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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: 0] [Impact Index Per Article: 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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Carneiro MMC, Ribeiro SNS, Menegol NA, Okubo R, Montemezzo D, Sanada LS. Nest positioning on motor development, sleep patterns, weight gain in preterm infants: systematic review. Pediatr Res 2024:10.1038/s41390-023-02972-w. [PMID: 38409428 DOI: 10.1038/s41390-023-02972-w] [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: 05/23/2023] [Revised: 11/24/2023] [Accepted: 12/03/2023] [Indexed: 02/28/2024]
Abstract
The aim was to evaluate the effects of Nest Positioning (NP) on motor development, sleep patterns, and weight gain in preterm newborns (PTNB) hospitalized in a neonatal intensive care unit (NICU). This study was constructed based on PRISMA guideline criteria. Systematic research was carried out in electronic databases: MEDLINE via PubMed, Web of Science, Scopus, and VHL-BIREME following the PICOS strategy. Studies with PTNB populations who were hospitalized in the NICU and received therapeutic NP as an intervention strategy in this population were included in this study. We sought outcomes related to sleep patterns, weight gain, and motor development. After selection, 12 studies were included in this systematic review, of which 5 (41.7%) evaluated motor development as their primary outcome, 6 (50%) sleep-wake cycle patterns, and 1 (8.3%), weight gain and, subsequently, hospital discharge. Qualitative results indicate that prolonged exposure to decubitus variations may favor PTNB hospitalized in NICUs acquiring flexor postures, stimulate their midline, and increase their total sleep time. Studies reported no adverse effects regarding the use of NP. Evidence suggests that NP benefits motor development and sleep pattern in PTNB hospitalized in NICUs. IMPACT: Nest positioning improves sleep quality in preterm newborns hospitalized in neonatal intensive care unit. Nest positioning improves motor development in preterm newborns hospitalized in neonatal intensive care unit. No evidence of nest positioning on weight gain was observed. Half of the included clinical studies showed good methodological quality. Nesting positioning is a secure and cost-effective method.
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Affiliation(s)
- Mayara M C Carneiro
- Programa de Pós-graduação em Fisioterapia, Department of Physical Therapy, Universidade do Estado de Santa Catarina, Florianópolis, SC, Brazil
| | - Simone N S Ribeiro
- Faculdade Ciências Médicas de Minas Gerais, Instituto de Previdência dos Servidores do Estado de Minas Gerais, Belo Horizonte, Brazil
| | - Natália A Menegol
- Programa de Pós-graduação em Fisioterapia, Department of Physical Therapy, Universidade do Estado de Santa Catarina, Florianópolis, SC, Brazil
| | - Rodrigo Okubo
- Programa de Pós-graduação em Fisioterapia, Department of Physical Therapy, Universidade do Estado de Santa Catarina, Florianópolis, SC, Brazil
| | - Dayane Montemezzo
- Programa de Pós-graduação em Fisioterapia, Department of Physical Therapy, Universidade do Estado de Santa Catarina, Florianópolis, SC, Brazil
| | - Luciana Sayuri Sanada
- Programa de Pós-graduação em Fisioterapia, Department of Physical Therapy, Universidade do Estado de Santa Catarina, Florianópolis, SC, Brazil.
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Orton J, Doyle LW, Tripathi T, Boyd R, Anderson PJ, Spittle A. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants. Cochrane Database Syst Rev 2024; 2:CD005495. [PMID: 38348930 PMCID: PMC10862558 DOI: 10.1002/14651858.cd005495.pub5] [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] [Indexed: 02/15/2024]
Abstract
BACKGROUND Infants born preterm are at increased risk of cognitive and motor impairments compared with infants born at term. Early developmental interventions for preterm infants are targeted at the infant or the parent-infant relationship, or both, and may focus on different aspects of early development. They aim to improve developmental outcomes for these infants, but the long-term benefits remain unclear. This is an update of a Cochrane review first published in 2007 and updated in 2012 and 2015. OBJECTIVES Primary objective To assess the effect of early developmental interventions compared with standard care in prevention of motor or cognitive impairment for preterm infants in infancy (zero to < three years), preschool age (three to < five years), and school age (five to < 18 years). Secondary objective To assess the effect of early developmental interventions compared with standard care on motor or cognitive impairment for subgroups of preterm infants, including groups based on gestational age, birthweight, brain injury, timing or focus of intervention and study quality. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO and trial registries in July 2023. We cross-referenced relevant literature, including identified trials and existing review articles. SELECTION CRITERIA Studies included randomised, quasi-randomised controlled trials (RCTs) or cluster-randomised trials of early developmental intervention programmes that began within the first 12 months of life for infants born before 37 weeks' gestational age (GA). Interventions could commence as an inpatient but had to include a post discharge component for inclusion in this review. Outcome measures were not prespecified, other than that they had to assess cognitive outcomes, motor outcomes or both. The control groups in the studies could receive standard care that would normally be provided. DATA COLLECTION AND ANALYSIS Data were extracted from the included studies regarding study and participant characteristics, timing and focus of interventions and cognitive and motor outcomes. Meta-analysis using RevMan was carried out to determine the effects of early developmental interventions at each age range: infancy (zero to < three years), preschool age (three to < five years) and school age (five to < 18 years) on cognitive and motor outcomes. Subgroup analyses focused on GA, birthweight, brain injury, time of commencement of the intervention, focus of the intervention and study quality. We used standard methodological procedures expected by Cochrane to collect data and evaluate bias. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS Forty-four studies met the inclusion criteria (5051 randomly assigned participants). There were 19 new studies identified in this update (600 participants) and a further 17 studies awaiting outcomes. Three previously included studies had new data. There was variability in the focus and intensity of the interventions, participant characteristics, and length of follow-up. All included studies were either single or multicentre trials and the number of participants varied from fewer than 20 to up to 915 in one study. The trials included in this review were mainly undertaken in middle- or high-income countries. The majority of studies commenced in the hospital, with fewer commencing once the infant was home. The focus of the intervention programmes for new included studies was increasingly targeted at both the infant and the parent-infant relationship. The intensity and dosages of interventions varied between studies, which is important when considering the applicability of any programme in a clinical setting. Meta-analysis demonstrated that early developmental intervention may improve cognitive outcomes in infancy (developmental quotient (DQ): standardised mean difference (SMD) 0.27 standard deviations (SDs), 95% confidence interval (CI) 0.15 to 0.40; P < 0.001; 25 studies; 3132 participants, low-certainty evidence), and improves cognitive outcomes at preschool age (intelligence quotient (IQ); SMD 0.39 SD, 95% CI 0.29 to 0.50; P < 0.001; 9 studies; 1524 participants, high-certainty evidence). However, early developmental intervention may not improve cognitive outcomes at school age (IQ: SMD 0.16 SD, 95% CI -0.06 to 0.38; P = 0.15; 6 studies; 1453 participants, low-certainty evidence). Heterogeneity between studies for cognitive outcomes in infancy and preschool age was moderate and at school age was substantial. Regarding motor function, meta-analysis of 23 studies showed that early developmental interventions may improve motor outcomes in infancy (motor scale DQ: SMD 0.12 SD, 95% CI 0.04 to 0.19; P = 0.003; 23 studies; 2737 participants, low-certainty evidence). At preschool age, the intervention probably did not improve motor outcomes (motor scale: SMD 0.08 SD, 95% CI -0.16 to 0.32; P = 0.53; 3 studies; 264 participants, moderate-certainty evidence). The evidence at school age for both continuous (motor scale: SMD -0.06 SD, 95% CI -0.31 to 0.18; P = 0.61; three studies; 265 participants, low-certainty evidence) and dichotomous outcome measures (low score on Movement Assessment Battery for Children (ABC) : RR 1.04, 95% CI 0.82 to 1.32; P = 0.74; 3 studies; 413 participants, low-certainty evidence) suggests that intervention may not improve motor outcome. The main source of bias was performance bias, where there was a lack of blinding of participants and personnel, which was unavoidable in this type of intervention study. Other biases in some studies included attrition bias where the outcome data were incomplete, and inadequate allocation concealment or selection bias. The GRADE assessment identified a lower certainty of evidence in the cognitive and motor outcomes at school age. Cognitive outcomes at preschool age demonstrated a high certainty due to more consistency and a larger treatment effect. AUTHORS' CONCLUSIONS Early developmental intervention programmes for preterm infants probably improve cognitive and motor outcomes during infancy (low-certainty evidence) while, at preschool age, intervention is shown to improve cognitive outcomes (high-certainty evidence). Considerable heterogeneity exists between studies due to variations in aspects of the intervention programmes, the population and outcome measures utilised. Further research is needed to determine which types of early developmental interventions are most effective in improving cognitive and motor outcomes, and in particular to discern whether there is a longer-term benefit from these programmes.
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Affiliation(s)
- Jane Orton
- Royal Women's Hospital, Parkville, Australia
- Department of Physiotherapy, University of Melbourne, Parkville, Australia
| | - Lex W Doyle
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia
| | - Tanya Tripathi
- Department of Physiotherapy, University of Melbourne, Parkville, Australia
| | - Roslyn Boyd
- The University of Queensland, Brisbane, Australia
| | - Peter J Anderson
- Department of Clinical Sciences, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Alicia Spittle
- Department of Physiotherapy, University of Melbourne, Parkville, Australia
- Murdoch Childrens Research Institute and the University of Melbourne, Parkville, Australia
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Fergus A, Wyker C, Heyl N, Lewis T, Hartsook K. Factors influencing caregiver buy-in to early intervention physical therapy. J Pediatr Rehabil Med 2024:PRM230025. [PMID: 38251072 DOI: 10.3233/prm-230025] [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] [Indexed: 01/23/2024] Open
Abstract
PURPOSE The family-centered care framework of Early Intervention (EI) has shifted the focus toward caregiver engagement, but the underlying processes that build this are unknown. The aims of this study were 1) to describe the process of caregiver engagement in therapy and (2) to identify factors perceived to influence caregiver buy-in, confidence, and engagement in EI. METHODS This preliminary descriptive study utilized quantitative questionnaires and qualitative semi-structured interviews of EI participants (23 caregivers and four physical therapists). Interviews were transcribed and theme coded until saturation was achieved and a concept map was developed. RESULTS All caregivers believed that their children benefited from EI, that they were empowered and confident in caring for their children, and their quality of life improved based on the quantitative data. The qualitative data revealed that building a rapport and therapeutic relationship is the foundation to developing buy-in. Reciprocal communication is critical to the relationship and the buy-in. Caregiver knowledge and awareness of progress foster caregiver buy-in and confidence once the relationship is established. CONCLUSION Improved understanding of the factors influencing the development of buy-in will provide a framework for the clinician to enhance caregiver buy-in. Enhanced buy-in may promote parental engagement and improved outcomes for the child and family.
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Alharbi AA, Albalwi AA. Exploring the Influential Factors Impacting the Provision of Family-Centered Care for Children with Cerebral Palsy in Saudi Arabia. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1868. [PMID: 38136070 PMCID: PMC10741779 DOI: 10.3390/children10121868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023]
Abstract
Family-centered care is widely considered as best practice in pediatric rehabilitation. We aimed to investigate parents' perception of the family-centeredness of health care services for their children with cerebral palsy (CP) using the Arabic Measure of Processes of Care-20 (AR-MPOC-20). We also explored factors related to the child (sex, secondary impairments, and gross motor classification system level) and environment (family and residential region) that may influence the family-centeredness of services in Saudi Arabia. This was a cross-sectional study of 223 children with CP (age 6 months-18.2 years, M = 6.2 + 3.7 years) and their parents. Generally, parents perceived services as less family-centered. The lowest average score was for 'Providing General Information' (M = 2.9 ± 1.5), while 'Respectful and Supportive Care' had the highest average (M = 4.6 ± 1.8). Factors influencing the provision of family-centered care included being a female child and a mother's educational level. In addition, all subscales of AR-MPOC-20 differed by region, p < 0.001, except for 'Providing Specific Information' which did not significantly differ by region p = 0.163. Clinicians should consider the families' need for information regarding their children's condition and available services, with special attention to the mothers of female children and mothers with low levels of education.
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Affiliation(s)
- Ahmad Abdullah Alharbi
- Department of Physical Therapy, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 71491, Saudi Arabia;
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Morera-Balaguer J, Lillo-Navarro C, de Oliveira-Sousa SL, Montilla-Herrador J, Escolar-Reina P, Rodríguez-Nogueira Ó, Medina-Mirapeix F. Parents of children with disabilities' perceptions regarding the quality of interaction with Health professionals working in early intervention: A qualitative descriptive study. J Clin Nurs 2023; 32:6519-6532. [PMID: 36380463 DOI: 10.1111/jocn.16580] [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] [Received: 07/08/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study is to explore the perceptions of parents of children with physical disabilities concerning the quality of their interaction with health professionals in early intervention programs. BACKGROUND Despite the consensus on the need for Patient and Family-Centered Care, there are still difficulties when executing such care. The quality of interaction among patients, families, and professionals is essential to facilitate the implementation of the programs. DESIGN A qualitative descriptive study with thematic analysis using a Modified Grounded Theory approach. METHODS Data were collected through seven focus groups with 28 parents of children with physical disabilities who were undergoing early intervention programs in three centres. The study followed the COREQ guidelines and checklist. RESULTS Two themes emerged from the experiences: 'exchange of information and education', which included all the activities, procedures, exercises and skills taught by the professionals to help parents care for their child; and 'interpersonal skills', which focused on the way the professional relates with the child and the parents. Several subthemes emerged within each theme. CONCLUSIONS This study identified which elements of the professional-parent interaction are considered by parents when evaluating the quality of their interaction with the health care provider of their children. RELEVANCE TO CLINICAL PRACTICE The results of this study bring to light certain behaviours and interactions that health professionals should consider in order to improve the perceptions of parents of children with disabilities regarding the quality of interaction in the context of early childhood intervention. PATIENT OR PUBLIC CONTRIBUTION Parents contributed to the data collected. Early intervention professionals were involved in participant checking to ensure the rigour of the study.
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Affiliation(s)
| | - Carmen Lillo-Navarro
- Department of Pathology and Surgery and Center for Translational Research in Physical Therapy (CEIT), University Miguel Hernandez, Alicante, Spain
| | - Silvana-Loana de Oliveira-Sousa
- Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigacion Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
| | - Joaquina Montilla-Herrador
- Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigacion Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
| | - Pilar Escolar-Reina
- Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigacion Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
| | - Óscar Rodríguez-Nogueira
- University of León, Health Sciences School, Nursing and Physical Therapy Department, León, Spain
| | - Francesc Medina-Mirapeix
- Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigacion Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
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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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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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Adiguzel H, Sarikabadayi YU, Elbasan B. Investigation of the effectiveness of family collaborative physiotherapy programs applied to high-risk infants. Physiother Theory Pract 2022:1-17. [PMID: 35387569 DOI: 10.1080/09593985.2022.2062504] [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: 10/18/2022]
Abstract
BACKGROUND The inclusion of families in intervention programs for infants may be more effective in ensuring adherence and positive outcomes. Approaches that include natural and enriched environments that provide communication and family interaction are important in the rehabilitation of high-risk infants. OBJECTIVE To compare the effectiveness of Family Collaborative Approach (FCA) and Neurodevelopmental Therapy (NDT)-based family training. METHODS High-risk infants (n = 63) with a mean age of 32.60 ± 4.53 months received early intervention for 12 weeks. Prechtl's General movements (GMs) assessment, Hammersmith Neonatal Neurological Examination (HNNE), Hammersmith Infant Neurological Examination (HINE), BAYLEY-III Scales of Infant and Toddler Development, and Third Addition (BSID-III) were performed. RESULTS Significant differences between groups were found in HINE scores at the 3rd, 6th, and 12th months (p ≤ .028), and in BSID-III scores at the 6th month (cognitive, language, and motor) (p < .001) and the 12th month (language) (p = .031). There was significant difference between NDT and control group in 3rd month HINE scores and Reflex&Reactions scores (p ≤ .021). FCA group and NDT group was significantly different from control group in 6th month HINE (p = .032) and 12th month HINE scores (p = .007). FCA group significantly different from NDT group (p ≤ .002) and control group (p < .001) in 6th month BSID-III cognitive, language, and motor scores. There was significant difference between FCA and control group in 12 month BSID-III language scores (p = .024). CONCLUSIONS Early physiotherapy interventions were effective in high-risk infants and FCA program was superior to NDT.
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Affiliation(s)
- Hatice Adiguzel
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kahramanmaras Sutcu Imam University, Dulkadiroglu, Turkey
| | | | - Bulent Elbasan
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gazi University, Cankaya, Turkey
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Active head lifting from supine in infancy in the general population: Red flag or not? Early Hum Dev 2021; 163:105466. [PMID: 34543946 DOI: 10.1016/j.earlhumdev.2021.105466] [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: 06/22/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Previously it had been had reported that active head lifting from supine (AHLS) in high-risk infants was associated with lower cognitive scores in the second year. AHLS was generally accompanied by stereotyped leg movements. AIMS To examine in a standardized way whether AHLS with or without stereotyped leg movements in the general population is associated with prenatal, perinatal, neonatal and socio-economic risk factors or with lower scores on concurrent infant tests. STUDY DESIGN Cross-sectional study SUBJECTS: 1700 infants aged 2-18 months representative of the Dutch population. OUTCOME MEASURES Infant Motor Profile (IMP) and Standardized Infant NeuroDevelopmental Assessment (SINDA). Assessments were video-recorded and included at the youngest ages 3min of behaviour in supine. AHLS and the presence of stereotyped leg movements were recorded. Standardized information on early risk factors was available. RESULTS AHLS occurred at 4-9 months (prevalence per months: 1-14%; highest prevalence at 6 months). It was not associated with early risk factors or scores on infant tests. When AHLS was accompanied by stereotyped leg movements it was associated with a higher prevalence of an IMP-variation score < P15 (Odds Ratio (OR) 2.472 [95%CI 1.017; 6.006]). Stereotyped leg movements irrespective of AHLS were associated with more unfavourable total IMP scores and IMP performance scores (B coefficients -3.212 [-4.065; -2.360], -2.521 [-3.783; -1.259]) and IMP variation and SINDA neurological scores (ORs 5.432 [3.409; 8.655], 3.098 [1.548; 6.202]). CONCLUSIONS The data suggest that AHLS is not a red flag. Rather its co-occurring stereotyped leg movements may signal less favourable neurodevelopment.
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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: 13] [Impact Index Per Article: 4.3] [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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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: 43] [Impact Index Per Article: 14.3] [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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