ASSESSING CHILD ENGAGEMENT IN PEDIATRIC REHABILITATION RESEARCH: LESSONS LEARNED FROM IMPLEMENTATION OF A RIDE-ON TOY NAVIGATION TRAINING PROGRAM

Purpose: Pediatric rehabilitation research has long recognized the importance of child engagement in promoting compliance with therapy and being predictive of positive outcomes following interventions.1,2 However, literature is limited on the systematic evaluation of engagement during pediatric interventions. Recently, several tools have been proposed to assess engagement among pediatric clients.3-5 We adapted existing frameworks3,5 and created a systematic, quantitative, and manualized coding system to score pediatric engagement during interventions. We tested this coding approach by assessing child engagement during a ride-on toy navigation (RNT) training program.

Description: We developed a 14-item coding system to assess engagement from a relational perspective as being co-constructed through interactions between the child and service-provider.1-3 We combined items from the Pediatric Rehabilitation Intervention Measure of Engagement-Observation3 (PRIME-O; 10 items) and the Pediatric Rehabilitation Observational Measure of Fidelity5 (PROF; 4 items) to score child and service provider characteristics relevant to our intervention and inclusive of affective, cognitive, and behavioral aspects of engagement.3 We adapted the PRIME-O’s 5-point Likert rating system3 to score all 14 items. A detailed coding manual comprising definitions and examples of each item within our training context was developed. We created a coding template using the Elan annotation software to code and annotate all instances of each observed item. Finally, annotation statistics from Elan (% time of the total session or rates of specific behaviors) were used to score items. The developed coding methodology was tested by scoring 10 sessions from a study that involved several clinicians delivering a RNT program with children with Unilateral Cerebral Palsy. Intra-rater and inter-rater reliability scores across both raters were high (>95%) for all coded videos. The measure was also able to discriminate between sessions with high and low child engagement

Summary of Use: The materials developed including the coding manual, Elan coding template, and data analytic procedures may be adapted and used by clinicians/researchers to systematically document child engagement during rehabilitation sessions.

Importance to Members: In-session child engagement is crucial to achieve positive outcomes following rehabilitation interventions. Yet, few objective measures exist to assess engagement systematically and track changes in children’s engagement over time. Moreover, several novel intervention programs claim to be ‘motivating’ for children without clear evidence quantifying child engagement during such programs compared to conventional therapy. A systematic and reliable method to assess child engagement across the affective, behavioral, and cognitive domains will help clinicians identify factors related to optimal states of engagement, accurately detect signs of disengagement, as well as implement strategies and assess their effectiveness in reengaging the child during rehabilitation sessions.