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Clinical Trials/NCT04247516
NCT04247516CompletedNot Applicable

A Study Protocol for an Online Intervention to Promote School Engagement Through Gamification in Children With Cerebral Palsy

University of Minho2 sites in 1 country60 target enrollmentStarted: September 1, 2021Last updated:
Conditions
Interventions

Trial Snapshot

Phase
Not Applicable
Status
Completed
Enrollment
60
Locations
2
Primary Endpoint
Children Interviews

Study Overview

Brief Summary

Cerebral Palsy (CP) is a neurological, non-progressive, and permanent developmental disorder that mainly affects movement and posture, with a prevalence of 3 to 4 children per 1000 live births. CP's motor impairments are often accompanied by disturbances of sensation, perception, cognition, communication, and behavior. These impairments echo in the activities of daily life, as well as in the learning process. Importantly, children with CP are especially prone to display working memory and EFs deficits, as well as difficulties in self-regulation, which might help explain some of their social and learning problems.

These children have a high risk of showing learning disabilities, which may arise before the schooling years. This risk is not exclusively determined by cognitive impairment, with children with a normative cognitive level still presenting specific learning difficulties (e.g., mathematics, reading).

Due to their clinical picture, children with disabilities, including CP, struggle with their difficulties in school. Consequently, they are prone to develop a poor School Engagement (SE) - multidimensional and multifaceted construct involving three interrelated dimensions: students' behaviors, emotions, and cognition.

In children with disabilities, one of the factors that contributes to lower SE is their high level of school absenteeism. These children miss, on average, 3 weeks of school in a school year due to health issues, which may hinder their academic performance. The promotion of SE in children with disabilities is, therefore, a priority.

To promote SE, Gamification strategies can be used. Gamification is the use of game elements (e.g., points, rewards, feedback) in non-game contexts. The potential of using Gamification is high and constitutes a unique opportunity to engage participants in specific activities, such as in intervention or learning contexts.

Therefore, through game mechanics, Gamification can be used as a tool to promote SE. This is because, it offers an attractive learning environment and converts difficult tasks into more appealing ones, motivating individuals to perform. Moreover, it enhances the degree and depth of participant engagement, rises behavior and lifestyle changes, promotes learning opportunities, motivates students, and improves intervention appeal, especially for youngsters. To conclude, this project aims to increase SE through Gamification in children with CP.

Literature has highlighted the need to focus interventions on SE and self-regulated learning (SRL) on a specific domain. Because children with CP are at high risk of presenting learning difficulties, especially in mathematics, this project will focus on mathematics performance. Moreover, SE is multidimensional, including behaviors, emotions, and cognitions related to school. Specifically, behavioral SE can be conceptualized in three levels: 1) school attendance and fulfillment of school work, 2) participation in class, and 3) active participation (e.g., doing extra school-work). Emotional SE refers to students' affective reactions and sense of connectedness with school. Finally, cognitive SE is related to personal investment in academic tasks, self-regulation, and value of the learning process. Because SRL may be compromised in children with CP, mainly due to difficulties in planning and setting goals, this project will promote SE in mathematics by developing SRL strategies in these children. SRL processes are key for students to attain their self-set goals and include competences of planning, execution, evaluation, and monitoring of the learning process. SE and SRL will be promoted through Gamification strategies on the Canvas platform.

Thus, the main purpose is to assess an intervention program with children with CP to increase SE, and enhance SRL, through Gamification Strategies in mathematics. Specifics aims:

  • Embed Gamification Strategies (e.g., rewards, collaboration, competition) in the Canvas Platform using the tools already available (e.g., forum/chat);
  • Develop and assess the efficacy and impact of the intervention in promoting SE, and SRL competences, through an integrated assessment approach (functional, educational, neurocognitive, and neuroimaging).

Detailed Description

Participants

30 children with CP, age-range between 8 and 15 years (elementary and middle school - 3rd grade to 9th grade), without cognitive impairments, will be selected. Agreements in partaking in the study are already in place with CP rehabilitation centers on the north of Portugal. Participants have already been evaluated through cognitive and neuropsychological tools. Specifically, children should present a cognitive performance at least in Medium- Low level (WISC-III) and should have eventual epilepsy episodes under control. Participants need to be able to use a computer and have internet access, and are required to have a native level of writing and reading skills in the Portuguese language.

Recruitment and selection

Recruitment will take place in the Portuguese associations of cerebral palsy. A collaboration agreement was established with the Federation of Portuguese Cerebral Palsy Associations (FPCPA), which includes 15 Cerebral Palsy Associations in Portugal. The Associations will evaluate their children and identify those who fulfil the inclusion criteria. The first contact with the parents/caregivers will be made by the associations and only after they accept to participate will the research team contact them. When identified, children and their parents will be debriefed, the consents delivered, explained, and signed.

Procedure

Study Design

Study Type
Interventional
Allocation
Randomized
Intervention Model
Parallel
Primary Purpose
Prevention
Masking
None

Eligibility Criteria

Ages
8 Years to 15 Years (Child)
Sex
All
Accepts Healthy Volunteers
No

Inclusion Criteria

  • Children should present a cognitive performance at least in Medium- Low level (WISC-III);
  • Children should have eventual epilepsy episodes under control;
  • Participants need to be able to use a computer and have internet access, and are required to have a native level of writing and reading skills in the Portuguese language.

Exclusion Criteria

  • Not provided

Arms & Interventions

Standard Control Group

No Intervention

The standard control group (CG) will not have access to the self-regulatory (SR) intervention program.

Online-intervention group I (IGI)

Experimental

Online-intervention group will receive on a 6-week long online intervention program. The program includes:

i) a narrative with SR competences embedded worked on a weekly basis during an online session; ii) weekly tasks/activities will be delivered to promote the SR reflected with the narrative exploration.

Intervention: Online-intervention group I (IGI) (Behavioral)

Online-intervention group II (IGII)

Experimental

Online-intervention group will receive on a 6-week long online intervention program. The program includes:

i) a narrative with SR competences embedded worked on a weekly basis during an online session; ii) weekly tasks/activities will be delivered to promote the SR reflected with the narrative exploration; iii) the program includes gamification strategies with the purpose of promoting engagement in participants.

Intervention: Online-intervention group II (IGII) (Behavioral)

Outcomes

Primary Outcomes

Children Interviews

Time Frame: post intervention (up to 6 weeks)

perceived intervention impact interview

Self-Regulation Learning

Time Frame: pre (week 1) and post (up to 6 weeks) intervention

SRL Strategies Inventory (Rosário et al., 2011) 1. Comprises nine self-regulated learning strategies presented in a Likert-like format of 5 points (1=never to 5=always); 2. Items assess the three phases of SRL model: PLEE (three items per each phase); i. Planning (e.g., ''I make a plan before I begin writing. I think about what I want to say and how I need to write it.'' - α=.80), ii. Execution (e.g., ''If I become distracted or lose concentration while I am in class or studying, then I usually try to regain my goals.'' - α=.85) iii. Evaluation (e.g., ''I compare the grades I receive with the goals I set for that subject.''- α=.87). A higher score in the SRL Strategies Inventory translates a better SRL perceived performance.

Functional magnetic resonance imaging (FMRI)

Time Frame: pre (week 1) and post (up to 6 weeks) intervention

A classic test of inhibitory control (Go-No-go task) will be used; another test will be adapted using images from the e-book of the "Incredible Adventures of the Anastácio, the Explorer". The purpose of this two moments evaluation is assess the change in self-control performance and the impact in the neurocognitive structures and neural connections.

Neuropsychological assessment (CANTAB) - Executive function performance

Time Frame: pre (week 1) and post (up to 6 weeks) intervention

This investigation follows the Miyake model of EF. This model postulates that EF is comprised of three latent variables, Inhibition, Shifting, and Updating, that can be learned through the individual's performance. The CANTAB application was selected to evaluate the baseline performance of the participant's pre-intervention and to evaluate the change in participant's performance after the intervention program, i.e., post-assessment. 6 tests were selected: Multitasking Test (Shifting); One Touch Stockings of Cambridge (Updating/Planning) - based upon the Tower of Hanoi test; Stop Signal Task (Inhibition Control); Spatial Working Memory - Working memory); Motor Screening Task (general assessment of sensorimotor deficits or lack of comprehension); Emotion Recognition Task (measure the ability to identify 6 basic emotions in facial expressions).

Engagement

Time Frame: pre (week 1) and post (up to 6 weeks) intervention

School Engagement Scale (Fredricks et al., 2005) 1. The scale comprises 14 items presented in a Likert-like format of 5 points (1=never to 5=always). 2. Items cluster in the three SE dimensions (i.e., behavioral, emotional, and cognitive). i. Behavioral Engagement scale comprises 5 items (e.g., "I follow the rules at school.") (α=.77); ii. Emotional Engagement scale comprises 6 items (e.g., "I feel happy in school.) (α=.86); iii. Cognitive Engagement scale comprises 8 items (e.g., I study at home even when I don't have a test.) (α=.82). A higher score in the School Engagement Scale translates a better-perceived engagement with school.

Secondary Outcomes

  • Session Evaluation(weekly (during 6 weeks))
  • Effort Measures - platform records(daily basis (during 6 weeks))

Investigators

Sponsor Class
Other
Responsible Party
Principal Investigator
Principal Investigator

Sílvia Lopes

Principal Investigator

University of Minho

Study Sites (2)

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