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Exploring factors associated with readiness to change during the acquisition of motor abilities in young children with cerebral palsy Sauve, Karen Ann


Purpose: The timing of physiotherapy intervention for optimal motor outcomes in children with cerebral palsy (CP) remains unknown. Dynamic Systems Theory (DST) suggests this timing is during transition periods when new motor behaviour is emerging; transition periods are identified by increased variability in motor performance. Additionally, factors within the child and environment are thought to influence motor acquisition. The aim of this study was to explore the relationships between these factors and motor acquisition in young children with CP. Specifically the following were examined: 1. a) Variability in motor abilities during a preceding time interval, b) Variability in motor performance during a preceding time interval, 2. Child factors, and 3. Environmental factors. Methods: For this case series, the sample comprised five children with CP, aged three to five years, and classified in levels I to III of the Gross Motor Function Classification System. Each child’s gross motor abilities and performance were assessed during ten home visits using the Gross Motor Function Measure and the Quality FM respectively. Mastery motivation and engagement in daily life were assessed through questionnaires. Environmental factors were described using field notes at each home visit. Results: No associations were found between a) variability in motor abilities or b) variability in motor performance and subsequent motor acquisition in each child individually nor when data were pooled across children. Mastery motivation was inversely associated with motor change (rs=-0.90, p=0.04) for the pooled data set. Child engagement and GMFM scores were not related nor were there trends in field note data with GMFM change scores. Conclusions: Although this study failed to identify associations between the factors explored, the results were likely impacted by the inability of the measurement tools used to capture subtle changes in motor behaviour in this sample. Further investigation is warranted using a larger, diverse sample of children with CP using nonlinear tools designed to measure movement variability. Greater understanding of the implications of variability on the emergence of motor abilities in this population could offer critical insight into how children with CP acquire motor abilities and select optimal motor strategies under task constraints.

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