The prediction of cerebral palsy (CP) and intervening as early as possible in the period of rapid brain development is imperative for infants with or at risk for CP.1 The evidence supporting the optimal type and intensity of intervention is limited. Thus, leaders in pediatric physical and occupational therapy in Australia developed a program called GAME (Goal Oriented Activity Focused Motor Enrichment) for infants at risk for CP and have provided evidence of its effectiveness.2,3 Elements of GAME are similar to intervention applied in early intervention (EI) in the United States. However, the amount, intensity, type of family involvement, motor training, and environment enrichment in EI are unclear.

BACKGROUND

The purpose of this study, targeting pediatric physical therapists (PTs) and occupational therapists (OTs) in the US, was to explore the frequency, duration, and type of practices PTs and OTs use currently in EI for infants with or at risk for CP and to determine if the current practice matches the best practices supported by the literature .

Participants:PTs and OTs providing or have provided EI services for infants and toddlers with or at risk for CP. Materials:An online, 36 item survey was developed and disseminated using Qualtrics online software. A survey link was distributed nationwide to EI providers.

METHODS

RESULTS

Findings from this study indicate that the majority of infants with or at risk for CP receive EI services provided by PTs and OTs before 6 months of age, once every one or two weeks. Therapists did not incorporate sufficient strategies for optimum environmental enrichment, comprehensive parental education on applying home program activities, and goal oriented interventions.

CONCLUSION

EARLY INTERVENTION SERVICES PROVIDED BY PHYSICAL AND OCCUPATIONAL THERAPISTS FOR INFANTS WITH OR AT RISK FOR CEREBRAL PALSY

AFNAN GMMASH, BSPT, MS; SUSAN K. EFFGEN, PT, PHD, FAPTA, D E PA R T M E N T O F R E H A B I L I TAT I O N S C I E N C E S , U N I V E R S I T Y O F K E N T U C K Y, L E X I N G T O N , K E N T U C K YRehabilitation Sciences Doctoral Program

References

Figure 1.Distribution of participants by region as defined by United States Census Bureau.

Figure 2. Frequency of using different strategies when providing home programs.

Figure 3. Frequency of assessing and enriching the home environment.

PURPOSE

Question Response N (% of respondents) Begin therapy services Between 0-5 months of age

Between 6-11 months of age

Between 12-18 months of age Older than 19 months of age

157 (58%) 90 (33%)

19 (7%) 3 (1%)

Frequency of early intervention

More than once a week Once a week Once every two weeks Once a month Less than once a month

34 (13%)

156 (58%) 68 (25%) 8 (3%)

3 (1%)

Infants are considered at high risk

for CP based on

General Movement Assessment scores MRI Cranial ultrasound Prematurity or medical history

4 (1%) 1 (.4%) 1 (.4%)

149 (55%)

Observed developmental delays 92 (34%)

Frequency of using COPM or GAS

Always Usually Occasionally Rarely/ Never

18 (7%) 22 (8%) 29 (11%)

200 (74%)

Assessment tools used Peabody Developmental Motor Scales Gross Motor Function Measure-88 &66 Developmental Assessment of Young Children 2nd-Edition Battelle–2nd Edition Developmental Inventory Alberta Infant Motor Scale Hawaii Early Learning Profile Infant Motor Profile Bayley Scales of Infant and Toddler Development, 3rd-Edition

Infant Motor Performance Scales Assessment, Evaluation &Programming

System for Infants and Children Hammersmith Infant Neurological Examination Do not use standardized tool

68 (25%) 45 (17%)

33 (12%) 23 (8%)

23 (8%) 13 (5%) 12 (4%)

12 (4%) 9 (3%) 6 (2%)

2 (.7%)

15 (6%)

Table 1. Services Provided by PTs and OTs for Infants with or at Risk for CP

Therapists working with infants and toddlers with or at risk for CP are advised to add the following to their intervention plans:• Use more sensitive assessment tools in

the early detection of CP. 1-4

• Include formal assessment tools for goal setting. 1-4

• Provide parents with written and illustrated home programs.1-4

• Use strategies to ensure environmental enrichment.2,3

IMPLICATIONS FOR PRACTICE

1. Morgan C, Novak I, Dale RC, Badawi N. Optimising motor learning in infants at high risk of cerebral palsy: a pilot study. BMC Pediatr. 2015;15(1):30.

2. Morgan C, Darrah J, Gordon AM, et al. Effectiveness of motor interventions in infants with cerebral palsy: a systematic review. Dev Med Child Neurol. 2016;58(9):900-909.

3. Morgan C, Novak I, Dale RC, Guzzetta A, Badawi N. Single blind randomised controlled trial of GAME (Goals, Activity, Motor, Enrichment) in infants at high risk of cerebral palsy. Res Dev Disabil. 2016;55:256-267.

4. Novak I, Morgan C, Adde L, et al. Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. JAMA Pediatr. 2017;171(9):897-907.

Contact information: Afnan Gmmash, MS, PT Asgm222@g.uky.edu

A total of 359 participants accessed the survey link. 296 therapists, (33% OTs and 67% PTs) from 42 states completed at least 50% of the survey items. Figure 1 specifies therapists by region.

DISCUSSION

Our findings also demonstrate that the intensity of the intervention provided for infants with or at risk for CP in the US is similar to those provided in the GAME intervention.14

The results from this study highlight some similarities and discrepancies between current and recommended practices. Even though the intensity, frequency and focus of EI services are similar to suggested practices, there is a lack of a comprehensive application of some of the principles of family-centered care and goal oriented activity-based motor enrichment.