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Measuring engagement during a novel upper extremity training program using joystick-operated ride-on toys
Ashley Guillot1,2, Eric Bae3, Timothy E Moore3
1Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT, USA.
Insights
Experienced therapists improve child engagement in Unilateral Cerebral Palsy (UCP) rehabilitation. Higher engagement, especially later in therapy, is linked to better motor outcomes, highlighting the need for structured assessment tools.
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.
Purpose:
Rehabilitation services for children with Unilateral Cerebral Palsy (UCP) are prolonged and intensive, making it difficult to sustain child engagement. Nevertheless, high engagement during sessions is linked to improved motor outcomes. We adapted existing frameworks to develop a coding scheme to assess in-session engagement during a novel intervention using ride-on toys to promote upper extremity function in children with UCP. We assessed the impact of therapist level of experience on in-session engagement during training sessions.
Materials And Methods:
Thirty-two intervention sessions involving 16 children aged 3 to 11 years with UCP and 10 therapists were assessed. We adapted existing tools to assess in-session engagement within the context of our intervention. Data were analysed using Bayesian ordered beta mixed-effects regression models.
Results:
Experienced therapists elicited higher levels of engagement compared to novice therapists. Engagement was higher during training sessions later in the program compared to early sessions. Session length was also related to engagement scores, with longer sessions eliciting greater efforts from therapists to sustain child engagement.
Conclusion:
Engagement should be assessed as a dynamic process co-constructed by the child, therapist, and their relationship over the course of an intervention. A systematic framework to assess in-session engagement is crucial to design strategies to promote in-session engagement and maximise positive therapeutic outcomes during rehabilitation sessions.
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