Difficult Paeds patient

The first fourth year placement I was allocated was at PMH in the orthopaedic ward. The main challenge I found on this placement was to adapt the approach to treatment for each patient according to their age, gender, personality, and behavioural characteristics. The usual use of education as a means to motivate patients to participate flies out the window. One patient I had particular difficulty treating was a nine year old boy from a small Aboriginal community many hours out of Perth. On initial assessment he communicated only by nodding or shaking his head or grimacing if in pain. He fixed his gaze downwards and would not respond to conversational questions or do what was asked of him (i.e. Ax AROM). Unsure of how good his English was, what form of encouragement to administer and whether I could use authority or discipline I could only manage to Ax PROM. The next session he agreed to go to the gym to play "games" and rather doing "exercises". I remained in control of the session by setting rules/ challenges and allocating times/no. of repetitions for each game and tried to stick by them. Kicking a soccer ball into goals, setting obsticals; jumping/ hopping in hoops, using a mini trampoline, balancing bean bags, etc. I gave him choices, ie which colour, which ball ect that dont effect Rx so he felt he had some control. I had to correct his movement with manual contact, or use of imagination (you are a star star sporting player; to stop limping) rather than words or demonstration. After lots of encouragement and laughs I found that he was interested so would listen and began to participate in conversation to enable me to build rapour. In one treatment session I gained trust and respect which I could see by the way he responded to the use of my voice and sticking to the boundaies I set. I was also able to assess and treat his problems throughout. I find it a real balancing act. It is also hard to come up with new activities once children get bored of the same tasks or equipment. What are your thoughts or experiences on creating an Ax/Rx plan or educating children effectively?