Storytelling-based Program Improves School Engagement in Children with CP, Study Suggests

An educational program that hones cognitive skills using storytelling appears to help promote engagement at school by children with cerebral palsy (CP), a study shows.

Although preliminary, this is the first report describing the benefits of educational interventions for improving school involvement in children with CP.

The study, “Promoting School Engagement in Children with Cerebral Palsy: A Narrative Based Program” was published in the International Journal of Environmental Research and Public Health.

Cerebral palsy is one of the most common physical disorders of childhood;  its lifelong impact is marked by trouble with posture, balance, and controlling movement.

Children with CP are especially prone to poor school engagement. In part, this happens because of their motor limitations, which make them struggle to follow school routines and limits their participation in school activities.

But difficulties in cognitive processes, including working memory and executive function, also are common and likely contribute to learning difficulties.

Executive functions are a set of cognitive skills necessary for the self-control of goal-targeted behaviors. These functions most likely influence school engagement by regulating the ability to follow rules, focus on a task, and sustain attention, for example. Unlike automatic tasks, these functions require effort and the use of self-regulation skills.

Despite its persistent neurological injuries, CP is seen as a disorder that can be modified if the right stimuli and training are provided to the patient. This “opens an opportunity for educational interventions, in which ‘the earlier the better’ is the rule of the thumb,” the researchers wrote.

Some scientists support the use of educational programs that train children’s executive functions and self-regulation capacities as a means to foster school participation and autonomy.

Building on this, a team led by researchers at the University of Minho, Portugal, created and tested an educational program aimed at promoting school engagement, drawing on the training of executive functions and self-regulation learning in children with CP.

The program consisted of a nine-week, narrative-based intervention program, focused on promoting children’s autonomy for daily activities, school trajectories, and pursuing goals.

On the same days of their usual rehabilitation sessions (e.g., occupational therapy), 15 patients, ages 8 to 12 (eight girls) were invited to read the children’s story “The Incredible Adventures of Anastácio, the Explorer,” written specifically for the program.

The story tells the adventures of Anastácio, who is challenged with a package left at his doorstep full of living tools (a map, a magnifying glass, a pencil, and a notepad) and a mission: find a plant to cure the sick rabbits living in the nearby forest. To overcome this challenge, he and his friends needed to find ways to overcome many obstacles. Throughout the adventure, children were encouraged to analyze daily activities, set goals, learn a set of self-regulation strategies, and reflect on divergent solutions.

To evaluate the program’s effectiveness, children and parents/caregivers completed a questionnaire addressing school engagement, and children underwent neuropsychological tests, both before and after completing the program.

School engagement was evaluated across three dimensions: behavioral engagement, emotional engagement, and cognitive engagement.

Behavioral engagement reflects the student’s involvement in school and social activities (e.g., school attendance, the fulfillment of schoolwork, and participation in activities). Emotional engagement refers to students’ feelings and affective reactions toward school (students’ interest, happiness, and valuing of school activities). Emotional engagement refers to school identification and feelings of belonging to the school community.

Results revealed that after completing the program, children improved in all domains of school engagement.

Data also showed that time has a significant main effect in each of the dimensions, but no significant differences were seen between boys and girls.

“These results, despite preliminary, are very encouraging and indicate that the Anastácio program could be considered a valuable tool to promote [school engagement] among children with CP,” the researchers wrote.

“Effective, tailored, narrative-based intervention programs focused on the training of strategies and addressing children’s needs are likely to counteract the impact of specific impairments in school and [activity daily living] challenges,” they wrote, adding that this is “likely to improve their will and skill competences and their overall quality of life”.

The team also proposes that future studies could test the program at younger ages (6–8 years) to help children with CP in earlier stages of their development.