk of bias were assessed using Joanna Briggs Institute tools and the RoB 2 tool. Results: Nine studies met the inclusion criteria, including 109 subjects, comprising randomized controlled trials and case series. Most studies involved children with mild to moderate motor impairment (GMFCS or MACS levels I-II). Motivation was assessed through heterogeneous approaches, including self-efficacy, mastery motivation, participation, adherence, and intrinsic motivation, with data collected from children, parents, therapists, or dyads. Conclusions: Although motivation is frequently cited as a critical component of effective rehabilitation in children with CP, its assessment remains inconsistent and methodologically fragmented. This mapping review, based on a limited and heterogeneous evidence base, highlights the need for standardized, validated, and developmentally appropriate tools to measure motivation-related constructs in pediatric CP rehabilitation.
