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

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.

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.

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.

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.