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Child-Caregiver Interactions During a Collaborative Motor Task in Children with Cerebral Palsy: A Descriptive Exploratory Study


Caregiver support is an important contextual factor in the daily functioning of children with cerebral palsy (CP), but few studies have examined child-caregiver interactions during collaborative motor tasks to identify characteristics of effective support that should be promoted in clinical interventions. The aims of this exploratory study were to (1) describe the interaction dynamics of children with CP and typically developing (TD) children with their respective caregivers during a collaborative motor task and (2) develop clinically relevant hypotheses regarding features of child-caregiver interactions that relate to effective caregiver support. Twelve child-caregiver dyads (6 including children with CP, 6 including TD children) participated. Each dyad attempted to construct the tallest tower structure in 10 min using marshmallows and raw spaghetti. Time-series of upper extremity positions were obtained through motion capture and used to examine child-caregiver movement coordination. Videos were coded for language structure and number of building materials used. Five TD dyads and one CP dyad successfully constructed a free-standing tower. During periods of increased tower breakage, TD dyads demonstrated increased movement coordination compared to CP dyads. Unsuccessful dyads (most of whom were CP dyads) demonstrated interaction dynamics characterized by the child leading in movement during periods of increased tower breakage. Overall, in TD dyads, caregivers used more interrogatives than imperatives, and children used more imperatives than interrogatives. This pattern was reversed for CP dyads. From these results we identified future hypotheses about aspects of interactions that may facilitate collaborative motor performance (and thus caregiver support) between children with CP and their caregivers.

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Data Availability

Conversation coding manual, conversation code, and movement coordination code available on the Open Science Framework (OSF):


  1. Abney, D. H., Paxton, A., Dale, R., & Kello, C. T. (2015). Movement dynamics reflect a functional role for weak coupling and role structure in dyadic problem solving. Cognitive Processing, 16(4), 325–332.

    Article  PubMed  Google Scholar 

  2. Anaby, D., Korner-Bitensky, N., Steven, E., Tremblay, S., Snider, L., Avery, L., & Law, M. (2017). Current rehabilitation practices for children with cerebral palsy: focus and gaps. Physical & Occupational Therapy in Pediatrics, 37(1), 1–15.

    Article  Google Scholar 

  3. Angeli, J. M., Harpster, K. L., Hanson, E., Sheehan, A., & Schwab, S. M. (2019). Patient-and caregiver-identified preferences: Dimensions of change in developmental therapy treatment goals. Developmental Neurorehabilitation, 22(1), 39–46.

    Article  PubMed  Google Scholar 

  4. Atkins-Burnett, S., & Allen-Meares, P. (2000). Infants and toddlers with disabilities: Relationship based approaches. Social Work, 45(4), 371–379.

    Article  Google Scholar 

  5. Barfoot, J., Meredith, P., Ziviani, J., & Whittingham, K. (2017). Parent-child interactions and children with cerebral palsy: An exploratory study investigating emotional availability, functional ability, and parent distress. Child: Care, Health and Development, 43(6), 812–822.

    Article  Google Scholar 

  6. Baum, F., & Fisher, M. (2014). Why behavioural health promotion endures despite its failure to reduce health inequities. Sociology of Health & Illness, 36(2), 213–225.

    Article  Google Scholar 

  7. Coco, M. I., & Dale, R. (2014). Cross-recurrence quantification analysis of categorical and continuous time series: An R package. Frontiers in Psychology, 5(510), 1–14.

    Article  Google Scholar 

  8. Cohen, J. (1960). A coefficient of agreement for nominal scales. Educational and Psychological Measurement, 20(1), 37–46.

    Article  Google Scholar 

  9. Cox, R. F., & van Dijk, M. (2013). Microdevelopment in parent-child conversations: From global changes to flexibility. Ecological Psychology, 25(3), 304–315.

    Article  Google Scholar 

  10. D’Arrigo, R., Ziviani, J., Poulsen, A. A., Copley, J., & King, G. (2018). Measures of parent engagement for children receiving developmental or rehabilitation interventions: a systematic review. Physical & Occupational Therapy in Pediatrics, 38(1), 18–38.

    Article  Google Scholar 

  11. Dale, R., & Spivey, M. J. (2006). Unraveling the dyad: Using recurrence analysis to explore patterns of syntactic coordination between children and caregivers in conversation. Language Learning, 56(3), 391–430.

    Article  Google Scholar 

  12. Davidson, A. (2015). Social determinants of health: A comparative approach. Oxford University Press.

    Google Scholar 

  13. Davis, T. J., Pinto, G. B., & Kiefer, A. W. (2017). The stance leads the dance: the emergence of role in a joint supra-postural task. Frontiers in Psychology, 8(718), 1–13.

    Article  Google Scholar 

  14. Duran, N. D., Paxton, A., & Fusaroli, R. (2019). ALIGN: Analyzing linguistic interactions with generalizable techNiques—A Python library. Psychological Methods, 24(4), 419.

    Article  Google Scholar 

  15. Dusing, S. C., Marcinowski, E. C., Rocha, N. A. C. F., Tripathi, T., & Brown, S. E. (2019). Assessment of parent-child interaction is important with infants in rehabilitation and can use high-tech or low-tech methods. Physical Therapy, 99(6), 658–665.

    Article  PubMed  Google Scholar 

  16. Flynn, V., & Masur, E. (2007). Characteristics of maternal verbal style: Responsiveness and directiveness in two natural contexts. Journal of Child Language, 34(3), 519–543.

    Article  PubMed  Google Scholar 

  17. Fusaroli, R., Bahrami, B., Olsen, K., Roepstorff, A., Rees, G., Frith, C., & Tylén, K. (2012). Coming to terms: Quantifying the benefits of linguistic coordination. Psychological Science, 23(8), 931–939.

    Article  Google Scholar 

  18. Karaaslan, O., Diken, I. H., & Mahoney, G. (2013). A randomized control study of responsive teaching with young Turkish children and their mothers. Topics in Early Childhood Special Education, 33(1), 18–27.

    Article  Google Scholar 

  19. Lira-Palma, D., González-Rosales, K., Castillo, R. D., Spencer, R., & Fresno, A. (2018). Categorical cross-recurrence quantification analysis applied to communicative interaction during Ainsworth’s Strange Situation. Complexity, 2018, 4547029.

    Article  Google Scholar 

  20. Marwan, N., & Kurths, J. (2004). Cross recurrence plots and their applications. In C. V. Benton (Ed.), Mathematical physics research at the cutting edge. (pp. 101–139). Nova Science Publishers Inc.

    Google Scholar 

  21. Marwan, N., Romano, M. C., Thiel, M., & Kurths, J. (2007). Recurrence plots for the analysis of complex systems. Physics Reports, 438(5–6), 237–329.

    Article  Google Scholar 

  22. Nicholls, D. A. (2018). The end of physiotherapy. Routledge.

    Google Scholar 

  23. Novak, I., McIntyre, S., Morgan, C., Campbell, L., Dark, L., Morton, N., … & Goldsmith, S. (2013). A systematic review of interventions for children with cerebral palsy: state of the evidence. Developmental Medicine & Child Neurology, 55(10), 885–910.

  24. Novak, I., Morgan, C., Fahey, M., Finch-Edmondson, M., Galea, C., Hines, A., … & Shore, B. (2020). State of the evidence traffic lights 2019: Systematic review of interventions for preventing and treating children with cerebral palsy. Current Neurology and Neuroscience Reports, 20(2), 1–21.

  25. Østensjø, S., Carlberg, E. B., & Vøllestad, N. K. (2004). Motor impairments in young children with cerebral palsy: Relationship to gross motor function and everyday activities. Developmental Medicine & Child Neurology, 46(9), 580–589.

    Article  Google Scholar 

  26. Pennington, L., Goldbart, J., & Marshall, J. (2004). Interaction training for conversational partners of children with cerebral palsy: A systematic review. International Journal of Language & Communication Disorders, 39(2), 151–170.

    Article  Google Scholar 

  27. Rosenbaum, P., & Stewart, D. (2004). The World Health Organization International Classification of functioning, disability, and health: a model to guide clinical thinking, practice and research in the field of cerebral palsy. Seminars in Pediatric Neurology, 11(1), 5–10. From Accessed 5 Oct 2019.

  28. Sebanz, N., Bekkering, H., & Knoblich, G. (2006). Joint action: bodies and minds moving together. Trends in Cognitive Sciences, 10(2), 70–76.

    Article  Google Scholar 

  29. Toro, J., & Martiny, K. (2020). New perspectives on person-centered care: An affordance-based account. Medicine, Health Care and Philosophy, 23(4), 631–644.

    Article  Google Scholar 

  30. World Health Organization. (2001). International classification of functioning, disability and health: ICF. World Health Organization.

    Google Scholar 

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We wish to thank Isabella Cipollone (UConn) and Sean Roach (UConn) for their contributions to video transcription. We would also like to thank the participants of this study.


This work was funded in part by an Ohio Physical Therapy Association Research Grant and Foundation for Physical Therapy Research Promotion of Doctoral Studies (PODS) Level I and Level II Awards supported by the American Physical Therapy Association Scholarship Fund and the Rhomberger Fund (SMS). This material was also based upon work supported by the National Science Foundation Graduate Research Fellowship under Grant No. (2035701) (NSC). Any opinion, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the National Science Foundation. The funding sources had no role in study design, data collection and analysis, or manuscript preparation.

Author information




Sarah M. Schwab: Conceptualization; Data curation; Formal analysis; Funding acquisition; Investigation; Methodology; Software; Visualization; Writing—original draft; Writing—review & editing. Nicole S. Carver: Data Curation; Formal analysis; Software; Writing—original draft; Writing—review & editing. Maia H. Forman: Formal analysis; Writing—review & editing. Drew H. Abney: Conceptualization; Methodology; Software; Writing—review & editing. Tehran J. Davis: Software; Writing—review & editing. Michael A. Riley: Conceptualization; Supervision; Writing—review & editing. Alexandra Paxton: Conceptualization; Methodology; Writing—review & editing. Paula L. Silva: Conceptualization; Methodology; Supervision; Writing—original draft; Writing—review & editing.

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Correspondence to Sarah M. Schwab.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Schwab, S.M., Carver, N.S., Forman, M.H. et al. Child-Caregiver Interactions During a Collaborative Motor Task in Children with Cerebral Palsy: A Descriptive Exploratory Study. J Dev Phys Disabil (2021).

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  • Cerebral palsy
  • Caregivers
  • Interaction
  • Physical therapy
  • Occupational therapy
  • Contextual factors