Family Centred Intervention and Early Diagnosis

Early Intervention

Early intervention services are a range of interventions that provide support and resources to families of infants and toddlers aged 0 to 3 years with special needs. [1]

Can Child[2] defines family-centered services as:

Family-centered services are comprised of a set of values, attitudes and approaches to serving children with special needs and their families.
Family-centered services recognize that every family is unique; that families are constants in a child’s life; and that they are experts in understanding their child’s abilities and needs.
Families work with service providers to make informed decisions about the services and supports children and families receive. In family-centered services, the strengths and needs of all family members are considered.
Children with developmental disabilities have the right to a variety of services, including:
An interdisciplinary early intervention team may include the following disciplines, depending on the family and child’s needs and availability of services [2]

An interdisciplinary early intervention team may include the following disciplines, depending on the needs of the family and child and the availability of services:

early intervention

Physical therapy / physiotherapy
Occupational therapy
Speech therapy
Vision therapy
Nursing
Assistive technology
Special education

Evaluation and follow-up care are provided in the child’s least restrictive or natural setting, usually in their home or daycare center. [3] Traditionally, early intervention has employed a specialist model in which a therapist sets goals and provides follow-up care based on impairment. Any interventions delivered by the home are adjunct to interventions delivered by healthcare professionals. The overall care and decision-making for the child is in the hands of the therapist. This model is called the rehabilitation model. [4]

Family-Centred Care

Over the past decade, there has been a shift from a therapist-driven model to a homeschooling/empowerment model. The Family Centered Care (FCC) model provides a collaboration between the therapist and family, where the family’s goals and wishes are at the heart of the intervention. [1] this The therapist acts as a “coach” to help families identify needs goals and solutions. Thus, the FCC shifted decision-making power from therapists to families, who had the power to set goals and plan intervention strategies. [1] When families are involved in their care and decisions Better outcomes for children, families and children. [4] Additionally, research has shown that the FCC model can increase parental satisfaction, reduce health care behavioral/emotional support costs for children, and speed recovery. [5]

Solution Focused Coaching

Traditionally, early intervention has been problem-oriented and focused on identifying impairments in the body. Interventions are aimed at repairing dysfunction, and decisions about care are made entirely by the therapist. However, through the Solution-Focused Coaching (SFC) model, therapists and families Work together to envision possibilities and find ways to address your family’s needs and goals. [6][1] Family empowerment is a priority for FSC. Additionally, the solution-focused coaching model looks at children’s strengths and abilities, not their problems, to initiate goals Setup and intervention planning. [1]

Early Diagnosis and Referral

Cerebral Palsy

The most common physical disability in childhood is cerebral palsy (CP), occurring in 1 in 500 births. CP is caused by brain damage early in development and manifests as postural and movement disturbances, resulting in limited mobility. [7] Traditionally, the diagnosis will be in Symptomatic 12 month and 24 month old. However, new research shows that the signs and symptoms of cerebral palsy appear and develop before the age of 2. Risk of Cerebral Infarction in Infants Under 2 Years Combined with Historical Neuroimaging and Standardized Motor and Neurological Assessment Paralysis is now predictable. [8] The use of diagnosis-specific early assessment can lead to referral to services that will enhance caregiver health, prevent secondary complications, and optimize infant cognitive and motor plasticity. [9] The following tools are commonly used in infants under 2 years of age Estimating the risk of a cerebral palsy diagnosis.

Hammersmith Infant Neurological Exam

HINE TEST[10]

The Hammersmith Infant Neurologic Examination (HINE) is a free tool with good interobserver reliability and is commonly used in infants between 3 and 24 months of age. It has shown high sensitivity in detecting CP in infants (98% in infants <5 months and 90% in infants >5 months). [8] Neurological function is tested using 26 different criteria based on motor behavior, cranial nerve function, protective response, reflexes, and gross and fine motor function. The symmetry of the left and right sides was also scored. [1] Test results not only identify at-risk children, but also detail Severity and type of movement disorder. With this specific information, early intervention can be targeted for specific neurological sequelae. [7]

Scores range from 0-73. Romeo et.al[7] found that testing of infants between 3 and 6 months exhibited the following pattern:

Score below 40: quadriplegia (GMFCS class IV and V) severe diplegia (class III)

40-60 points: mild or moderate paraplegia (grade I-II); hemiplegia (grade I-II) [7]

gross motor function classification system

The Gross Motor Function Classification System (GMFCS) tool classifies children under the age of 2 into five different levels based on their voluntary movements. It specifically focuses on mobility transfers and sitting. These standards address children’s functional limitations and mass [11] The GMFC is a method for classifying functional severity rather than a diagnostic tool.

The Gross Motor Function Classification System – Extended and Revised (GMFCS – E & R) for children 2 years and younger is as follows:[11]

Level I: Infant in and out of sitting and floor sitting, hands free to manipulate objects. Babies crawl on hands and knees, pull to stand, and grab furniture to walk a few steps. Babies walk between 18 months and 2 years without any assistive mobility devices.
Level II: Infant remains seated on the floor but may need support on the hands for balance. Babies crawl on their stomachs or on their hands and knees. Babies may pull to stand and grab furniture for a few steps.
Level III: Infant remains seated on the floor with lumbar support. Babies roll and crawl forward on their stomachs.
Level 4: Infant can control the head but needs trunk support while sitting on the floor. Babies can roll over on their backs or on their stomachs.
Level V: Physical impairment limiting voluntary control of movement. The infant is unable to maintain the anti-gravity position of the head and torso in the prone and sitting positions. Babies need adult assistance to roll.

*** Results in low- and middle-income countries were less favorable, with more than 73% of children classified as GMFCS levels III-IV. [12]

The Prechtl General Movement Assessment

The Prechtl General Movement Assessment is a general movement tool in which clinicians can watch short videos of infants lying on their backs. The quality and type of 26 movements were scored as ‘normal’ or ‘abnormal’. Abnormal movements are further classified into one of three The following categories:

Poor repertoire (movement sequences are monotonous; movements of different body parts are not complex)
Cracked synchronization (lack of smooth, fluid movement; stiffness; simultaneous relaxation and contraction of trunk and extremity muscles [13]
Chaos (chaos without smoothness and sudden movements of large magnitude) [14] [13] [1]

Based on the score on this test, the type and severity of CP can be predicted. This tool is reliable and fast, but requires training. [1]

Prechtl Exam[14]