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]
Resources
- CanChild Family Centred Service
- Gross Motor Function Classification System – Expansion and Revision (GMFCS-ER)
- Importance of Early Intervention and Early Recognition for Cerebral Palsy
- Early Intervention in Cerebral Palsy
- Cerebral Palsy Introduction
References
- ↑ Jump up to:1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Versfeld, P. Family-Centred Intervention and Early Diagnosis Course. Plus , 2021.
- ↑ Jump up to:2.0 2.1 CanChild from McMaster University. Available at www.canchild.org
- ↑ Tomasello NM, Manning AR, Dulmus CN. Family-centered early intervention for infants and toddlers with disabilities. Journal of Family Social Work. 2010 Mar 24;13(2):163-72.
- ↑ Jump up to:4.0 4.1 Dalmau M, Balcells-Balcells A, Giné C, Cañadas M, Casas O, Salat Y, Farré V, Calaf N. How to implement the family-centered model in early intervention. Anales de psicología. 2017;33(3):641-51.
- ↑ Raghupathy MK, Rao BK, Nayak SR, Spittle AJ, Parsekar SS. Effect of family-centered care interventions on motor and neurobehavior development of very preterm infants: a protocol for systematic review. Systematic reviews. 2021 Dec;10(1):1-8.
- ↑ Baldwin P, King G, Evans J, McDougall S, Tucker MA, Servais M. Solution-focused coaching in pediatric rehabilitation: an integrated model for practice. Physical & Occupational Therapy in Pediatrics. 2013 Nov 1;33(4):467-83
- ↑ Jump up to:7.0 7.1 7.2 7.3 Romeo DM, Ricci D, Brogna C, Mercuri E. Use of the Hammersmith Infant Neurological Examination in infants with cerebral palsy: a critical review of the literature. Developmental Medicine & Child Neurology. 2016 Mar;58(3):240-5.
- ↑ Jump up to:8.0 8.1 Novak I, Morgan C, Adde L, Blackman J, Boyd RN, Brunstrom-Hernandez J, Cioni G, Damiano D, Darrah J, Eliasson AC, De Vries LS. Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. JAMA pediatrics. 2017 Sep 1;171(9):897-907.
- ↑ Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment. J Novak et al (2017). AMA pediatrics, 2017 171(9), 897–907.
- ↑ De Sanctis R, Coratti G, Pasternak A, Montes J, Pane M, Mazzone ES, Young SD, Salazar R, Quigley J, Pera MC, Antonaci L. Developmental milestones in type I spinal muscular atrophy. Neuromuscular Disorders. 2016 Nov 1;26(11):754-9.
- ↑ Jump up to:11.0 11.1 Palisano R, Rosenbaum P, Bartlett D, Livingston M. GMFCS – E & R Gross Motor Function Classification System Expanded and Revised. Hamilton, ON: CanChild Centre for Childhood Disability Research, McMaster University, 2007.
- ↑ Jahan I, Muhit M, Hardianto D, Laryea F, Chhetri AB, Smithers‐Sheedy H, McIntyre S, Badawi N, Khandaker G. Epidemiology of cerebral palsy in low‐and middle‐income countries: preliminary findings from an international multi‐centre cerebral palsy register. Developmental Medicine & Child Neurology. 2021 May 24.
- ↑ Jump up to:13.0 13.1 Einspieler C, Prechtl HF, Ferrari F, Cioni G, Bos AF. The qualitative assessment of general movements in preterm, term and young infants—review of the methodology. Early human development. 1997 Nov 24;50(1):47-60.
- ↑ Jump up to:14.0 14.1 Aizawa CY, Einspieler C, Genovesi FF, Ibidi SM, Hasue RH. The general movement checklist: A guide to the assessment of general movements during preterm and term age. Jornal de Pediatria. 2021 Aug 18;97:445-52.