Caregiver-Provided Physical Therapy Home Programs for Children with Motor Delay: A Scoping Review

Harnessing Mobility: A Medically Complex Child's Home Program Utilizing an In-Home Body Weight Support System

PURPOSE

To describe a home program for a child with medical complexity using an over-ground body weight support (BWS) system.

SUMMARY OF KEY POINTS

Children with medical complexity often use home programs due to challenges with regular therapy attendance. In this case, effective home program components including child centered design, family leadership, and best practice principles were prioritized around the PUMA (portable mobility aid for children). This BWS system was to be used for 1 hour per day to support mobility and active play.

STATEMENT OF CONCLUSIONS

The CMC and family demonstrated high adherence, using over-ground BWS 87% of the 135 days it was accessible with an average daily usage of 59 min spread across 1-3 bouts per day. The average daily fun index during usage was 7/10.

RECOMMENDATIONS FOR CLINICAL PRACTICE

This home program demonstrated over-ground BWS technology as a feasible, fun platform for functional mobility and socialization in a child with significant medical and physical limitations.

Parents' Perspectives on the Application of Home Activities in Early Intervention

Aims: This study explored parents' successes, challenges, and recommendations in relation to the application of home activities in early intervention.Methods: An electronic survey was prepared with Qualtrics software and distributed to parents of children with motor delays. Three open-ended questions were included at the end of the survey. Participants were the child's primary caregiver or guardian and their child must be currently receiving early intervention services or have received early intervention services from a physical or an occupational therapist in the United States in the past 5 years. Two coders used content analysis to analyze parents' responses to open-ended questions.Results: A total of 252 participants responded to at least one of the open-ended questions that were included in the survey. Responses were grouped into codes and categories that lead to the emergence of four themes. The themes indicated parent-reported challenges, successes, and recommendations in relation to team collaboration, individualization of activities, developmental gains, and parental support.Conclusions: The results of this study suggest that more focus should be directed toward parent-therapist partnership, multidisciplinary collaboration, and personalization of activities in early intervention. Parents-reported experiences and recommendation could assist early intervention personnel in advancing services provided for children with motor delays.

Parental Adherence to Home Activities in Early Intervention for Young Children With Delayed Motor Development

OBJECTIVE

The purpose of this study was to investigate the relationship between characteristics of home activities and coaching practices with the adherence of parents of children with motor delays to home activities provided by physical therapists and occupational therapists in early intervention.

METHODS

An online survey study was developed and distributed to physical therapists and occupational therapists across the United States. A survey flier was posted online in parent support groups, physical and occupational therapy groups, newsletters, and organizations supporting parents of children with disabilities.

RESULTS

A total of 720 respondents participated in the survey, and 446 participants from 49 states met the inclusion criteria and were included in the analysis. Parents indicated that physical therapists and occupational therapists applied the 5 coaching practices (joint planning, observation, practice, reflection, and feedback). However, parents (63%) reported more time was needed on coaching. Parents stated that therapists' modeling the activities was the most helpful teaching technique that enhanced their adherence to home activities. Coaching practices, appropriateness of the home activities to daily routines and home environment, provision of home activities enjoyed by the child, and parent self-efficacy were all significantly associated with adherence to home activities.

CONCLUSIONS

Parents' adherence to home activities is affected not only by the type of coaching used by the therapists but also by the characteristics of the home activities provided for young children with delayed motor development.

IMPACT

The results of this study provide additional evidence supporting individualization of home activities to promote parents' continuous provision of learning opportunities to promote their children's development. There was also support of the therapists' use of the 5 coaching practices in early intervention to support the parent's application of home activities when the therapists are not present.

LAY SUMMARY

This study explored the use of home activities from the parents' perspective and provided valuable recommendations to therapists to improve parents' adherence to the recommended home activities in early intervention.

Starting at Birth: An Integrative, State-of-the-Science Framework for Optimizing Infant Neuromotor Health

Numerous conditions and circumstances place infants at risk for poor neuromotor health, yet many are unable to receive treatment until a definitive diagnosis is made, sometimes several years later. In this integrative perspective, we describe an extensive team science effort to develop a transdiagnostic approach to neuromotor health interventions designed to leverage the heightened neuroplasticity of the first year of life. We undertook the following processes: (1) conducted a review of the literature to extract common principles and strategies underlying effective neuromotor health interventions; (2) hosted a series of expert scientific exchange panels to discuss common principles, as well as practical considerations and/or lessons learned from application in the field; and (3) gathered feedback and input from diverse stakeholders including infant caregivers and healthcare providers. The resultant framework was a pragmatic, evidence-based, transdiagnostic approach to optimize neuromotor health for high-risk infants based on four principles: (a) active learning, (b) environmental enrichment, (c) caregiver engagement, and (d) strength-based approaches. In this perspective paper, we delineate these principles and their potential applications. Innovations include: engagement of multiple caregivers as critical drivers of the intervention; promoting neuromotor health in the vulnerability phase, rather than waiting to treat neuromotor disease; integrating best practices from adjacent fields; and employing a strengths-based approach. This framework holds promise for implementation as it is scalable, pragmatic, and holistically addresses both the needs of the infant and their family.

Parents' Experiences with Implementing Therapy Home Programs for Children with Down Syndrome: A Scoping Review

This scoping review explores parents' experiences with implementing therapy home programs to determine the factors that influence compliance with incorporating therapy activities into their daily routines. Articles that described the experience of parents of children with Down syndrome with implementing an occupational therapy home program were included in this study. Peer-reviewed articles published within the past fifteen years (January 2003 - January 2018) were also included. Six articles met inclusion criteria. Three themes emerged: (1) emphasis on contextualization, (2) the parent-therapist relationship, and (3) emotional burden of parents. The findings suggest that practitioners develop interventions that are enfolded into the family's daily routine as well as considering the parents' emotional resources and learning style when designing therapy activities.

Child and parent perceptions of acceptability and therapeutic value of a socially assistive robot used during pediatric rehabilitation

Purpose: Socially assistive robots are emerging as a method of supporting the rehabilitation of children with physical disabilities. To date there has been no in-depth analysis of parent and child perspectives regarding the use of socially assistive robots for pediatric rehabilitation. The purpose of this study was to capture the experiences of parents and children who participated in a rehabilitation session with a socially assistive rehabilitation robot.Methods: An interpretivist qualitative design was used. Semi-structured interviews of five parent-child pairs were undertaken to examine their experiences during a rehabilitation session with the NAO robot. Interviews were analyzed using inductive thematic analysis.Results: Five themes were identified: 1) affective influence, 2) independence, 3) preference for human interaction, 4) accessibility of therapy and 5) familiarity with technology.Conclusion: Based on parent and child perspectives, the NAO robot is an acceptable complement to rehabilitation therapies. Children and parents perceived the NAO robot to have therapeutic value through its potential to enhance engagement, promote child independence during rehabilitation exercises and its potential support a rehabilitation program when a human therapist is not accessible.Implications for rehabilitationSocially assistive robots are an acceptable tool to support the delivery of exercise programs in pediatric rehabilitation.Therapists need to consider how to provide a positive affective experience during rehabilitation sessions, the use of socially assistive robots may be one method of doing this.When using socially assistive robots to support rehabilitation the individual needs and preferences of the child and family should be considered.Socially assistive robots may have a role in supporting home exercises programs; future work is needed to determine the feasibility of this.