Does Context Matter? Mastery Motivation and Therapy Engagement of Children with Cerebral Palsy

ABSTRACT

Aims: To determine if mastery motivation at baseline predicts engagement in two goal-directed upper limb (UL) interventions for children with unilateral cerebral palsy (UCP). Methods: Participants were 44 children with UCP, mean age 7 years 10 months, Manual Ability Classification System level I (N = 23) or II (N = 21). Twenty-six children received intensive novel group-based intervention (Hybrid Constraint Induced Movement Therapy, hCIMT) and 18 received distributed individual occupational therapy (OT). Caregivers completed the Dimensions of Mastery Questionnaire (DMQ) parent-proxy report at baseline. Children's engagement was independently rated using the Pediatric Volitional Questionnaire (PVQ). Associations between children's mastery motivation and engagement were examined using linear regression. Results: Children who received hCIMT had lower DMQ persistence at baseline (p = .05) yet higher PVQ volitional (p = .04) and exploration (p = .001) scores. Among children who received hCIMT, greater object-oriented persistence was associated with task-directedness (β 0.25, p = .05), seeking challenges (β = 0.51, p = .02), exploration (β = 0.10, p = .03), and volitional scores (β = 0.23, p = .01). Conclusion: Despite having lower levels of persistence prior to engaging in UL interventions, children who received hCIMT demonstrated greater engagement in goal-directed tasks than children who received individual OT. Within hCIMT, children's motivational predisposition to persist with tasks manifested in their exploration and engagement in therapy.

KEYWORDS. :

• Cerebral palsy
• context
• engagement
• motivation
• rehabilitation
• upper limb

Declaration of Interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Trial Registration: ACTRN12613000181707

FUNDING

Laura Miller was supported by a National Health Medical Research Council (NHMRC) Scholarship (1039832) and a University of Queensland Research Scholarship. Roslyn N. Boyd is supported by a Career Development Fellowship from the NHMRC of Australia (1037220). This project was supported by funding from the National Health Medical Research Council Grant (COMBiT project grant: 1003887).

ABOUT THE AUTHORS

Laura Miller is Course Coordinator and Senior Lecturer in Occupational Therapy with the Australian Catholic University and is interested in the personal and environmental influences on occupational performance outcomes for children with developmental disabilities. She has particular interest in working with families and coaching children and caregivers to enhance self efficacy. Jenny Ziviani is the Professor of Children's Allied Health Research, a conjoint position between Children's Health Queensland and The University of Queensland. As well as intervention strategies for children with a range of developmental disabilities, she is concerned with the motivational aspects of therapy interventions to enhance engagement. Robert S. Ware is Senior Statistician at the Child Health Research Centre, The University of Queensland. He has published extensively in the field of developmental disability, and is particularly interested in strategies to improve primary health care for people with intellectual disability. Roslyn N. Boyd is a Professor of Cerebral Palsy Research at the University of Queensland and has conducted more than 14 randomized trials including upper limb rehabilitation in unilateral CP, web based training in CP and ABI, parenting interventions in preterm, CP and ABI. She is interested in outcomes across the ICF including the area of context and mastery motivation, which are infrequently studied.