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B Cunha A, Orlando JM, Alghamdi ZS, Lobo MA. Depth and Quality of Recommendations in Popular Sources About How to Play with Infants: Content Analysis. Phys Occup Ther Pediatr 2024:1-23. [PMID: 38952029 DOI: 10.1080/01942638.2024.2371807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 06/19/2024] [Indexed: 07/03/2024]
Abstract
AIM Systematically evaluate the depth and quality of play recommendations provided in popular sources for parents of infants in the first year of life. METHODS This represents the second stage of a larger analysis of educational content available to parents. Two coders (>90% agreement) extracted and coded play activities from popular websites, applications, and books screened from a systematic online search. Depth of instruction variables were extracted. Activity quality was rated based on opportunities for child-initiated movement, problem-solving with objects, and responsive communication. RESULTS 4370 play activities from 214 sources were analyzed. Activities were likely to suggest specific ages for infants and that a caregiver be present. Less than half of the activities incorporated toys or provided guidance about how to position or physically support infants. Activity quality was low; most activities did not explicitly encourage parents to provide opportunities for child-initiated movement, problem-solving with objects, or quality communication. CONCLUSIONS Parents may encounter a large number of play activities in popular sources, but the depth of instruction and quality of those activities could be improved. Provision of higher-quality education to parents may enhance parent-child play interactions to positively impact parent and child outcomes, especially for children at risk for delays.
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Affiliation(s)
- Andrea B Cunha
- Department of Physical Therapy, Munroe Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Julie M Orlando
- Department of Physical Therapy and Biomechanics & Movement Science Program, University of Delaware, Newark, DE, USA
| | - Zainab S Alghamdi
- Department of Physical Therapy and Biomechanics & Movement Science Program, University of Delaware, Newark, DE, USA
| | - Michele A Lobo
- Department of Physical Therapy and Biomechanics & Movement Science Program, University of Delaware, Newark, DE, USA
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King G, Graham F, Ahkbari Ziegler S. Comparing three coaching approaches in pediatric rehabilitation: contexts, outcomes, and mechanisms. Disabil Rehabil 2024; 46:2708-2719. [PMID: 37386721 DOI: 10.1080/09638288.2023.2229731] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 06/21/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE This Perspectives paper advances understanding of coaching in pediatric rehabilitation. We compare three coaching approaches designed for pediatric rehabilitation: Coping with and Caring for Infants with Special Needs (COPCA), Occupational Performance Coaching (OPC), and Solution-Focused Coaching in Pediatric Rehabilitation (SFC-peds). OBJECTIVES Our objectives are to contrast the theory underpinning the approaches, discuss the evidence for outcomes and hypothesized mechanisms of change, consider the necessary mindsets of effective coaches, and propose directions for research and practice. SUMMARY The coaching approaches have different theoretical bases and are designed for specific contexts, yet are similar in their mechanisms of change and intended outcomes. There is growing evidence of important effects of coaching on coachees' goal achievement, empowerment, and capacity building. Studies indicate that stakeholders value coaching, and provide a preliminary understanding of the mechanisms, including engagement and self-efficacy, by which coaching approaches support clients' self-directed and sustained change. Open, curious, and client-centered practitioner mindsets are fundamental to effective coaching. CONCLUSIONS Coaching is a distinctive group of relational, goal-oriented, and evidence-based approaches that support goal achievement and empowerment. These approaches reflect and advance an ongoing paradigm shift in pediatric rehabilitation-a movement from therapist-as-expert approaches to those that build empowerment and capacity.
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Affiliation(s)
- Gillian King
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Fiona Graham
- Rehabilitation and Research Unit, University of Otago, Wellington, New Zealand
| | - Schirin Ahkbari Ziegler
- School of Health Sciences, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
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Arnevik Austrheim K, Skagen C, Rieber J, Melfald Tveten K. Practice, play, repeat - individualized outcomes after the "intensity matters!"-program for children with disabilities - a descriptive multicase study. Disabil Rehabil 2024; 46:2847-2852. [PMID: 37452469 DOI: 10.1080/09638288.2023.2233905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/28/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE To examine and categorize individual outcomes after the "Intensity matters!"-program, a new, cross-professional intensive intervention for children with disabilities across Norway. MATERIALS AND METHODS 84 children and their parents/legal guardian were enrolled in this multicase study. Participants were active in defining goals, and hereby the content of the intervention. The pre-settled goals were grouped into the categories of body functions and structure, activities and participation inspired by the components of the International Classification of Functioning, Disability, and Health (ICF). The pre-settled goals were assessed pre- and post-intervention by using The Canadian Occupational Performance Measure (COPM). A clinically important change was predefined as a change ≥2 points. RESULTS 1004 pre-settled goals were categorized into focus areas, where 62.4% were categorized as activity; functional mobility (n = 626). Post-intervention assessment of the COPM ratings of child performance and satisfaction showed a mean change of 3.7 (range -0.25;8.5) and 3.8 (range 0.25;10), respectively. CONCLUSION The majority of participants in the "Intensity Matters!"-program had a clinically important change in their individual goals after only three weeks of intervention. This study supports the use of client-centered measures in rehabilitation for children with disabilities, but a further examination of long-term outcome is warranted.
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Affiliation(s)
| | - C Skagen
- Children's Physiotherapy Center, Bergen, Norway
| | - J Rieber
- Children's Physiotherapy Center, Bergen, Norway
| | - K Melfald Tveten
- Children's Physiotherapy Center, Bergen, Norway
- Department of Health and Function, Western Norway University of Applied Sciences, Bergen, Norway
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Graham FP, Williman JA, Desha LN, Snell D, Jones B, Ingham TR, Latu A, Maggo JK, Ranta A, Ziviani J. Occupational Performance Coaching for Children With Neurodisability: A Randomized Controlled Trial Protocol. Can J Occup Ther 2024; 91:4-16. [PMID: 36919383 PMCID: PMC10903119 DOI: 10.1177/00084174231160976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Background. Occupational Performance Coaching (OPC) is a goal-oriented approach in which client agency takes precedence in goal selection, analysis, choice of action, and evaluation of success. The intended outcomes of OPC are improved occupational performance and participation in clients' life situations. Randomized clinical trials are needed to determine the effectiveness of OPC. Purpose. This study protocol outlines a randomized controlled trial (RCT) of OPC compared to usual care with caregivers of children with neurodisability in improving child, caregiver, and family occupational performance. Method. A single-blind, 2-arm parallel-group, cluster RCT of OPC compared to usual care is planned. Therapists delivering the intervention (N = 14) are randomized to "OPC training" or "usual care" groups. The primary outcome is occupational performance improvement in caregiver (N = 84) identified goals. Implications. Findings will provide translational evidence of the effectiveness of OPC and clarify intervention processes. Areas of future OPC research and development will be indicated.
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Affiliation(s)
- Fiona P. Graham
- Fiona P. Graham, Rehabilitation Teaching and Research Unit, University of Otago Wellington, 23A Mein Street, Newtown, Wellington 6242, New Zealand. Phone: ++64 364 3620.
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Sol ME, Kotte EMW, Bolster EAM, Hermsen S, van der Lugt R, Elbers S, Sanders M, Bloemen MAT. Using a behavior change toolkit in pediatric physical therapy to support physical activity: A feasibility study. PLoS One 2023; 18:e0286116. [PMID: 37956123 PMCID: PMC10642777 DOI: 10.1371/journal.pone.0286116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 05/09/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Physical activity levels of children with disabilities are low, as these children and their parents face a wide variety of both personal and environmental barriers. Behavior change techniques support pediatric physical therapists to address these barriers together with parents and children. We developed the What Moves You?! intervention Toolkit (WMY Toolkit) filled with behavioral change tools for use in pediatric physical therapy practice. OBJECTIVE To evaluate the feasibility of using the WMY Toolkit in daily pediatric physical therapy practice. METHODS We conducted a feasibility study with a qualitative approach using semi-structured interviews with pediatric physical therapists (n = 11). After one day of training, the pediatric physical therapists used the WMY Toolkit for a period of 9 weeks, when facilitating physical activity in children with disabilities. We analyzed the transcripts using an inductive thematic analysis followed by a deductive analysis using a feasibility framework. RESULTS For acceptability, pediatric physical therapists found that the toolkit facilitated conversation about physical activity in a creative and playful manner. The working mechanisms identified were in line with the intended working mechanisms during development of the WMY Toolkit, such as focusing on problem solving, self-efficacy and independence. For demand, the pediatric physical therapists mentioned that they were able to use the WMY Toolkit in children with and without disabilities with a broad range of physical activity goals. For implementation, education is important as pediatric physical therapists expressed the need to have sufficient knowledge and to feel confident using the toolkit. For practicality, pediatric physical therapists were positive about the ease of which tools could be adapted for individual children. Some of the design and materials of the toolkit needed attention due to fragility and hygiene. CONCLUSION The WMY Toolkit is a promising and innovative way to integrate behavior change techniques into pediatric physical therapy practice.
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Affiliation(s)
- Marleen E. Sol
- Research Group Lifestyle & Health, Knowledge Center for Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, The Netherlands
- Master Education Pediatric Physical Therapy, Institute of Human Movement Studies, HU University of Applied Sciences, Utrecht, The Netherlands
| | | | - Eline A. M. Bolster
- Research Group Lifestyle & Health, Knowledge Center for Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, The Netherlands
- Master Education Pediatric Physical Therapy, Institute of Human Movement Studies, HU University of Applied Sciences, Utrecht, The Netherlands
| | | | - Remco van der Lugt
- Research Group Co-Design, Research Centre for Learning and Innovation, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Stefan Elbers
- Research Group Lifestyle & Health, Knowledge Center for Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Margreet Sanders
- Research Group Lifestyle & Health, Knowledge Center for Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, The Netherlands
- Master Education Pediatric Physical Therapy, Institute of Human Movement Studies, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Manon A. T. Bloemen
- Research Group Lifestyle & Health, Knowledge Center for Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, The Netherlands
- Master Education Pediatric Physical Therapy, Institute of Human Movement Studies, HU University of Applied Sciences, Utrecht, The Netherlands
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Altunalan T, Sarı Z, Doğan TD, Hacıfazlıoğlu NE, Akman İ, Altıntaş T, Uzer S, Akçakaya NH. Early developmental support for preterm infants based on exploratory behaviors: A parallel randomized controlled study. Brain Behav 2023; 13:e3266. [PMID: 37798860 PMCID: PMC10636377 DOI: 10.1002/brb3.3266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Preterm infants are at high risk for developmental disabilities, and their parents are at increased risk for high stress. Early intervention programs are applied to reduce these adverse outcomes. The primary aim is to compare the efficacy of the novel Explorer Baby early intervention program for the holistic development of preterm infants. The second objective was to compare the stress levels of their mothers. METHODS Randomized clinical trial with 38 weeks-6 months corrected age preterm infants at low risk for cerebral palsy, randomly assigned to experimental (Explorer Baby) or active control neurodevelopmental therapy (NDT) groups. Fifty-seven infants were enrolled in the study, and 51 (26 Explorer Baby, 25 NDT) completed it. Bayley III was used as a primary outcome before, during, and after the intervention. RESULTS When we compared the changes between the groups before and after therapy, no significant differences were found in any of the primary or secondary outcomes (between-group comparisons). When comparing the changes in both groups before and after therapy (in-group comparison), the Explorer Baby group demonstrated significant improvements in cognitive (Hedges' g = .83) and explorative language skills (Hedges' g = .65), whereas the NDT group showed improved parent-child dysfunctional interaction (Hedges' g = 2.66) between T0-T1 and T0-T2. CONCLUSIONS The Explorer Baby early intervention program may be a preferred option to support premature infants without brain injury, as it shows greater skill acquisition than NDT, although not statistically significant. Both methods are safe as they support premature babies without negatively affecting mothers' overall stress levels.
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Affiliation(s)
- Turgay Altunalan
- Department of Physiotherapy and Rehabilitation, Faculty of Health ScienceKaradeniz Technical UniversityTrabzonTurkey
- Department of Physiotherapy and Rehabilitation, Faculty of Health ScienceMarmara UniversityIstanbulTurkey
- Family Consultation CenterSpastic Children's Foundation of Turkey ‐ Cerebral Palsy TurkeyIstanbulTurkey
| | - Zübeyir Sarı
- Department of Physiotherapy and Rehabilitation, Faculty of Health ScienceMarmara UniversityIstanbulTurkey
| | - Tuba Derya Doğan
- Family Consultation CenterSpastic Children's Foundation of Turkey ‐ Cerebral Palsy TurkeyIstanbulTurkey
- Department of Physiotherapy and Rehabilitation, Faculty of Health ScienceIstinye UniversityIstanbulTurkey
| | - Nilüfer Eldeş Hacıfazlıoğlu
- Clinic of Pediatric Neurology, Zeynep Kamil Gynecologic and Pediatric Training and Research HospitalUniversity of Health SciencesIstanbulTurkey
| | - İpek Akman
- Department of Pediatrics, Faculty of MedicineDemiroglu Bilim UniversityIstanbulTurkey
| | - Tuğba Altıntaş
- Department of Health SciencesUskudar UniversityIstanbulTurkey
| | - Sevil Uzer
- Clinic for Child Neurology and Social PediatricsChild Centre MaulbronnMaulbronnGermany
| | - Nihan Hande Akçakaya
- Family Consultation CenterSpastic Children's Foundation of Turkey ‐ Cerebral Palsy TurkeyIstanbulTurkey
- Department of Neurology, Faculty of MedicineDemiroglu Bilim UniversityİstanbulTurkey
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Sørvoll M, Øberg GK, Girolami GL. Motor control and skill acquisition in pediatric physical therapy: an enactive proposal. Front Psychol 2023; 14:1226593. [PMID: 37901085 PMCID: PMC10611475 DOI: 10.3389/fpsyg.2023.1226593] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023] Open
Abstract
Theories of motor control and skill acquisition strongly influence and guide various fields of clinical practice. In last decades, changes in theoretical frameworks related to the conceptualization of brain plasticity, functional structures within the child, and environment have led to a revision of therapy approaches progressing from therapist-driven to child-initiated approaches. Even though theoretical frameworks and clinical practice are closely linked to the child's body, the profession has paid less attention to theories concerning the body's role and status in interpersonal relationships when fostering motor control and skill acquisition in children. In this theoretical paper we discuss the theoretical frameworks of motor control and skill acquisition that currently guide clinical practice. Through highlighting valuable contributions of these theories, we explore theoretical and practical benefits pediatric physical therapy can acquire by taking an enactive approach as a means to bring the child as a subject into focus. We rely on enactive concepts of embodiment, autonomy, and participatory sense-making in our exploration to provide an extended understanding of motor control and skill acquisition shaping our beliefs about what counts in therapeutic encounters in pediatric physical therapy.
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Affiliation(s)
- Marit Sørvoll
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Gunn Kristin Øberg
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Clinical Therapeutic Services, University Hospital North Norway, Tromsø, Norway
| | - Gay L. Girolami
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
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King N, Wiley M, Rose A, Fergus A. Delivery of School-based Physical Therapy via Telehealth: Perceptions and Attitudes of School-based Physical Therapists. Phys Occup Ther Pediatr 2023; 44:180-197. [PMID: 38410919 DOI: 10.1080/01942638.2023.2228898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/15/2023] [Indexed: 02/28/2024]
Abstract
AIMS School-based physical therapists (SBPTs) rapidly transitioned to telehealth during the pandemic. This study explored the perceptions of, and strategies utilized by, SBPTs delivering therapy via telehealth. METHODS Using a grounded theory qualitative design, semi-structured interviews were completed with 13 SBPTs. Interviews were transcribed and theme coded until saturation was achieved. RESULTS The following themes emerged: supports and education, challenges, strategies promoting success, and the outcomes of telehealth. SBPTs overcame challenges including those associated with technology, communication, space, equipment, and examination. Coaching techniques, incorporation into the daily routine, and the sharing of demonstrations promoted success. Telehealth service delivery was perceived to improve communication with educational teams and families, improve efficiency and productivity, increase access to students, promote an appreciation of the family and home context, and enhance family engagement. SBPTs believe incorporating elements of telehealth in conjunction with in-person delivery is ideal. CONCLUSIONS While the COVID-19 pandemic forced a rapid transition to telehealth for SBPTs, lessons learned could have a long-lasting positive impact on school-based services. The benefits of telehealth should be considered in the delivery of school-based physical therapy services.
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Affiliation(s)
- Natalie King
- Division of Physical Therapy, Shenandoah University, Winchester, VA, USA
| | - Michele Wiley
- Division of Physical Therapy, Shenandoah University, Winchester, VA, USA
| | - Alexa Rose
- Division of Physical Therapy, Shenandoah University, Winchester, VA, USA
| | - Andrea Fergus
- Division of Physical Therapy, Shenandoah University, Winchester, VA, USA
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Neamatallah ZA. Level of knowledge of sports coaches and physical education teachers in physical therapy. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The topic of physical therapy has concerned widely among the developed scholarly works but little in the developing context, thus this study pursues to explore the role of level of knowledge of both sports and physical education teachers in the area of physical therapy in context of Jeddah, Saudi Arabia. The study was a descriptive in its nature and through using the questionnaire, the data collected from Jeddah City in Saudi Arabia for further perceptions in this topic. A total of 98 participants involved in this study, and the results showed the majority of the participants had adequate knowledge about the important role and potential benefits of the physical therapy in their workplaces. The implications provided of this study indicate the need to integrate the training sessions of the physical therapy into sports events and activities to avoid injuries and improve rehabilitation and treatment of these injuries once occurred. For further exploration of this issue a larger with different sample is needed to fulfill the research gaps in this field.
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Affiliation(s)
- Ziyad A Neamatallah
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, SAUDI ARABIA
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10
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Akhbari Ziegler S, Suárez X. Reliability, Construct Validity and Completeness of the "Winterthur Observation Protocol" Applied to Early Intervention in Pediatric Physiotherapy Using Coaching. Phys Occup Ther Pediatr 2023; 43:596-610. [PMID: 36823516 DOI: 10.1080/01942638.2023.2181724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 02/02/2023] [Accepted: 02/10/2023] [Indexed: 02/25/2023]
Abstract
AIM To assess intra- and inter-rater reliability, construct validity and completeness of the "Winterthur Observation Protocol" (WOP). METHODS Intra-rater and inter-rater reliability were calculated with the interclass correlation coefficient (ICC) with 95% confidence intervals and Cohens's kappa coefficient based on 18 5-min sequences from six video-recorded early intervention sessions rated by two assessors. Construct validity was based on an increase of coaching over time (three video-recorded sessions) in six therapists during a course on coaching techniques. WOP's completeness - the capacity to cover at least 95% of the specific coaching strategies - was assessed based on 18 video-recorded sessions. RESULTS Intra-rater reliability was excellent: ICCs of continuous variables varied from .87 to 1.0; the kappa-value of categorical variables was 0.90. Inter-rater reliability was sufficient to excellent: ICCs of continuous variables were .47-1.0; the kappa-value of categorical variables was .89, indicating excellent intra-rater reliability. Increasing application of coaching behavior during the course provided evidence of construct validity. More than 95% of the specific coaching strategies could be scored with the WOP. CONCLUSION The WOP is a promising instrument to quantify the contents of early intervention approaches in pediatric physical therapy using coaching. Results must be interpreted with caution due to limited generalizability.
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Affiliation(s)
- Schirin Akhbari Ziegler
- School of Health Sciences, Institute of Physiotherapy, Zurich University of Applied Sciences ZHAW, Winterthur, Switzerland
| | - Ximena Suárez
- Facultad de Medicina, Universidad Nacional Autónoma de México Mexico City, Mexico
- Medicine faculty, Universidad de Salamanca, Salamanca, Spain
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Akhbari Ziegler S, de Souza Morais RL, Magalhães L, Hadders-Algra M. The potential of COPCA's coaching for families with infants with special needs in low- and middle-income countries. Front Pediatr 2023; 11:983680. [PMID: 37082703 PMCID: PMC10111824 DOI: 10.3389/fped.2023.983680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 03/16/2023] [Indexed: 04/22/2023] Open
Abstract
Infants at high biological risk of or with a neurodevelopmental disorder run a high risk of delayed school readiness. This is especially true for infants in low- and middle-income countries (LMICs). This perspective paper first summarizes evidence on intervention elements that are effective in promoting family well-being and child development in infants at high biological risk in high income countries. Crucial elements are family centeredness, goal orientation, a home setting, focus on activity and participation, and challenging the infant to explore the world and the own body by means of self-produced movements. The studies revealed that coaching as applied in COPCA (COPing and CAring for infants with special needs) is a pivotal element determining the success of intervention.The paper continues by describing COPCA and its coaching. Next, we report on two pilot studies addressing COPCA's implementation in Brazil. Finally, we discuss why COPCA is a promising early intervention program for infants at high biological risk of neurodisability in LMICs: COPCA is adapted to the families' strengths and needs, it empowers families and promotes child development therewith facilitating school readiness. Moreover, it may be delivered by tele-coaching therewith eliminating families' burden to travel to distant intervention clinics.
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Affiliation(s)
- Schirin Akhbari Ziegler
- School of Health Sciences, Institute of Physiotherapy, Zurich University of Applied Sciences ZHAW, Winterthur, Switzerland
- Correspondence: Schirin Akhbari Ziegler
| | | | - Lívia Magalhães
- Department of Occupational Therapy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Pediatrics, Division of Developmental Neurology and University of Groningen, Faculty of Theology and Religious Studies, Groningen, Netherlands
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Huisenga D, la Bastide-van Gemert S, Van Bergen AH, Sweeney JK, Hadders-Algra M. Motor development in infants with complex congenital heart disease: A longitudinal study. Dev Med Child Neurol 2023; 65:117-125. [PMID: 35665492 PMCID: PMC10084079 DOI: 10.1111/dmcn.15287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 12/31/2022]
Abstract
AIM To evaluate whether infants with complex congenital heart disease (CCHD) have an increased risk of impaired quality of motor behavior and delayed motor milestones. METHOD A cohort of 69 infants with CCHD (43 males, 26 females) were assessed with the Infant Motor Profile (IMP) at three time periods between 6 to 18 months, mean ages in months (SD): 6.4 (0.7); 12.7 (1.0); 18.5 (0.7) IMP data were available from a reference sample of 300 Dutch infants. Analyses included multivariable logistic regression analysis to estimate differences in IMP scores below the 15th centile between children with CCHD and the reference group, and linear mixed-effects models to assess the effect of ventricular physiology and systemic oxygen saturation (SpO2) of less than 90% on IMP outcomes. RESULTS Infants with CCHD had increased risks of total IMP scores below the 15th centile (lowest odds ratio [OR] at 18mo: 6.82 [95% confidence interval {CI} 2.87-16.19]), especially because of lower scores in the domains of variation, adaptability, and performance. Children with single ventricle CCHD scored consistently 3.03% (95% CI 1.00-5.07) lower than those with two ventricle physiology, mainly from contributions of the variation and performance domains. SpO2 of less than 90% was associated with 2.52% (95% CI 0.49-4.54) lower IMP scores. INTERPRETATION CCHD, especially single ventricle physiology, increases risk of impaired motor development. WHAT THIS PAPER ADDS Complex congenital heart disease (CCHD) substantially increases risk of impaired motor development. CCHD is associated with motor delay and reduced motor variation and adaptability. Single ventricle physiology increases the risk of impaired motor behavior.
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Affiliation(s)
- Darlene Huisenga
- Advocate Children's Hospital, Department of Pediatric Rehabilitation and Development, Oak Lawn, Illinois, USA.,University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands
| | - Sacha la Bastide-van Gemert
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Andrew H Van Bergen
- Advocate Children's Hospital, Department of Pediatric Rehabilitation and Development, Oak Lawn, Illinois, USA.,Advocate Children's Hospital, Advocate Children's Heart Institute, Division of Pediatric Cardiac Critical Care, Oak Lawn, Illinois, USA
| | - Jane K Sweeney
- Rocky Mountain University of Health Professions, Provo, Utah, USA
| | - Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands
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13
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Choong EA, Schladen MM, Alles YB. Relationship-driven, family-centered care via TelePT: Reflections in the wake of COVID-19. Front Psychol 2022; 13:1030741. [DOI: 10.3389/fpsyg.2022.1030741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/24/2022] [Indexed: 12/05/2022] Open
Abstract
In response to the throttling of children’s therapy programs precipitated by COVID-19 shutdowns, interest in the use of telehealth has increased among service providers at both the clinical and administrative levels. TelePT promises to be particularly appropriate in devising programs of on-going, therapeutic exercise interventions for children with neuromotor disorders. From the lay perspective, physical/physiotherapy (PT) which is seemingly characterized by the “hands-on,” and corrective approach to managing impairments, makes it a counter-intuitive candidate for delivery over telehealth. Over the past decades, however, PT as a discipline has increasingly adhered to a relationship-driven, family-centered model of intervention. This model is “hands-off,” figuratively if not always literally, and hence is not necessarily disconsonant with delivery mediated by telehealth technology. The current study explores in-depth the experiences and reflections of seven practicing therapists, on the impact of telehealth, telePT on the operationalization of relationship-based, family-centered methods into therapy. Interpretative phenomenological analysis was selected as the analytic method for understanding participants’ experience providing services using both distance and standard face-to-face practice modalities. Results identified eight principal themes emerging from participants’ descriptions of their experience of delivering therapy over telePT. Four of these themes correspond to the tenets of relationship-driven, family-centered care identified across four frameworks applied to pediatric rehabilitation. The remaining four themes focus on the particularities of the telePT modality and its viability in clinical practice. The ability telePT afforded to “see into the child’s environment” emerged arguably as the greatest value of the modality in patient care. It revealed to therapists so much that they did not know about their patients’ progress and, more strikingly, had not realized they did not know. TelePT provides a unique window into the child’s functioning in the hours he is not in therapy. Given its potential in parent–therapist relationship building, assuring the ecological validity of therapy programs, and the empowerment of families who seek it, telePT is likely to be part of the future of PT and one driver of its evolution as a profession. There is a compelling case to retain telePT modalities offering them alongside in-person formats for convenience, safety, and service quality enhancement.
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Infant motor behaviour and functional and cognitive outcome at school-age: A follow-up study in very high-risk children. Early Hum Dev 2022; 170:105597. [PMID: 35689969 DOI: 10.1016/j.earlhumdev.2022.105597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/31/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND The Infant Motor Profile (IMP) is an appropriate tool to assess and monitor infant motor behaviour over time. Infants at very high risk (VHR) due to a lesion of the brain generally show impaired motor development. They may grow into or out of their neurodevelopmental deficit. AIMS Evaluate associations between IMP-trajectories, summarised by IMP-scores in early infancy and rates of change, and functional and cognitive outcome at school-age in VHR-children. STUDY DESIGN Longitudinal study. SUBJECTS 31 VHR-children, mainly due to a brain lesion, who had multiple IMP-assessments during infancy, were re-assessed at 7-10 years (school-age). OUTCOME MEASURES Functional outcome was assessed with the Vineland-II, cognition with RAKIT 2. Associations between IMP-trajectories and outcome were tested by multivariable linear regression analyses. RESULTS When corrected for sex, maternal education and follow-up age, initial scores of total IMP, variation and performance domains, as well as their rates of change were associated with better functional outcome (unstandardised coefficients [95% CI]): 36.44 [19.60-53.28], 33.46 [17.43-49.49], 16.52 [7.58-25.46], and 513.15 [262.51-763.79], 356.70 [148.24-565.15], and 269 [130.57-407.43], respectively. Positive rates of change in variation scores were associated with better cognition at school-age: 34.81 [16.58-53.03]. CONCLUSION Our study indicated that in VHR-children IMP-trajectories were associated with functional outcome at school-age, and to a minor extent also with cognition. Initial IMP-scores presumably reflect the effect of an early brain lesion on brain functioning, whereas IMP rate of change reflects whether infants are able to grow into or out of their initial neurodevelopmental deficit.
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15
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King G, Smart E, Bowman L, Pinto M. Social participation interventions targeting relational outcomes for young people with physical and developmental disabilities: an umbrella review and narrative synthesis. Disabil Rehabil 2022:1-14. [PMID: 35695048 DOI: 10.1080/09638288.2022.2085332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Purpose: To synthesize knowledge about social participation interventions targeting relational outcomes for young people with physical and developmental disabilities.Method: An umbrella review with a narrative synthesis was conducted to integrate findings of review articles examining social participation interventions targeting relational outcomes (e.g., peer interaction and friendships). Six databases were searched to identify reviews published between 2010 and 2021.Results: Five reviews were identified, examining participation interventions, social/community integration interventions, recreational sport programs, online peer mentorship programs, and augmentative and alternative communication interventions to promote social interaction with peers. Interventions associated with improvements in relational outcomes included group-based programs, programs involving personalized goals, arts-based programs, and multi-component social communication interventions. Recommendations for future research included better description of interventions to identify active ingredients and key mechanisms, measurement of participants' experiences, and the need for interventions to be aligned with the nature of the outcomes examined. Preliminary intervention principles are proposed to guide the design of social participation interventions: individualizing, contextualizing, and immersion in social settings.Conclusions: There are multiple pathways by which to influence the relational outcomes of young people with disabilities. There are implications for the design of social participation interventions based on an ecological/experiential and relational perspective.IMPLICATIONS FOR REHABILITATIONImprovements in relational outcomes are associated with participation in group-based programs, programs involving personalized goals, arts-based programs, and multi-component social communication interventions.Three evidence-informed principles can help guide the design of social participation interventions: (1) personalizing, (2) contextualizing, and (3) immersion in social settings.Greater attention to aligning the nature of intervention with desired outcomes is needed to more effectively measure and promote relational outcomes.
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Affiliation(s)
- Gillian King
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Eric Smart
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Laura Bowman
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Madhu Pinto
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
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16
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Hadders-Algra M. The developing brain: Challenges and opportunities to promote school readiness in young children at risk of neurodevelopmental disorders in low- and middle-income countries. Front Pediatr 2022; 10:989518. [PMID: 36340733 PMCID: PMC9634632 DOI: 10.3389/fped.2022.989518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/27/2022] [Indexed: 11/14/2022] Open
Abstract
This paper discusses possibilities for early detection and early intervention in infants with or at increased risk of neurodevelopmental disorders in low- and middle-income countries (LMICs). The brain's high rate of developmental activity in the early years post-term challenges early detection. It also offers opportunities for early intervention and facilitation of school readiness. The paper proposes that in the first year post-term two early detection options are feasible for LMICs: (a) caregiver screening questionnaires that carry little costs but predict neurodevelopmental disorders only moderately well; (b) the Hammersmith Infant Neurological Examination and Standardized Infant NeuroDevelopmental Assessment (SINDA) which are easy tools that predict neurodisability well but require assessment by health professionals. The young brain's neuroplasticity offers great opportunities for early intervention. Ample evidence indicates that families play a critical role in early intervention of infants at increased risk of neurodevelopmental disorders. Other interventional key elements are responsive parenting and stimulation of infant development. The intervention's composition and delivery mode depend on the infant's risk profile. For instance, in infants with moderately increased risk (e.g., preterm infants) lay community health workers may provide major parts of intervention, whereas in children with neurodisability (e.g., cerebral palsy) health professionals play a larger role.
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Affiliation(s)
- Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Pediatrics, Division of Developmental Neurology and University of Groningen, Faculty of Theology and Religious Studies, Groningen, The Netherlands
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17
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Morgan C, Fetters L, Adde L, Badawi N, Bancale A, Boyd RN, Chorna O, Cioni G, Damiano DL, Darrah J, de Vries LS, Dusing S, Einspieler C, Eliasson AC, Ferriero D, Fehlings D, Forssberg H, Gordon AM, Greaves S, Guzzetta A, Hadders-Algra M, Harbourne R, Karlsson P, Krumlinde-Sundholm L, Latal B, Loughran-Fowlds A, Mak C, Maitre N, McIntyre S, Mei C, Morgan A, Kakooza-Mwesige A, Romeo DM, Sanchez K, Spittle A, Shepherd R, Thornton M, Valentine J, Ward R, Whittingham K, Zamany A, Novak I. Early Intervention for Children Aged 0 to 2 Years With or at High Risk of Cerebral Palsy: International Clinical Practice Guideline Based on Systematic Reviews. JAMA Pediatr 2021; 175:846-858. [PMID: 33999106 PMCID: PMC9677545 DOI: 10.1001/jamapediatrics.2021.0878] [Citation(s) in RCA: 142] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
IMPORTANCE Cerebral palsy (CP) is the most common childhood physical disability. Early intervention for children younger than 2 years with or at risk of CP is critical. Now that an evidence-based guideline for early accurate diagnosis of CP exists, there is a need to summarize effective, CP-specific early intervention and conduct new trials that harness plasticity to improve function and increase participation. Our recommendations apply primarily to children at high risk of CP or with a diagnosis of CP, aged 0 to 2 years. OBJECTIVE To systematically review the best available evidence about CP-specific early interventions across 9 domains promoting motor function, cognitive skills, communication, eating and drinking, vision, sleep, managing muscle tone, musculoskeletal health, and parental support. EVIDENCE REVIEW The literature was systematically searched for the best available evidence for intervention for children aged 0 to 2 years at high risk of or with CP. Databases included CINAHL, Cochrane, Embase, MEDLINE, PsycInfo, and Scopus. Systematic reviews and randomized clinical trials (RCTs) were appraised by A Measurement Tool to Assess Systematic Reviews (AMSTAR) or Cochrane Risk of Bias tools. Recommendations were formed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and reported according to the Appraisal of Guidelines, Research, and Evaluation (AGREE) II instrument. FINDINGS Sixteen systematic reviews and 27 RCTs met inclusion criteria. Quality varied. Three best-practice principles were supported for the 9 domains: (1) immediate referral for intervention after a diagnosis of high risk of CP, (2) building parental capacity for attachment, and (3) parental goal-setting at the commencement of intervention. Twenty-eight recommendations (24 for and 4 against) specific to the 9 domains are supported with key evidence: motor function (4 recommendations), cognitive skills (2), communication (7), eating and drinking (2), vision (4), sleep (7), tone (1), musculoskeletal health (2), and parent support (5). CONCLUSIONS AND RELEVANCE When a child meets the criteria of high risk of CP, intervention should start as soon as possible. Parents want an early diagnosis and treatment and support implementation as soon as possible. Early intervention builds on a critical developmental time for plasticity of developing systems. Referrals for intervention across the 9 domains should be specific as per recommendations in this guideline.
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Affiliation(s)
- Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Lars Adde
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic and Clinical Services, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- Grace Centre for Newborn Care, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | | | - Roslyn N. Boyd
- The University of Queensland, St Lucia, Queensland, Australia
| | | | - Giovanni Cioni
- IRCCS Fondazione Stella Maris, Pisa, Italy
- University of Pisa, Pisa, Italy
| | | | - Johanna Darrah
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Linda S. de Vries
- University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | | | | | | | - Darcy Fehlings
- Holland Bloorview Kids Rehabilitation Hospital, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Hans Forssberg
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Andrea Guzzetta
- IRCCS Fondazione Stella Maris, Pisa, Italy
- University of Pisa, Pisa, Italy
| | - Mijna Hadders-Algra
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Petra Karlsson
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Beatrice Latal
- University Children’s Hospital Zurich, Zurich, Switzerland
| | - Alison Loughran-Fowlds
- Grace Centre for Newborn Care, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Catherine Mak
- The University of Queensland, St Lucia, Queensland, Australia
| | - Nathalie Maitre
- Nationwide Children’s Hospital, The Ohio State University, Columbus
| | - Sarah McIntyre
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Cristina Mei
- Orygen, Parkville, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Angela Morgan
- The Royal Children’s Hospital, Melbourne, Australia
- University of Melbourne, Parkville, Victoria, Australia
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | | | - Domenico M. Romeo
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli, Universitá Cattolica del Sacro Cuore, Rome, Italy
| | - Katherine Sanchez
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Alicia Spittle
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Physiotherapy, University of Melbourne, Parkville, Victoria, Australia
| | | | - Marelle Thornton
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jane Valentine
- Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | | | - Koa Whittingham
- The University of Queensland, St Lucia, Queensland, Australia
| | - Alieh Zamany
- Eugene Child Development and Rehabilitation Center, Oregon Health and Science University, Eugene
| | - Iona Novak
- The University of Sydney, Sydney, Australia
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18
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Akhbari Ziegler S, Rhein M, Meichtry A, Wirz M, Hielkema T, Hadders‐Algra M. The Coping with and Caring for Infants with Special Needs intervention was associated with improved motor development in preterm infants. Acta Paediatr 2021; 110:1189-1200. [PMID: 33047325 PMCID: PMC7984220 DOI: 10.1111/apa.15619] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 12/12/2022]
Abstract
AIM We compared the impact of standard infant physiotherapy and the family-centred programme, Coping with and Caring for Infants with Special Needs (COPCA), in infants born before 32 weeks without significant brain lesions. METHODS This randomised controlled trial was carried out in patients' homes and outpatient settings in Switzerland between January 2016 and October 2019. We used data from the national SwissNeoNet register and an assessment battery that included infant and family outcomes and video analyses of therapy sessions. The Infant Motor Profile was the primary outcome instrument. RESULTS The COPCA group comprised six boys and two girls with a median gestational age of 27 weeks (range 25-30), and the standard care group comprised seven boys and one girl with a median gestational age of 29.5 weeks (range 26-31). COPCA participants improved significantly more between baseline and 18 months in the IMP variation (9.0 percentage points, 95% confidence interval: 0.3-17.5) and performance (12.0 percentage points, 95% confidence interval: 4.1-20.6) domains than standard care participants. COPCA coaching was positively associated with IMP scores at 18 months, but some standard care actions were negatively associated. CONCLUSION COPCA was associated with better motor outcome in infants born before 32 weeks than standard infant physiotherapy.
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Affiliation(s)
- Schirin Akhbari Ziegler
- School of Health Professions Institute of Physiotherapy Zurich University of Applied Sciences ZHAW Winterthur Switzerland
| | - Michael Rhein
- Department of Pediatrics Kantonsspital Winterthur Winterthur Switzerland
- University Children`s Hospital Zurich Zurich Switzerland
| | - André Meichtry
- School of Health Professions Institute of Physiotherapy Zurich University of Applied Sciences ZHAW Winterthur Switzerland
| | - Markus Wirz
- School of Health Professions Institute of Physiotherapy Zurich University of Applied Sciences ZHAW Winterthur Switzerland
| | - Tjitske Hielkema
- Department of Pediatrics Division of Developmental Neurology University Medical Center Groningen University of Groningen Groningen The Netherlands
| | - Mijna Hadders‐Algra
- University of Groningen University Medical Center Groningen Department of Pediatrics Division of Developmental Neurology Groningen The Netherlands
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19
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Hadders-Algra M. Early Diagnostics and Early Intervention in Neurodevelopmental Disorders-Age-Dependent Challenges and Opportunities. J Clin Med 2021; 10:861. [PMID: 33669727 PMCID: PMC7922888 DOI: 10.3390/jcm10040861] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 12/20/2022] Open
Abstract
This review discusses early diagnostics and early intervention in developmental disorders in the light of brain development. The best instruments for early detection of cerebral palsy (CP) with or without intellectual disability are neonatal magnetic resonance imaging, general movements assessment at 2-4 months and from 2-4 months onwards, the Hammersmith Infant Neurological Examination and Standardized Infant NeuroDevelopmental Assessment. Early detection of autism spectrum disorders (ASD) is difficult; its first signs emerge at the end of the first year. Prediction with the Modified Checklist for Autism in Toddlers and Infant Toddler Checklist is possible to some extent and improves during the second year, especially in children at familial risk of ASD. Thus, prediction improves substantially when transient brain structures have been replaced by permanent circuitries. At around 3 months the cortical subplate has dissolved in primary motor and sensory cortices; around 12 months the cortical subplate in prefrontal and parieto-temporal cortices and cerebellar external granular layer have disappeared. This review stresses that families are pivotal in early intervention. It summarizes evidence on the effectiveness of early intervention in medically fragile neonates, infants at low to moderate risk, infants with or at high risk of CP and with or at high risk of ASD.
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Affiliation(s)
- Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Paediatrics-Section Developmental Neurology, 9713 GZ Groningen, The Netherlands
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20
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Hoyt CR, L'Hotta AJ, Bauer AH, Chang CH, Varughese TE, Abel RA, King AA. Activity competence among infants and toddlers with developmental disabilities: Rasch analysis of the Infant Toddler Activity Card Sort (ITACS). J Patient Rep Outcomes 2021; 5:14. [PMID: 33475869 PMCID: PMC7818375 DOI: 10.1186/s41687-021-00287-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Development is rapid in the first years of life. Developmental delays appearing during this critical period have the potential to persist throughout the child’s life. Available standardized assessments for this age record a child’s ability to successfully complete discrete skills but fail to capture whether the child incorporates those skills into daily routines that are meaningful to the child and family. The Infant Toddler Activity Card Sort (ITACS) is a newly developed photograph-based early intervention tool to measure the participation-related concept of activity competence using caregiver report. The purpose of the present study was to use Rasch analysis to determine if ITACS items comprehensively measure the construct of child activity competence. Results A total of 60 child/caregiver dyads participated. The dichotomous caregiver-reported responses (present vs. absent) on the 40 individual ITACS items were used in Rasch analysis, and three iterations of the model were completed. The final model included 51 child/caregiver dyads and 67 ITACS assessments with a good spread of individual ability measure (6.47 logits). All items demonstrated adequate infit except for “sleeping” (range 0.68–1.54). Five items (sleeping, eating at restaurants, brushing teeth, crawling, and interact with pets) demonstrated high Mean Square (MNSQ) outfit statistics and one (take a bath) demonstrated low MNSQ outfit. ITACS items demonstrated a good spread of item difficulty measures (6.27 logits), and a clear ceiling was observed. Three activity items (smiling, breastfeeding, and playing with adults) were rarely endorsed as concerns. The activities most likely to be reported as challenging were “crying/communicating” and “going to school”. Person and item reliability statistics were adequate (0.79 and 0.80, respectively). The separation between individuals and between items were adequate to good (1.96 and 1.99, respectively). Conclusions Findings indicate that ITACS items are measuring a unidimensional construct--activity competence in early childhood. The Rasch analysis of caregiver responses suggest that some activities are more likely to be considered challenging and may be important targets for intervention. These results provide evidence to further validate the ITACS as a caregiver report measure and support its use in the early intervention setting to facilitate caregiver driven goal development.
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Affiliation(s)
- Catherine R Hoyt
- Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Blvd, MSC 8505-66-1, MO, 63108, St. Louis, USA.
| | - Allison J L'Hotta
- Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Blvd, MSC 8505-66-1, MO, 63108, St. Louis, USA
| | - Anna H Bauer
- Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Blvd, MSC 8505-66-1, MO, 63108, St. Louis, USA
| | - Chih-Hung Chang
- Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Blvd, MSC 8505-66-1, MO, 63108, St. Louis, USA.,Institute of Informatics, Washington University School of Medicine, St. Louis, MO, USA.,Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Taniya E Varughese
- Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Blvd, MSC 8505-66-1, MO, 63108, St. Louis, USA
| | - Regina A Abel
- Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Blvd, MSC 8505-66-1, MO, 63108, St. Louis, USA.,Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Allison A King
- Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Blvd, MSC 8505-66-1, MO, 63108, St. Louis, USA.,Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.,Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.,Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.,Institute of Public Health, Washington University School of Medicine, St. Louis, MO, USA
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21
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Hadders‐Algra M, Tacke U, Pietz J, Rupp A, Philippi H. Standardized Infant NeuroDevelopmental Assessment developmental and socio-emotional scales: reliability and predictive value in an at-risk population. Dev Med Child Neurol 2020; 62:845-853. [PMID: 31837010 PMCID: PMC7317584 DOI: 10.1111/dmcn.14423] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2019] [Indexed: 01/05/2023]
Abstract
AIM To assess the reliability and predictive validity of the developmental and socio-emotional scales of the Standardized Infant NeuroDevelopmental Assessment (SINDA). METHOD To assess reliability, two sets of three assessors forming eight assessor-pairs independently rated the developmental and socio-emotional scales of 60 infants. To evaluate predictive validity, 223 infants (gestational age 30wks [range 23-41wks]; 117 males, 106 females) attending a non-academic outpatient clinic were assessed by different assessors with SINDA's neurological, developmental, and socio-emotional scales. Atypical neurodevelopmental outcome at a corrected age of 24 months or older implied a Bayley Mental or Psychomotor Developmental Index score of less than 70 or neurological disorder (including cerebral palsy). Behavioural and emotional disorders were classified according to the International Classification of Diseases, 10th Revision. Predictive values were calculated from SINDA (2-12mo corrected age, median 7mo) and typical versus atypical outcome, and for intellectual disability only (Mental Developmental Index <70). RESULTS Assessors highly agreed on the developmental and socio-emotional assessments (developmental scores: Spearman's rank correlation coefficient ρ=0.972; single socio-emotional behaviour items: Cohen's κ=0.783-0.896). At 24 months or older, 65 children had atypical outcome. Atypical neurological scores predicted atypical outcome (sensitivity 83%, specificity 96%); atypical developmental scores predicted intellectual disability (sensitivity 77%, specificity 92%). Atypical emotionality and atypical self-regulation were associated with behavioural and emotional disorders. INTERPRETATION SINDA's three scales are reliable, and have a satisfactory predictive validity for atypical developmental outcome at 24 months or older in a non-academic outpatient setting. SINDA's developmental scale has promising predictive validity for intellectual disability. SINDA's socio-emotional scale is a tool for caregiver counselling. WHAT THIS PAPER ADDS Standardized Infant NeuroDevelopmental Assessment (SINDA)'s developmental and socio-emotional scales have excellent interrater reliability. Replication of the satisfactory validity of SINDA's neurological scale for atypical outcome.
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Affiliation(s)
- Mijna Hadders‐Algra
- University of GroningenUniversity Medical Center GroningenDepartment of PaediatricsDivision of Developmental NeurologyGroningenthe Netherlands
| | - Uta Tacke
- University Children’s Hospital (UKBB)BaselSwitzerland
| | - Joachim Pietz
- Palliative Care Team for Children and AdolescentsFrankfurtGermany
| | - André Rupp
- Department of NeurologySection of BiomagnetismUniversity of HeidelbergHeidelbergGermany
| | - Heike Philippi
- Centre for Child NeurologyGoethe UniversityFrankfurt am MainGermany
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22
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General Movement Assessment from videos of computed 3D infant body models is equally effective compared to conventional RGB video rating. Early Hum Dev 2020; 144:104967. [PMID: 32304982 DOI: 10.1016/j.earlhumdev.2020.104967] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/29/2020] [Accepted: 02/03/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND General Movement Assessment (GMA) is a powerful tool to predict Cerebral Palsy (CP). Yet, GMA requires substantial training challenging its broad implementation in clinical routine. This inspired a world-wide quest for automated GMA. AIMS To test whether a low-cost, marker-less system for three-dimensional motion capture from RGB depth sequences using a whole body infant model may serve as the basis for automated GMA. STUDY DESIGN Clinical case study at an academic neurodevelopmental outpatient clinic. SUBJECTS Twenty-nine high risk infants were assessed at their clinical follow-up at 2-4 month corrected age (CA). Their neurodevelopmental outcome was assessed regularly up to 12-31 months CA. OUTCOME MEASURES GMA according to Hadders-Algra by a masked GMA-expert of conventional and computed 3D body model ("SMIL motion") videos of the same GMs. Agreement between both GMAs was tested using dichotomous and graded scaling with Kappa and intraclass correlations, respectively. Sensitivity and specificity to predict CP at ≥12 months CA were assessed. RESULTS Agreement of the two GMA ratings was moderate-good for GM-complexity (κ = 0.58; ICC = 0.874 [95%CI 0.730; 0.941]) and substantial-good for fidgety movements (FMs; Kappa = 0.78, ICC = 0.926 [95%CI 0.843; 0.965]). Five children were diagnosed with CP (four bilateral, one unilateral CP). The GMs of the child with unilateral CP were twice rated as mildly abnormal with FMs. GM-complexity and somewhat less FMs, of both conventional and SMIL motion videos predicted bilateral CP comparably to published literature. CONCLUSIONS Our computed infant 3D full body model is an attractive starting point for automated GMA in infants at risk of CP.
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Akhbari Ziegler S, Hadders‐Algra M. Coaching approaches in early intervention and paediatric rehabilitation. Dev Med Child Neurol 2020; 62:569-574. [PMID: 32065385 PMCID: PMC7187136 DOI: 10.1111/dmcn.14493] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2020] [Indexed: 01/04/2023]
Abstract
Currently, coaching is increasingly applied to foster the involvement of families with an infant or young child with special needs in early intervention and paediatric rehabilitation. Coaching practices are included in many forms of intervention and are regarded as essential to reach beneficial outcomes for the child and family. There are, however, many ambiguities that blur the concept of coaching and hamper its understanding and integration as an evidence-based approach in early intervention and paediatric rehabilitation: lack of differentiation between coaching and training of families, for example. Challenges to incorporate coaching into professional practice relate to adult learning processes and knowledge acquisition, and transformation of attitudes, beliefs, and treatment habits. In this paper, we review the barriers encountered and the possibilities available to promote successful implementation of coaching in early childhood interventions. WHAT THIS PAPER ADDS: Literature defines coaching ambiguously, which hampers its implementation in early intervention. The term 'coaching' should be reserved for relationship-directed, family-centred intervention.
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Affiliation(s)
- Schirin Akhbari Ziegler
- School of Health ProfessionsInstitute of PhysiotherapyZurich University of Applied Sciences ZHAWWinterthurSwitzerland
| | - Mijna Hadders‐Algra
- University of Groningen, University Medical Center GroningenDepartment of Paediatrics, Division of Developmental NeurologyGroningenthe Netherlands
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Akhbari Ziegler S, Mitteregger E, Hadders‐Algra M. Caregivers' experiences with the new family-centred paediatric physiotherapy programme COPCA: A qualitative study. Child Care Health Dev 2020; 46:28-36. [PMID: 31800118 PMCID: PMC7003945 DOI: 10.1111/cch.12722] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 09/23/2019] [Accepted: 11/26/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Caregivers' experiences during early intervention of their infant with special needs have consequences for their participation in the intervention. Hence, it is vital to understand caregivers' view. This study explored caregivers' experiences with the family-centred early intervention programme "COPing with and CAring for infants with special needs" (COPCA). METHODS The data of this qualitative study were collected after 6 months of COPCA intervention in 15 families with an infant with special needs. COPCA was delivered by paediatric physiotherapists in training to become COPCA coaches. Caregivers filled out a study-specific questionnaire with three open-ended questions addressing (a) their overall experience with COPCA, (b) what aspects of COPCA they had experienced as important, and (c) what they had learned during the intervention process. The answers were analysed using a content analyses approach. RESULTS Respondents were mothers. Interrater reliability of the content analyses of the three questions was twice excellent (κ = .95 and κ = .92) and once good (κ = .77). The content analysis of the first question resulted in four categories and three subcategories, for example, evaluation of COPCA as a form of intervention and benefit from COPCA. The content analyses of the second question resulted in eight categories, for example, home-based intervention, support from the therapist, and the attainment of competences. The content analyses of the third question generated seven categories and four subcategories, for example, to support the infant autonomously at home and to recognize the competences of the infant, caregiver confidence, and relationship with the infant. CONCLUSIONS The participating mothers appreciated the COPCA early intervention programme. They especially valued its home-based setting, the support from the coach, and the experience being able to participate as active partners in the intervention make their own decisions. This means that the mothers valued the family-centred, ecological, and relationship-based elements of early intervention that currently are recommended.
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Affiliation(s)
- Schirin Akhbari Ziegler
- School of Health Professions, Institute of PhysiotherapyZurich University of Applied Sciences ZHAWWinterthurSwitzerland
| | - Elena Mitteregger
- School of Health Professions, Institute of PhysiotherapyZurich University of Applied Sciences ZHAWWinterthurSwitzerland
| | - Mijna Hadders‐Algra
- University of GroningenUniversity Medical Center Groningen, Department of Pediatrics, Division of Developmental NeurologyGroningenThe Netherlands
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Hielkema T, Hamer EG, Boxum AG, La Bastide-Van Gemert S, Dirks T, Reinders-Messelink HA, Maathuis CGB, Verheijden J, Geertzen JHB, Hadders-Algra M. LEARN2MOVE 0–2 years, a randomized early intervention trial for infants at very high risk of cerebral palsy: neuromotor, cognitive, and behavioral outcome. Disabil Rehabil 2019; 42:3752-3761. [DOI: 10.1080/09638288.2019.1610508] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Tjitske Hielkema
- Department of Pediatrics, Division of Developmental Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Elisa G. Hamer
- Department of Pediatrics, Division of Developmental Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Neurology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Anke G. Boxum
- Department of Pediatrics, Division of Developmental Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sacha La Bastide-Van Gemert
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tineke Dirks
- Department of Pediatrics, Division of Developmental Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Heleen A. Reinders-Messelink
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Rehabilitation Center “Revalidatie Friesland”, Beetsterzwaag, The Netherlands
| | - Carel G. B. Maathuis
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Johannes Verheijden
- BOSK, Association of persons with a physical disability, Utrecht, The Netherlands
| | - Jan H. B. Geertzen
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mijna Hadders-Algra
- Department of Pediatrics, Division of Developmental Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Ward R, Reynolds JE, Pieterse B, Elliott C, Boyd R, Miller L. Utilisation of coaching practices in early interventions in children at risk of developmental disability/delay: a systematic review. Disabil Rehabil 2019; 42:2846-2867. [PMID: 31021669 DOI: 10.1080/09638288.2019.1581846] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: To conduct a systematic review of early intervention programs (0-5 years) utilising coaching practice characteristics, to identify (i) implementation fidelity; (ii) parent training processes, and (iii) outcome measures of capacity building in parents. The coaching practice characteristics of (1) joint planning, (2) observation, (3) action/practice, (4) reflection and (5) feedback identified by Rush and Shelden were utilised.Method: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed. A comprehensive search of 6 electronic databases was undertaken in March 2016 and updated in February 2018.Results: Of 2397 articles, 18 papers met full inclusion criteria. Of these, 5 were randomised controlled trials. Only one specifically evaluated the impact of parent coaching versus therapist only delivered interventions. Risk of bias and study quality using Downs and Black checklist for clinical trial quality yielded the following descriptive ratings: Seven studies: "Poor" (scores 1-13); Six studies: "Fair" (scores 15-17); and five "Good" (scores 20-24).Conclusion: Coaching in early intervention is well accepted. Nevertheless, this review identified a continued lack of operationalised definitions; inconsistency in the reporting of therapist training and adherence to active ingredients/coaching principles; and an absence of outcome measures focused on parent capacity.Implications for RehabilitationContemporary early intervention services recognise the importance of engaging parents as active participators in their child's development. This is evident by the increase in interventions that utilise parent coaching practices. The findings of this systematic review indicate the need for professionals to:•Describe and document fidelity of coaching practices in the delivery of intervention.•Objectively measure changes in parent capacity and self-efficacy as a result of the coaching based intervention.The reporting of parent capacity measures will allow us to truly examine the effectiveness of coaching practices in empowering families to support their child to realise their full potential.
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Affiliation(s)
- Roslyn Ward
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Bentley, Australia.,Perth Children's Hospital, Kids Rehab WA, Nedlands, Australia
| | - Jess E Reynolds
- Health Department, Child and Adolescent Health Services, Perth, Australia
| | - Bridget Pieterse
- Health Department, Child and Adolescent Health Services, Perth, Australia
| | - Catherine Elliott
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Bentley, Australia.,Perth Children's Hospital, Kids Rehab WA, Nedlands, Australia
| | - Roslyn Boyd
- Queensland Cerebral Palsy and Rehabilitation Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Laura Miller
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
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