Coaching approaches in early intervention and paediatric rehabilitation

Parents in the Driver's Seat-Experiences of Parent-Delivered Baby-mCIMT Coached Remotely

Background/Objectives: Recent guidelines on early intervention in children at high risk of cerebral palsy (CP) recommend parental involvement and family-centered home-based interventions with parents as primary trainers. Therapist coaching by home visitation is resource demanding, and telerehabilitation is a viable option for remote intervention and coaching. This study aims to describe parents' experiences of engaging in Baby-mCIMT coached remotely. Their infants are at high risk of unilateral cerebral palsy and the parents have been the primary trainers in regard to home-based intervention, optimizing the use of the affected hand. Methods: A qualitative approach involving semi-structured interviews with eight parents was employed. Data were analyzed using qualitative content analysis. Results: The overarching theme "Parents in the driver's seat-learning through remote coaching to create conditions to enhance the child's motor skills" describes parents' experiences as primary training providers. The following three underlying categories with subcategories were identified: (1) Baby-mCIMT coached remotely in an everyday context-practical and technical prerequisites; (2) the child's response and the therapists' coaching supports active parental learning; (3) capability and sense of control-strengthening and demanding aspects. Conclusions: Our findings revealed that Baby-mCIMT coached remotely empowered the parents as primary trainers, which provided them with opportunities for understanding and learning about their child and their development. The findings underscore the importance of responsive professional guidance and a strong therapist-parent relationship to succeed with the Baby-mCIMT program coached remotely and to manage the digital coaching format.

The Development and Pilot Testing of a Fidelity Checklist for a Family-Centered Telehealth Intervention for Parents of Children with Motor Delay

This multi-methods study describes the development of a pediatric rehabilitation telehealth intervention fidelity checklist, estimates its inter-rater reliability, and documents raters' implementation experience. A literature scan and expert consultation identified eighteen key behaviors and categorized them into three subdomains, measured using a 5-point measurement system. To estimate the checklist's inter-rater reliability, three raters scored 33 video recordings. A Shrout and Fleiss Class 1,1 intraclass correlation (ICC)) and 95% confidence intervals (CI) calculated ICCs = 0.5 (CI: 0, 0.9) for both the Therapist and the Parent-Therapists subdomains, and the Parent subdomain an ICC = 0.3 (CI: 0, 0.8). In the implementation surveys, raters reported high levels of satisfaction (100%), ease of use (84% to 88%), and confidence in their video ratings (87% to 100%). Changes in procedures and scoring were recommended. Capturing raters' implementation experiences is crucial in the early evaluation of the fidelity checklists for telehealth.

Comparing three coaching approaches in pediatric rehabilitation: contexts, outcomes, and mechanisms

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.

Current perspectives on perinatal mental health and neurobehavioral development: focus on regulation, coregulation and self-regulation

PURPOSE OF REVIEW

Perinatal mental health research provides an important perspective on neurobehavioral development. Here, we aim to review the association of maternal perinatal health with offspring neurodevelopment, providing an update on (self-)regulation problems, hypothesized mechanistic pathways, progress and challenges, and implications for mental health.

RECENT FINDINGS

(1) Meta-analyses confirm that maternal perinatal mental distress is associated with (self-)regulation problems which constitute cognitive, behavioral, and affective social-emotional problems, while exposure to positive parental mental health has a positive impact. However, effect sizes are small. (2) Hypothesized mechanistic pathways underlying this association are complex. Interactive and compensatory mechanisms across developmental time are neglected topics. (3) Progress has been made in multiexposure studies. However, challenges remain and these are shared by clinical, translational and public health sciences. (4) From a mental healthcare perspective, a multidisciplinary and system level approach employing developmentally-sensitive measures and timely treatment of (self-)regulation and coregulation problems in a dyadic caregiver-child and family level approach seems needed. The existing evidence-base is sparse.

SUMMARY

During the perinatal period, addressing vulnerable contexts and building resilient systems may promote neurobehavioral development. A pluralistic approach to research, taking a multidisciplinary approach to theoretical models and empirical investigation needs to be fostered.

Coaching to Support Children With Disabilities in Occupational Therapy: A Literature Review

IMPORTANCE

Coaching is an effective intervention strategy in occupational therapy but there lacks consensus in the literature about terms, definitions, and approaches used which can be barriers to the clinical use of this method.

OBJECTIVE

The purpose of this review is to understand how coaching adults is used as an intervention to support children with disabilities.

METHODS

Guidelines from foundational scoping review articles and PRISMA-ScR were followed. Studies using adult coaching as an intervention to support children with disabilities were reviewed. A total of 20 articles met inclusion criteria and were included in the review.

FINDINGS

The use of coaching terms and definitions vary. There are commonalities with coaching structures, "key ingredients," and use of outcome measures among studies which can provide a starting framework for occupational therapists wanting to use coaching as an intervention in their practice.

CONCLUSIONS AND RELEVANCE

Coaching adults to support children with disabilities is already known to be an effective occupational therapy intervention strategy. Developing structured protocols with clearer and more unified terminology may improve the fidelity of this intervention approach.

WHAT THIS ARTICLE ADDS

This article presents current practices in adult coaching to support children with disabilities in Occupational Therapy. The authors discuss commonalities across coaching practices for therapists who wish to use coaching protocols in their clinical practice.

Parent coaching to enhance community participation in young children with developmental disabilities: A pilot randomized controlled trial

BACKGROUND

Parent coaching emerges as a preferred approach for enhancing performance and participation of children with developmental disabilities (DD), but limited clinical trials examine its effects on community participation.

AIM

To evaluate whether parent coaching, specifically using Occupational Performance Coaching (OPC), enhances community participation among young children with DD.

METHOD AND PROCEDURES

A pilot double-blind randomized controlled trial was conducted. Parents of 50 children with DD (31 male, 19 female, mean age 4 years 10 months) were randomly assigned to the OPC group (n = 25) or parent consultation group (n = 25). Each parent received a maximum of eight coaching sessions or consultations. The primary outcome was children's community participation as assessed through parent-report measures at baseline, pre-intervention, post-intervention, and an 8-week follow-up.

OUTCOMES AND RESULTS

Both groups showed significant improvements in parent-identified, goal-specific community participation after the intervention (mean difference [MD]=2.26-2.56), and these improvements were sustained during the follow-up. Despite a trend favoring parent coaching, the group difference in the improvements was not evident (MD=0.18-0.28). Both groups displayed positive improvements in children's overall community involvement post-intervention (MD=0.32); however, the time effects were not statistically significant.

CONCLUSIONS AND IMPLICATIONS

OPC, by coaching parents, could enhance goal-specific community participation in children with DD, producing effects similar to those achieved through parent consultation.

Family-Centered Early Intervention Deaf/Hard of Hearing (FCEI-DHH): Foundation Principles

This article is the fifth in a series of eight articles that comprise a special issue on Family-Centered Early Intervention (FCEI) for children who are deaf or hard of hearing (DHH) and their families, or FCEI-DHH. The 10 FCEI-DHH Principles are organized conceptually into three sections (a) Foundation Principles, (b) Support Principles, and (c) Structure Principles. Collectively, they describe the essential Principles that guide FCEI for children who are DHH and their families. This article describes the Foundation Principles (Principles 1 and Principle 2). The Foundation Principles emphasize the essential elements of ensuring that families with children who are DHH can access early intervention (EI) and other appropriate supports, as well as highlight the need for provision of EI that is family-centered. Implementation of these FCEI-DHH Principles is intended to improve the lives and the outcomes of children who are DHH and their families around the globe.

Analysis of a model for pediatric physical therapy and clinical education via telehealth

A novel entry-level collaborative clinical learning experience (CLE) in pediatric physical therapy (PT) delivered via telehealth was implemented involving 12 families, 54 DPT students, and 12 clinical instructors (CIs). Children of various ages, a wide range of home environments, and diagnoses received individualized PT via telehealth during a four-week CLE. Retrospective quantitative and qualitative analyses of student documentation, video recordings of sessions, and CI, student, and caregiver survey responses were performed. All children demonstrated qualitative improvements and 73% demonstrated quantitative improvements. CIs, students, and caregivers believed the children benefited from the experience and 98% believed the children were able to work toward their goals. Most students (95%) and CIs (100%) felt that it was a valuable and effective learning experience. Most (>71%) CIs and students believed students were able to learn in all relevant domains of the clinical performance instrument. This model provides a unique CLE for students in both pediatric PT and telehealth.

Short-term effects of SAFE early intervention approach in infants born preterm: A randomized controlled single-blinded study

OBJECTIVE

Recent literature suggests that goal-oriented and family-based interventions in enriched environment have a beneficial effect on neuromotor and cognitive development. We aimed to examine the short-term effects of SAFE (Sensory strategies, Activity-based motor training, Family collaboration, and Environmental Enrichment) early intervention approach on motor, cognitive, speech and language, and sensory development in preterm infants.

METHODS

The study's sample population consisted of 24 preterm infants with corrected ages between 9 and 10 months. Infants in the control group participated in the family training program in accordance with the neurodevelopmental therapy principles (NDT). Infants in the treatment group were included in the family training program according to the principles of the SAFE Early Intervention Approach. Affordances in the Home Environment for Motor Development-Infant Scale (AHEMD-IS), Test of Sensory Functions in Infants (TSFI), Canadian Occupational Performance Measure (COPM), and Bayley Scales of Infant and Toddler Development III (Bayley III) were used to evaluate infants in both groups before and after 10 weeks of treatment (AHEMD-IS). The Depression, Anxiety, Stress Scale Short Form was used to assess the parents' mental health (DASS-SF).

RESULTS

The interaction effects (time × group) revealed significant differences for Bayley-III cognitive and language scores, TSFI total score, and AHEMD-IS total score in favor of the SAFE group (p < .05). However, there were no differences in Bayley-III motor composite score, COPM Performance score, and COPM Satisfaction score between the interaction effects (time × group) of the groups (p > .05).

CONCLUSIONS

SAFE early intervention approach improved cognitive, speech and language, sensory outcomes and provide enriched home environment in all domains when compared to NDT-based home program. SAFE is a promising novel early intervention approach for preterm infants.

Prioritising rehabilitation in early childhood for inclusive education: a call to action

PURPOSE

This commentary examines the provisions for early childhood development (ECD) in the global action plan for rehabilitation published by the World Health Organisation (WHO) within the context of the United Nations' Sustainable Development Goal (SDG) for inclusive education.

METHODS

The meeting reports of the WHO Rehabilitation 2030 for 2017 and 2019 and the related documents were reviewed along with ECD policy documents from WHO, UNICEF, UNESCO, and the World Bank.

RESULTS

The importance of a life-course approach to rehabilitation for the health and wellbeing of persons with disabilities was highlighted in the Rehabilitation 2030. However, the critical and foundational role of rehabilitation in ECD for children with disabilities to facilitate inclusive education, especially in low- and middle-income countries as envisioned by the SDG 4.2, was not clearly addressed. Children under 5 years with developmental delays and disabilities who are not developmentally on track in health and psychosocial wellbeing require timely rehabilitation to ensure that they benefit from inclusive education.

CONCLUSIONS

The culture and practice of rehabilitation should be nurtured from infancy as an indispensable component of ECD to adequately prepare children with developmental disabilities for inclusive education and ensure effective rehabilitation services over the life course. IMPLICATIONS FOR REHABILITATIONRehabilitation is an integral and critical component of early childhood development to optimise school readiness for children with developmental disabilities.Routine newborn screening, developmental assessment, and surveillance of children from birth are foundational to any effective rehabilitation in early childhood.Global investment to promote and support rehabilitation services from early childhood within the health systems and across all levels of service delivery including community settings is warranted to achieve the sustainable development goals for children with disabilities.

Acceptability of a Multimodal Telerehabilitation Intervention for Children Ages 3-8 Years with Motor Difficulties: Results of a Qualitative Study

PURPOSE

The purpose of this study is to explore the acceptability of a telerehabilitation intervention provided to parents of children with motor difficulties.

MATERIAL AND METHODS

Sixteen parents of children were purposefully recruited to participate in semi-structured interviews aimed at assessing the acceptability of the telerehabilitation intervention. Interviews were analyzed thematically.

RESULTS

All participants described evolving acceptability associated with their interactions with the web platform. The opportunities generated, suitability in relation to families' values and perceived effects positively impacted acceptability. The understanding and consistency of intervention delivery, the child's level of involvement, the associated parental burden of the intervention and the therapeutic alliances created also affected acceptability.

CONCLUSION

Our study findings support the acceptability of a telerehabilitation intervention for families of children with motor difficulties. Telerehabilitation seems to be more acceptable to families with children without suspected or confirmed diagnoses.

Evolution of a System to Monitor Infant Neuromotor Development in the Home: Lessons from COVID-19

In the nine months leading up to COVID-19, our biomedical engineering research group was in the very early stages of development and in-home testing of HUGS, the Hand Use and Grasp Sensor (HUGS) system. HUGS was conceived as a tool to allay parents' anxiety by empowering them to monitor their infants' neuromotor development at home. System focus was on the evolving patterns of hand grasp and general upper extremity movement, over time, in the naturalistic environment of the home, through analysis of data captured from force-sensor-embedded toys and 3D video as the baby played. By the end of March, 2020, as the COVID-19 pandemic accelerated and global lockdown ensued, home visits were no longer possible and HUGS system testing ground to an abrupt halt. In the spring of 2021, still under lockdown, we were able to resume recruitment and in-home testing with HUGS-2, a system whose key requirement was that it be contactless. Participating families managed the set up and use of HUGS-2, supported by a detailed library of video materials and virtual interaction with the HUGS team for training and troubleshooting over Zoom. Like the positive/negative poles of experience reported by new parents under the isolation mandated to combat the pandemic, HUGS research was both impeded and accelerated by having to rely solely on distance interactions to support parents, troubleshoot equipment, and securely transmit data. The objective of this current report is to chronicle the evolution of HUGS. We describe a system whose design and development straddle the pre- and post-pandemic worlds of family-centered health technology design. We identify and classify the clinical approaches to infant screening that predominated in the pre-COVID-19 milieu and describe how these procedural frameworks relate to the family-centered conceptualization of HUGS. We describe how working exclusively through the proxy of parents revealed the family's priorities and goals for child interaction and surfaced HUGS design shortcomings that were not evident in researcher-managed, in-home testing prior to the pandemic.

Reliability, Construct Validity and Completeness of the "Winterthur Observation Protocol" Applied to Early Intervention in Pediatric Physiotherapy Using Coaching

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.

The potential of COPCA's coaching for families with infants with special needs in low- and middle-income countries

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.

Relationship-driven, family-centered care via TelePT: Reflections in the wake of COVID-19

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.

A telehealth nursing intervention to improve the transition from the neonatal intensive care unit to home for infants & caregivers: Preliminary evaluation

PURPOSE

The purpose of this nurse-led telehealth intervention was to support caregivers and infants during the difficult period of transition from the neonatal intensive care unit (NICU) to home.

METHODS

The Baby Steps project was designed using quality improvement methodology, and was implemented in April 2020 at a stand-alone pediatric institution in South Florida. Using a nurse-led telehealth model, follow-up nursing care was provided in the home setting for two weeks after discharge. Any infant cared for in the NICU and discharged to a home setting in the state of Florida was eligible for services. Encounters included assessment, anticipatory guidance, connection with community resources, and general support. Caregiver satisfaction, unplanned emergency care use, and 30-day readmissions were assessed.

RESULTS

Within the first 18 months of the program, a total of 378 infants were enrolled, and 74.6% received follow-up services in the home setting (n = 282). Caregivers reported high satisfaction with the program (100% strongly agree or agree). There was a 46% decrease in 30-day readmissions from baseline rates, and a substantial decrease in use of emergency care services within a month of discharge as compared to infants discharged during the same time period who did not receive services (30.9% vs.13.8%).

DISCUSSION

This nurse-led intervention was found to be a feasible and highly satisfactory approach to improve NICU patient outcomes and support caregivers during transition from hospital to home.

PRACTICE IMPLICATIONS

Nurses can provide post-discharge telehealth support, which not only improves caregiver satisfaction but also decreases readmissions and emergency care use among NICU patients.

Rethinking early intervention rehabilitation services for children with motor difficulties: engaging stakeholders in the conceptualization of telerehabilitation primary care

PURPOSE

Rehabilitation services for children with mild motor difficulties are limited. Telehealth could be a novel avenue through which to provide these services. With the input of various stakeholder groups, this study aimed to develop a logic model for a new primary care telerehabilitation intervention and to identify influencing implementation factors.

METHODS AND MATERIALS

A participatory research design was used. A logic model, developed in consultation with five healthcare managers, was discussed with four stakeholder groups. Focus groups were conducted with clinicians (n = 9), pediatric healthcare managers (n = 5), and technology information consultants (n = 2), while parents (n = 4) were interviewed to explore their perceptions of the proposed intervention, and factors influencing implementation. Transcribed discussions were analyzed using reflexive thematic analysis.

RESULTS

Stakeholders supported the delivery of telerehabilitation services for children with mild motor difficulties. Although agreement was generated for each logic model component, important recommendations were voiced related to service relevance and sustainability, parent and community capacity building, and platform dependability, security, and support. Identified factors influencing the implementation encompassed consumer, provider, technological, systemic and contextual barriers and facilitators. Strategies to address them were also suggested.

CONCLUSION

This study demonstrates the value of, and a process to engage stakeholders in the designing of pediatric telerehabilitation services and its implementation.IMPLICATIONS FOR PRACTICEPediatric telerehabilitation service are complex interventions which operate in complicate systems.Designing telerehabilitation services with stakeholders is recommended, yet how to do so often not clear.This study demonstrated that the development of a logic model can provide a systematic framework to helps guide the co-design process with stakeholders.Resulting recommendation underscored a broader vision for the intervention and identified crucial factors and strategies required for its successful implementation and sustainability.

Training Intervention and Program of Support for Fostering the Adoption of Family-Centered Telehealth in Pediatric Rehabilitation: Protocol for a Multimethod, Prospective, Hybrid Type 3 Implementation-Effectiveness Study

BACKGROUND

Children with disability face long wait times for rehabilitation services. Before the COVID-19 pandemic, telehealth adoption was low across pediatric rehabilitation. Owing to the COVID-19 pandemic restrictions, pediatric therapists were asked to rapidly shift to telehealth, often with minimal training. To facilitate the behavior changes necessary for telehealth adoption, provision of appropriate evidence-based training and support is required. However, evidence to support the effective implementation of such training is lacking. The successful real-world implementation of a training intervention and program of support (TIPS) targeting pediatric therapists to enhance the adoption of family-centered telerehabilitation (FCT) requires the evaluation of both implementation and effectiveness.

OBJECTIVE

This study aimed to evaluate TIPS implementation in different pediatric rehabilitation settings and assess TIPS effectiveness, as it relates to therapists' adoption, service wait times, families' perception of service quality, and costs.

METHODS

This 4-year, pan-Canadian study involves managers, pediatric occupational therapists, physiotherapists, speech-language pathologists, and families from 20 sites in 8 provincial jurisdictions. It will use a multimethod, prospective, hybrid type 3 implementation-effectiveness design. An interrupted time series will assess TIPS implementation. TIPS will comprise a 1-month training intervention with self-paced learning modules and a webinar, followed by an 11-month support program, including monthly site meetings and access to a virtual community of practice. Longitudinal mixed modeling will be used to analyze indicators of therapists' adoption of and fidelity to FCT collected at 10 time points. To identify barriers and facilitators to adoption and fidelity, qualitative data will be collected during implementation and analyzed using a deductive-inductive thematic approach. To evaluate effectiveness, a quasi-experimental pretest-posttest design will use questionnaires to evaluate TIPS effectiveness at service, therapist, and family levels. Generalized linear mixed effects models will be used in data analysis. Manager, therapist, and family interviews will be conducted after implementation and analyzed using reflective thematic analysis. Finally, cost data will be gathered to calculate public system and societal costs.

RESULTS

Ethics approval has been obtained from 2 jurisdictions (February 2022 and July 2022); approval is pending in the others. In total, 20 sites have been recruited, and data collection is anticipated to start in September 2022 and is projected to be completed by September 2024. Data analysis will occur concurrently with data collection, with results disseminated throughout the study period.

CONCLUSIONS

This study will generate knowledge about the effectiveness of TIPS targeting pediatric therapists to enhance FCT adoption in pediatric rehabilitation settings, identify facilitators for and barriers to adoption, and document the impact of telehealth adoption on therapists, services, and families. The study knowledge gained will refine the training intervention, enhance intervention uptake, and support the integration of telehealth as a consistent pediatric rehabilitation service option for families of children with disabilities.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05312827; https://clinicaltrials.gov/ct2/show/NCT05312827.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/40218.

Involving Caregivers of Autistic Toddlers in Early Intervention: Common Practice or Exception to the Norm?

PURPOSE

Family-centered practice (FCP) is a core component of early intervention (EI) associated with improved child and family outcomes, but little is known about community-based speech-language pathologists' (SLPs') inclusion of families in EI. Many caregivers of autistic children experience caregiving-related stress, making these intervention principles especially critical to the provision of optimal services. This study aimed to characterize EI SLPs' use of FCP coaching strategies and the quality of caregiver-SLP relationships.

METHOD

Participants included 25 families with an autistic toddler and their EI SLP. One intervention session for each SLP-family dyad was recorded and coded for the SLP's use of FCP coaching strategies. Caregivers and SLPs completed surveys about their working alliance, caregiver perceptions of family-centered care, and SLPs' approach to FCP.

RESULTS

SLPs primarily use child-directed strategies without caregiver involvement. When involving caregivers, SLPs infrequently use coaching strategies that are important for caregiver learning and collaboration (e.g., joint planning and guided practice with feedback). However, caregivers perceived their child's services to be highly family-centered, and caregivers and SLPs rated their working alliance to be of high quality.

CONCLUSIONS

The presence of strong caregiver-SLP working alliances alongside infrequent usage of effective coaching strategies indicates that SLPs may engage caregivers in ways that are perceived to be highly collaborative but are not optimal for caregiver involvement in all aspects of their child's services (goal setting and implementation of intervention). Consideration of family preferences and SLP beliefs about FCP will inform ways to disseminate FCPs needed to optimize families' capacities to support their child's development.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20113550.

The predictive ability of the Lacey Assessment of Preterm Infants (LAPI), Cranial Ultrasound (cUS) and General Movements Assessment (GMA) for Cerebral Palsy (CP): A prospective, clinical, single center observational study

BACKGROUND AND AIM

The LAPI, cUS and GMA are assessments used clinically in the UK to identify preterm infants at high risk of neurodevelopmental disabilities such as cerebral palsy. This study investigated the ability of these assessments to predict cerebral palsy at 2 years corrected gestational age.

METHODS

Design: Prospective longitudinal cohort study including infants born <30 weeks' gestation from a single tertiary neonatal intensive care unit. The LAPI and cUS were undertaken as part of routine care before term equivalent age and the GMA was undertaken at 11-18 weeks corrected gestational age.

RESULTS

There were 123 eligible infants and 95 infants (77.2%) were included. Thirteen infants (13.7%) had a diagnosis of CP at 2 years. There was no significant difference in gestational age, gender, or birth weight between the groups with and without a diagnosis of CP. The highest accuracy of prediction of CP was achieved by an aberrant, absent fidgety general movements classification with a sensitivity of 92.3% and specificity of 98.9%. Combining the GMA to include the cUS or LAPI did not increase the predictive accuracy.

CONCLUSION

The GMA when undertaken in clinical practice had high accuracy for predicting CP at 2 years corrected age in infants born <30 weeks gestation; LAPI and cUS did not improve this accuracy.

A Qualitative Study Exploring Parental Perceptions of Telehealth in Early Intervention

Using telehealth as a mode of service delivery has the potential to address some long-standing challenges in early intervention (EI) services such as waiting lists to access services. Yet, little is known about parent perceptions of telehealth in EI based on their lived experiences partnering with EI practitioners. The purpose of this study was to explore parent perceptions on using telehealth, especially on family-professional partnerships and coaching. Interviews were conducted with 15 parents of children receiving EI services via telehealth from June to August of 2021. Almost half of the participants reflected under-represented racial and ethnic backgrounds. Constant comparative analysis and emergent coding were used for data analysis. The findings showed that the advantages outnumbered the disadvantages regarding telehealth. Participants reported that telehealth provided a safe and flexible option and eliminated the wait to access EI services. However, participants identified some disadvantages to telehealth including telehealth precluded substantive interactions with therapists and limited access to technology. The findings also indicated that telehealth enhanced family-professional partnerships. Nearly all participants valued coaching during telehealth. Participants suggested initial supports to facilitate EI via telehealth, including stable internet access, telehealth training, and an initial in-person visit. Implications for research and practice are discussed.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10882-022-09853-w.

A Study on the Use of Milieu Teaching to Promote Overseas Marketers’ Communication Skills and Confidence in Language Learning

Language plays an extremely important role for people in terms of engaging in various learning activities. Due to the progress of network technologies, it is an immediate goal for enterprises to take a completely new development direction with the application of network technology. Nevertheless, they encounter many difficulties in carrying out overseas marketing such as localization transformation, jet lag, lack of professional marketers, problems with sellers’ product quality, problems with customers’ credit checks, international payment problems, and logistics and delivery problems. These problems mainly result from a difference in language families. The current study was conducted as an experimental study with the participation of overseas marketers in Hebei province. Milieu teaching was implemented with an experimental group and traditional teaching was maintained in the control group for a 20-week (3 h per week) experimental procedure. The research results revealed significantly positive effects of (1) milieu teaching on communication skills, (2) milieu teaching on language learning confidence, and (3) communication skills on language learning confidence. Based on the results, it can be stated that the study is expected to help effectively enhance the communication skills and language learning confidence of overseas marketers to achieve the goals of promoting oral expression and language-use skills.

Process Evaluation of Home-based Bimanual Training in Children with Unilateral Cerebral Palsy (The COAD-study): A Mixed Methods Study

PURPOSE

To evaluate the processes and factors that influenced implementation and impact of a home-based bimanual training program in children with unilateral cerebral palsy aged 2 through 7 years.

METHODS

The program encompassed bimanual task-specific training (3.5 hours/week for 12 weeks) adopting either implicit or explicit motor learning. A therapist and remedial educationalist coached parents. This mixed methods study included course attendance monitoring, questionnaires, registration form, video analysis, interviews, focus group discussion, and drop-out monitoring.

RESULTS

Fourteen families participated. The program was not fully implemented as intended. Parents positively experienced the training and were well able to provide it. The program was demanding for the children and time-consuming for parents. Several components positively contributed to the program: task-analysis, instructional videos, and coaching by a therapist and remedial educationalist. Several modifications to the program were proposed.

CONCLUSION

Home-based bimanual training forms a demanding but promising therapeutic approach with potential for optimization.

Parental engagement in early intervention for infants with cerebral palsy-A realist synthesis

BACKGROUND

Emphasis on parental engagement strategies within occupational therapy and physiotherapy early intervention (EI) programmes for infants at high risk of cerebral palsy (CP) has increased. This reflects consensus that increasing parent participation enhances treatment efficacy, potentially improving infant and parent outcomes. However, evaluation of parental engagement in EI is complex. Despite the growing application of parental engagement strategies, aligned with family-centred care practice, theoretical evaluation is currently lacking within the literature. This realist synthesis aimed to identify component theories underlying EI strategies to support parental engagement and to use empirical findings to evaluate how these work in practice.

METHODS

Realist synthesis: Databases Medline, Embase, Amed, CINAHL and PsychInfo were searched (from February 1985 - February 2020); further articles were sourced from reference lists. A data extraction form was used, and a Critical Appraisal Skills Programme tool was used to assess study rigour.

RESULTS

Twenty-six articles were included. Quality of relationships, parent education and intervention co-design were the key themes related to parental engagement strategies. Findings indicate that constructive parent reasoning mechanisms of trust, belief, sense of control, perceived feasibility of home programme delivery and ultimately motivation are linked to the underlying intervention resources afforded by specific strategies (e.g., coaching pedagogy). These responses are precursors to engagement outcomes that include increased parental self-efficacy and adherence. Importantly, parental self-efficacy can initiate a process of change leading to improved parental confidence and anxiety.

CONCLUSIONS

Sensitively designed programme strategies, centred on relational quality between parent, infant and therapist, are fundamental for effective parent connection, involvement and investment within EI for infants with CP.

Benefits of an Intensive Individual CO-OP Intervention in a Group Setting for Children with DCD

Purpose

The present study focused on the impact of an adapted Cognitive Orientation to daily Occupational Performance (CO-OP) five-day intervention program for children with developmental coordination disorder (DCD). Important adaptations were the new combination of individual CO-OP sessions and group activities, the short and intensive program that was followed by a training and coaching trajectory, and the use of video logs.

Materials and Methods

Eighteen children with DCD (aged 8-16 years) participated in the five-day intervention during which they worked on three intervention goals. After the intervention, during an eight-week training and coaching trajectory for parents and children, children worked on a transfer goal. Assessment took place at four moments in time: two pretest measures, a posttest measure, and a 3-month follow-up measure. Primary outcome measures focused on changes in performance and satisfaction of self-chosen intervention and transfer goals. The secondary outcome measure explored changes in children's attitude, motivation, and confidence in relation to motor skill activities, social skills, and level of participation.

Results

Significant improvements were found with regard to the performance and satisfaction of intervention goals. For the transfer goal, only parents reported significant improvements. Finally, parents indicated potential improvements with regard to the attitude, motivation, and confidence of their children, but not for their social skills or level of participation.

Conclusion

The findings are promising with regard to the efficacy of this adapted CO-OP intervention for improving intervention goals, but less effective for transfer of learned skills to other goals after the intervention. Future research should focus on how postintervention parental coaching can be improved in order to increase generalization and transfer.

Accelerating progress on early childhood development for children under 5 years with disabilities by 2030

The likelihood of a newborn child dying before their fifth birthday (under-5 mortality rate) is universally acknowledged as a reflection of the social, economic, health, and environmental conditions in which children (and the rest of society) live, but little is known about the likelihood of a newborn child having a lifelong disability before their fifth birthday if he or she survives. Available data show that globally the likelihood of a child having a disability before their fifth birthday was ten times higher than the likelihood of dying (377·2 vs 38·2 per 1000 livebirths) in 2019. However, disability funding declined by 11·4% between 2007 and 2016, and only 2% of the estimated US$79·1 billion invested in early childhood development during this period was spent on disabilities. This funding pattern has not improved since 2016. This paper highlights the urgent need to prioritise early childhood development for the beneficiaries of global child survival initiatives who have lifelong disabilities, especially in low-income and middle-income countries, as envisioned by the Sustainable Development Goals agenda. This endeavour would entail disability-focused programming and monitoring approaches, economic analysis of interventions services, and substantial funding to redress the present inequalities among this cohort of children by 2030.

Pediatric rehabilitation services during COVID-19 pandemic in the United Arab Emirates

Introduction/Objective. COVID-19 pandemic has changed the rehabilitation practice across the globe. A sudden transition from in-person therapy at the center to remote therapy challenged the managers and multi-disciplinary team members providing pediatric rehabilitation. The main objective of this research was to assess the provision of services for children with disabilities during COVID-19 in the United Arab Emirates. Methods. Two surveys were developed by the research team, one for the managers and the others for multidisciplinary team members. Both surveys were validated through experts followed by a pilot study. The final versions of the survey were sent to all the pediatric rehabilitation centers within the United Arab Emirates in September 2020. A total of 44 managers and 434 multidisciplinary team members completed the survey. Results. The accessibility of the pediatric rehabilitation services was reported to be very high with 77%. Regarding the cost for running the services, almost half (46%) of managers reported them to be costlier than normal. Telerehabilitation was the most common approach utilized with synchronized live video calls (86%), YouTube video clips (88%), and created own videos (65%). Conclusion. Telerehabilitation appeared to be the most efficient model used for pediatric rehabilitation during the pandemic. The future investments for the continued use of telerehabilitation require planning, budgeting, investing, and creating supportive environments for parents, children, and multidisciplinary team members. There is a need for sharing platforms for educational and therapeutic resources created during the pandemic, with ongoing research on telerehabilitation.

Family-centered care on a physiotherapy course: case reports

Abstract Introduction: Family-Centered Care (FCC) is a philosophy that recognizes the family as a partner in the intervention process and currently constitutes one of the most important practices in pediatric physical therapy intervention. For this reason, FCC should be part of pediatric physiotherapy training so that future physiotherapists are able to include it in their clinical practice. Objective: To verify the feasibility of applying FCC as part of an undergraduate Physiotherapy course, focusing on the activity of children with different health conditions. Methods: This is a case report, based on information collected from medical records, on an intervention program carried out with 5 children and their families, in the home, once a week for seven weeks, by students of physical therapy in pediatrics. For pre- and post-intervention assessment of the children, standardized instruments were used: Gross Motor Function Measure (GMFM) and the Alberta Infant Motor Scale (AIMS). Reports were collected from families and students regarding the FCC experience. Results: The children with neurological impairment increased the GMFM target area score by more than 5%, indicating clinical improvement. A child at biological risk had a pre-intervention AIMS percentile of < 25 and a post-intervention percentile of 50, while another child with developmental delay did not alter his percentile. At the end of the intervention, families reported greater confidence in carrying out activities with their children and students reported the experience as relevant to their professional training. Conclusion: The practical application of FCC proved promising in the academic context of pediatric physical therapy.

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.

The Evolution of Telehealth From Pre-COVID-19 Pandemic Through A Hybrid Virtual Care Delivery Model: A Pediatric Hospital's Journey

The COVID-19 pandemic transformed care delivery and influenced telehealth adoption by rehabilitation professionals and their patients. The purpose of this paper is to describe a pediatric health system's telehealth services pre-pandemic and how those services were scaled during the pandemic. A secondary aim is to provide a roadmap for the operational delivery of telehealth and rehabilitation services, including transition to a hybrid care delivery model. Findings suggested that telehealth can be rapidly scaled to address patient healthcare needs for an early intervention population during a pandemic. Telehealth use during the pandemic helped ensure continuity of care and likely reduced the risk of exposure to patients and staff to the virus. Benefits included enhanced access to care, and savings in time and money for families. Interestingly, as the pandemic declined, the use of telehealth services declined due to patient preference, with many families opting to request a return to in-person care.

Pediatric Physical Therapy Telehealth and COVID-19: Factors, Facilitators, and Barriers Influencing Effectiveness-a Survey Study

PURPOSE

The purpose of this study was to identify the important factors, facilitators, and barriers for telehealth effectiveness as described by pediatric physical therapists, transitioning from in-person to telehealth during the COVID-19 pandemic.

METHODS

Pediatric physical therapists' responses to 3 open-ended questions and 1 multipart Likert Scale question from an anonymous survey were collected and analyzed using thematic analysis and descriptive statistics.

RESULTS

Three overarching themes (Caregiver Engagement, Technology, and Resilience) were identified and accompanied by 3 subthemes (Personal Attributes, Equity, and COVID-Specific Considerations). Themes were supported by the Likert Scale question with Child/Caregiver Interaction, Internet Connection, and Family Factors identified as the most important factors related to telehealth effectiveness.

CONCLUSIONS

High caregiver engagement and access to stable technology were most important for telehealth effectiveness. The telehealth service model met a need during the pandemic; however, emerging evidence suggests that it could be considered as an effective service delivery mode postpandemic.

Contextual, Client-Centred Coaching Following a Workshop: Assistants Capacity Building in Special Education

Assistants serve an essential role in special education to support children with disabilities, but they should be properly trained and supervised. The coaching approach represents one trend that has been gradually implemented in occupational therapy (OT) and rehabilitation services. Still, few studies clearly define the coaching intervention, measure the fidelity of coaching practices, or evaluate capacity building of the caregivers in the long term. This quasi-experimental study compared one-on-one coaching in natural environments following a workshop with a training workshop. Both public schools do not have regular OT services. The primary outcome was the assistant's performance, measured with the Goal Attainment Scaling (GAS). The secondary outcome was the fidelity of coaching implementation, measured with the Coaching Practices Rating Scale (CPRS). The GAS showed an increased performance of the assistants after the intervention, with significant differences between groups post-intervention (p = 0.015) and large effect size (r = 0.55), but no long-term significant improvements were found at the follow-up (p = 0.072). The CPRS showed an adequate implementation of the five coaching components (joint planning, observation, action, reflection, and feedback), with a total score of 3.5 ± 0.72 (mean ± SD). The results suggest that coaching sessions provided by OTs in schools may improve assistants' skills to facilitate the student's participation.

The Coping with and Caring for Infants with Special Needs intervention was associated with improved motor development in preterm infants

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.

Early Diagnostics and Early Intervention in Neurodevelopmental Disorders-Age-Dependent Challenges and Opportunities

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.

Occupational Performance Coaching With Parents to Promote Community Participation of Young Children With Developmental Disabilities: Protocol for a Feasibility and Pilot Randomized Control Trial

Background: High rates of restricted community participation have been reported in young children with developmental disabilities. Occupational performance coaching (OPC), grounded in self-determination theory, aims to facilitate children's participation in life situations through coaching parents. However, there have been limited randomized controlled trials demonstrating the efficacy of OPC, especially with a specific focus on children's community participation. The proposed study is the first step in evaluating the feasibility and acceptability of conducting a pilot randomized controlled trial of OPC in Hong Kong and testing its initial efficacy (in comparison to parent consultation) in promoting children's community participation. Method/Design: A feasibility and pilot double-blind randomized controlled trial will be undertaken. Fifty children aged 6 years or below with developmental disabilities and their parents will be recruited from early intervention centers and/or through social media in Hong Kong. Parents will be randomly assigned to receive OPC or consultation, and will be blinded to group allocation. Outcomes will be assessed by blinded assessors at baseline, pre-intervention, post-intervention, and follow-up. Predetermined success criteria will be used to assess the feasibility of the trial. Qualitative interviews will be conducted with parents to explore the acceptability and perceived impact of OPC. Discussion: This trial will test whether the study protocol and OPC are feasible and acceptable, as well as assess the initial efficacy of OPC to obtain effect size estimates. The results of the trial will inform future preparations for conducting a full-scale efficacy trial of OPC. Trial Registration: ClinicalTrials.gov, U.S. National Library of Medicine, National Institutes of Health (#NCT04796909), Registered on 15th March 2021.

Occupational Performance Coaching with Parents to Promote Community Participation and Quality of Life of Young Children with Developmental Disabilities: A Feasibility Evaluation in Hong Kong

Participation in community activities contributes to child development and health-related quality of life (HRQOL), but restricted participation has been reported in children with disabilities. Occupational performance coaching (OPC) is an intervention that targets participatory goals in child performance through coaching parents, with evidence of effectiveness for pediatric populations. Little is known about the feasibility of OPC in Hong Kong, or its effect on children's community participation and HRQOL. A mixed-methods case study design was applied to explore Hong Kong parents' experience of OPC in relation to goal achievement, community participation, and HRQOL change in children. Four parents of young children with developmental disabilities (aged five to six years) received OPC for three to eight sessions within one to three months. Quantitative pre- and post-intervention data were analyzed descriptively. Semi-structured interviews with parents were conducted at post-intervention, and analyzed using content analysis. Results showed a trend of improvement in goal performance, child involvement in community activities, and specific aspects of HRQOL among most participants. Parents perceived undertaking OPC positively, described gaining insights and skills, and felt supported. The findings suggest that OPC warrants further investigation for use in Hong Kong, to promote children's community participation and quality of life.

Impact of a family-centred early intervention programme in South India on caregivers of children with developmental delays

BACKGROUND

This study evaluated the impact on caregiver strain and family empowerment among caregivers of children with disabilities who received training and education as part of a family-centred community-based early intervention programme in South India.

METHODS

This prospective open cohort longitudinal study compared change from baseline to two years post-intervention among caregivers of the first cohort of children who were enrolled in the programme. Paired t-tests determined effect on the Modified Caregiver Strain Index (MCSI) and Family Empowerment Scale (FES), and p-values were adjusted for multiple comparisons using the False Discovery Rate approach.

RESULTS

Of the 308 caregivers (91% women), 44% provided care to children with cerebral palsy and 56% to children with other developmental delays. The mean age of the children at baseline was 3.3 (±1.5 years). The overall mean change from baseline in the FES was 4.1 (95% CI: 3.3, 4.9; p < 0.001) representing improved empowerment. The mean change for the MCSI score was -3.7 (95% CI: -4.5, -2.9; p < 0.001) representing reduced caregiver strain.

CONCLUSIONS

A family-centred early intervention programme that provides training and education to caregivers of children with developmental delays demonstrated positive change in caregiver strain and family empowerment.Implications for RehabilitationThe well-being of a child is influenced by the well-being of their caregiver.Improving caregiver well-being can help improve care and support for children with developmental delays.A family-centred early intervention therapy programme that includes training and education to caregivers can reduce strain and improve family empowerment.