Motivation and motivation-related factors in children with disabilities

1. Introduction

Disability is a general term including impairments in body structures, activity limitations, and participation restrictions that negatively affect an individual’s environmental and self-interaction [1]. Conditions such as cerebral palsy (CP), spinal cord injuries, neuromuscular disorders, and brachial plexus damage lead to disability according to current literature [1, 2].

The meaning of the word motivation is “to want.” It is critical to setting a goal and achieving it. “Motivation” as a term attempts to capture the “how” and “what” that causes a person to act [3]. Motivation has two basic components: intrinsic motivation and extrinsic motivation [4]. Extrinsic motivation is to perform an activity in order to achieve a specific result. The prominent characteristic of extrinsic motivation is that the individual wants to do the activity for a specific purpose, not because they enjoy it [3, 4]. Intrinsic motivation is to want to do something not only for a purpose but also it is natural, interesting, or enjoyable [5]. Intrinsic motivation represents the most impactful type of motivation because it is completely independent and is related to one’s wish [4]. Motivation plays a crucial role in the rehabilitation of children with disabilities. Further, low motivation may reduce participation and could affect the efficacy of the rehabilitation.

Previous studies have shown that the motivation of children with disabilities is lower than their typically developing peers [6, 7, 8]. However, the lack of motivation could affect the effectiveness of treatment by reducing participation in rehabilitation [8, 9]. A study conducted by Simpson et al. stated that a child’s motivation to treatment significantly affects participation in treatment and its success [10]. Jarvikoski et al. found that the child’s motivation to participate in rehabilitation is a strong indicator of physical and psychosocial recovery [11]. Also, it is well understood that participation is critical for rehabilitation success, and patients’ participation in rehabilitation can only be achieved by satisfying their basic needs such as autonomy, competence, and relationship, in order to increase their motivation towards rehabilitation [12]. Although rehabilitation specialists have long recognized that motivation affects rehabilitation outcomes, the dynamic nature of motivation has made it difficult to evaluate motivation [13]. New methods and scales developed to evaluate motivation are very promising in this regard [12, 13]. Therefore, the purpose of this study is to determine the motivation level and investigate the relationship of motivation level with socio-demographic characteristics (i.e., age, gender, comorbidities), functional level, and family satisfaction with rehabilitation centers in children with disabilities. It was hypothesized that there would be a relationship between motivation and family satisfaction, comorbidities, and functional level, and there would be no relationship between the motivation level and the children’s gender and age. In order to increase motivation, it is necessary to have information about motivation and motivation-related factors. Assessing motivation and motivation-related factors will contribute to a better understanding of motivation and the development of optimal rehabilitation conditions.

2. Methods

3. Results

4. Discussion

The motivation of children with disabilities is becoming increasingly important in the field of rehabilitation. However, there is no study to assess the motivation of children with disabilities who participated in a rehabilitation program in Turkey. This study is the first to assess motivation in this population, and it investigated the relationship of motivation level with socio-demographic characteristics, functional level, and family satisfaction with rehabilitation centers. The results of this study showed that the motivation of the children with disabilities who were participating in the rehabilitation program was relatively high. Children’s motivation level was significantly correlated to family satisfaction with rehabilitation centers but not socio-demographic characteristics and functional level.

Tatla et al. found that the PMOT score of the children participating in the rehabilitation program was relatively high which is consistent with the results of the current study [13]. However, autonomy sub-scale scores were lower in the current study compared to Tatla et al. The items in the autonomy sub-scale assessed how well the child managed their options of exercises during the rehabilitation session. The results of this study suggested that children have limitations in choosing exercise for their rehabilitation sessions. Providing children with the opportunity to choose the exercises or encouraging them to make suggestions may improve their motivation in the autonomy area. The increase in autonomy sub-scale scores may signify the development of intrinsic motivation which is the most impactful type of motivation.

Miller et al. stated that age and gender have no effect on motivation [6]. Majnemar et al. found no significant relationship between motivation and age and gender in children with cerebral palsy [18]. In the current study, the value-usefulness sub-scale which questions the patient’s belief in rehabilitation was observed to be more highly scored in females than males, but no significant difference was found between the total motivation scores of males and females. The results of the current study are consistent with the literature, showing that age and gender do not affect the motivation level. However, males’ and females’ belief in rehabilitation may be different.

Miller et al. found no association between the functional level and motivation [6]. However, Majnemar et al. stated that there is a weak to moderate relationship between motivation and functional level [18]. The results of this study are similar to those of Miller et al. In the current study, children’s total WeeFIM score was 108.23 ± 22.14 out of a maximum of 126 points. Children in Miller et al.’s study were at a high functional level, while children in Majnemar et al.’s study were at both low and high functional levels [6, 18]. It was assumed that the discrepancy between the current study and Majnemar et al. could be due to the difference in the functional level of children who were included.

The results of the current study also indicated that the satisfaction of families with the rehabilitation centers was moderately correlated with children’s motivation. The aforementioned result suggests that improving family satisfaction with rehabilitation centers, potentially through modifying the physical conditions of rehabilitation centers and focusing on the interest of the family, may increase the motivation level of children. To the best of our knowledge, there is no study about the aforementioned issue in the literature, so these results may direct future research in this area.

Penny et al. have shown that infants with comorbidities such as premature birth and seizure problems have lower motivation scores in their studies investigating factors influencing the motivation of infants [19]. In the current study, there was no significant difference in children’s motivation level based on presence or absence of comorbidities. Children without comorbidities comprised 80.6% of the study’s sample, and this high rate may have contributed to their high motivation levels.

Meyns et al. have shown that more complicated or simpler exercises according to the child’s functional level may reduce the motivation of the child, so the exercises should be adapted to their functional level [4]. Tatla et al. asked the open-ended question: “How could this therapy session have been better?” The responses of the children were as follows: “playing soccer,” “making another puzzle,” “no need for anything else,” “our rehabilitation program is already amusing” [13]. The same question was also directed to the children. The children in the current study answered that they were more fun and more motivating “to do exercises in the form of playing games, exercising in music accompaniment, playing ball, playing different games, doing different exercises, doing easier, and-or harder exercises.” Further, 22.58% of children stated that their rehabilitation programs were already fun. These results indicated that rehabilitation interventions should be determined according to the child’s functional level and interest during the rehabilitation process.

Regular participation in rehabilitation is crucial for success, and participation of patients in rehabilitation can only be achieved by increasing their motivation to rehabilitation [12]. Since interventions should be planned in an attempt to increase the motivation of children to rehabilitation, it may be useful to assess the motivation levels of children and motivation-related factors.

The current study has some limitations. Only children with high functional levels were included. Therefore, it is difficult to determine the relationship between functional level and motivation. For this reason, the results of this study should be interpreted with caution. Additionally, there are many factors that could not be eliminated in the current study, which may affect motivation in children such as socio-economic level, education level, income status of the family, and the number of years participating in a rehabilitation program. The lack of analysis of these factors has caused some of them to be overlooked, and they may be related to motivation.

In summary, the satisfaction of family with rehabilitation centers was related to motivation. However, age and gender were not related to motivation. It was also found that functional level and comorbidities were not related to children’s motivation. However, these results were obtained in the study including children with high functional levels and a high proportion of children without comorbidities. In order to obtain more robust evidence regarding the effects of the functional level and comorbidities on motivation, there is a need for research to be done with a wider distribution of samples in terms of functional level and comorbidities.