Motivation to Move in Young Children with Cerebral Palsy

Purpose/Hypothesis: In children with neuromotor disabilities, the degree of functional limitation is influenced not only by the severity of physical impairment but also by non-physical factors, such as cognition and motivation to move. Motivation to move has been measured in infants with typical development but has not been well studied in infants with physical disabilities. Our objective was to report motivation to move in young children with CP and to determine if there was a relationship between motivation to move and motor function.

Number of Subjects: Thirty-seven toddlers with CP (20 boys, mean age 26.3 months) were included. All children could initiate pulling to stand (score of at least 1 on the Gross Motor Function Measure item 52) but were not able to take independent steps. Participants were enrolled in a clinical trial (NCT#02340026) at a pediatric academic medical center in a large US city and were randomly allocated to one of two dose-matched physical therapy programs.

Materials/Methods: Videos of randomly selected biweekly 30-minute physical therapy sessions (420 total) were coded for motivation to move per Atun-Einy and colleagues (2013). The 5-point ordinal scale considers the child’s behavior on five factors (persistence to move, frequency of position changes, time in motion, strength of stimulus to elicit movement and energy level), with 5 being highly motivated to move and 1 being weakly motivated to move. One researcher coded all videos in five 6-minute sections. The median value was used as the overall score for analysis. A second researcher double coded 20% of 128 videos for reliability, with a maximum difference of 1 considered reliable. The Gross Motor Function Measure (GMFM-66) was scored by a blinded assessor at baseline. Descriptive statistics are reported and Spearman correlation was used to evaluate the relationship between motivation to move and gross motor function.

Results: All videos in the double-coded dataset reached reliability. There were no differences between groups and therefore results were combined for the full sample. Median motivation to move was 3.0 (range for total video scores 1.0-3.0; range for video section scores 1.0-4.0) which is similar to that reported in 7-month old infants with typical development and lower than reported in 12-month old infants. Higher motivation to move was related to greater gross motor function (r=0.62, p< 0.0001), but not age (r=0.16, p=0.35).

Conclusions: Young children with CP demonstrate a range in motivation to move, with children who have greater gross motor function generally demonstrating higher motivation to move.

Clinical Relevance: Apart from their physical impairment, motivation to move may influence response to rehabilitation therapies in children with CP. Future work should explore the trajectory of motivation to move over the developmental years and the relationship between motivation to move and rehabilitation outcomes in children with CP.