Assessing motivation in cerebral palsy during rehabilitation: a systematic review

Background: Motivation is widely recognized as a key factor influencing learning and rehabilitation outcomes in children with cerebral palsy (CP). Despite its acknowledged relevance, motivation is rarely assessed systematically in pediatric neurorehabilitation, and there is limited consensus regarding appropriate outcome measures. Objectives: This systematic mapping review aimed to examine how motivation-related constructs are assessed in rehabilitation studies involving children with CP, identifying the instruments used and evaluating the extent to which motivation is explicitly measured across different rehabilitation contexts. Methods: The review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420250651843). PubMed and Scopus were searched for studies published between 2013 and 2025. Eligible studies included rehabilitation interventions for children with CP that incorporated a clearly defined motivation-related outcome. Study quality and risk of bias were assessed using Joanna Briggs Institute tools and the RoB 2 tool. Results: Nine studies met the inclusion criteria, including 109 subjects, comprising randomized controlled trials and case series. Most studies involved children with mild to moderate motor impairment (GMFCS or MACS levels I–II). Motivation was assessed through heterogeneous approaches, including self-efficacy, mastery motivation, participation, adherence, and intrinsic motivation, with data collected from children, parents, therapists, or dyads. Conclusions: Although motivation is frequently cited as a critical component of effective rehabilitation in children with CP, its assessment remains inconsistent and methodologically fragmented. This mapping review, based on a limited and heterogeneous evidence base, highlights the need for standardized, validated, and developmentally appropriate tools to measure motivation-related constructs in pediatric CP rehabilitation.