Measuring engagement during a novel upper extremity training program using joystick-operated ride-on toys

Area of Science:

• Pediatric Rehabilitation
• Occupational Therapy
• Child Development

Background:

• Rehabilitation for children with Unilateral Cerebral Palsy (UCP) is intensive and lengthy, posing challenges to maintaining child engagement.
• Sustained child engagement during therapy sessions is crucial for achieving optimal motor outcomes in UCP.
• Novel interventions utilizing adaptive frameworks are needed to enhance engagement in pediatric rehabilitation.

Purpose of the Study:

• To develop and validate a coding scheme for assessing in-session engagement during a novel ride-on toy intervention for children with UCP.
• To investigate the influence of therapist experience on child engagement levels during UCP rehabilitation sessions.

Main Methods:

• Adaptation of existing engagement assessment tools for a pediatric UCP intervention context.
• Analysis of 32 intervention sessions involving 16 children (3-11 years) with UCP and 10 therapists.
• Utilizing Bayesian ordered beta mixed-effects regression models for data analysis.

Main Results:

• Therapist experience significantly impacts child engagement, with experienced therapists achieving higher engagement levels.
• Child engagement increased in later therapy sessions compared to earlier ones.
• Session duration correlated positively with engagement, indicating longer sessions may foster greater therapist effort to maintain engagement.

Conclusions:

• In-session engagement is a dynamic, co-constructed process between child and therapist, evolving throughout the intervention.
• A systematic framework for assessing in-session engagement is essential for developing targeted strategies to improve therapeutic outcomes in pediatric rehabilitation.
• Understanding and optimizing engagement is key to maximizing the effectiveness of rehabilitation for children with UCP.