What are children, families, and professionals aiming for?
The aim of Early Intervention is “to support the child’s development, functioning, and participation within the context of the family and community” [Damiano & Longo, 2021. “Early intervention evidence for infants with or at risk for cerebral palsy: an overview of systematic reviews”]. This definition captures some of the changes in thinking we have undergone, but, is there a better way to reach those goals? Do we have some key lessons aligned with the best available scientific evidence, preferences of children and families, and the experience of professionals?
In this post, we will dig deep into some of the key elements that make up the paradigm shift in Early Intervention. In this way, we will be able to identify 5 lessons learned in the EACD meeting —so we will review the last ones in Georgia, Paris, Póznan, and the last meeting held, EACD Europe 2021— as well as events such as the Summer School in Pisa, 2019.
Offering enriching natural environments, developing them and routines have an important role within the intervention, as well as the importance of the caregivers-infant interaction [Guzzetta, 2019. “Early intervention in high-risk newborns: the VISIBLE project”] and the relationship with peers. It implies in turn that goals are geared toward infant and child access to the environment in multiple ways [Livingstone & Paleg, 2013. “Practice considerations for the introduction and use of power mobility for children], assessing environmental barriers and enablers. In this way, Early Intervention allows for increased variability of practice, learning opportunities, complexity, and generalization of skills.
Active goal-directed, right level of challenge, repetitive and intensive
In both young and older children, self-initiated movement is a concept with ample evidence for motor learning. To identify activity and participation goals and encourage increased physical activity in children at high-risk or with disabilities is one the most representative pictures of Early Intervention paradigm shift [Reedman et al., 2019. “Efficacy of Participation-Focused Therapy on Performance of Physical Activity Participation Goals and Habitual Physical Activity in Children With Cerebral Palsy: A Randomized Controlled Trial”]. For example, in children with cerebral palsy, recommendations for clinical practice include intervention options guided by active child-initiated movements [Morgan et al., 2021. “Early Intervention for Children Aged 0 to 2 Years With or at High Risk of Cerebral Palsy. International Clinical Practice Guideline Based on Systematic Reviews”].
Practice can be developed with a level of challenge that is “just right” and necessary to allow success in problem-solving conditions and to optimize the child’s enjoyment. When the strategy carried out is effective, the challenge can be increased —by modifying the task or the environment— thus increasing the complexity and generalization of the activity. . In this sense, repetition and intensity are essential to enhance child learning, variability in practice, and consequently, neuroplasticity [Boyd, 2020 “Neuro-rehabilitation to Optimize Neuroplasticity In Children With Cerebral Palsy”].
Meaningful and fun!
Early Intervention in 21st century emphasizes the need for functional goals and strategies to be based on functional and meaningful activities for the child and family. Ensuring the child is actively involved, positively engaged, and having fun. It is precisely “Fun” one of the “F-words” [Rosenbaum & Gorter, 2011. “The ‘F-words’ in childhood disability: I swear this is how we should think!] that is less represented in the evidence for interventions for children with significant motor involvement [de Campos et al., 2021 “Families and Providers Partner for Change: The F-Words in Action”].
Parent/ caregiver guided
Early Intervention comes at a particularly sensitive time in terms of neuroplasticity [Cioni, 2018 “Neuroplasticity”]. But it is also the first moment when we can turn the focus not only towards the infants’ needs, to include also specific support needs for parents or caregivers.
In addition, within the intervention processes, families have the role of decision-making guide and expert on their children. When interventions are carried out by the primary caregivers — incorporating family training, parental feedback and adapting the environment or task, and identifying goals— it leads to parent empowerment. This is when Early Intervention is most effective [Wales, 2021. “What is parent empowerment?”]; [Baker et al., 2012. “The role of family-centered therapy when used with physical or occupational therapy in children with congenital or acquired disorders”].
A universal right
21st-century Early Intervention is a universal right, which of course must include low and middle-resource areas and countries. Reinforcing the competencies for knowledge translation in Early Intervention will help us to summarize, disseminate, exchange, and adapt the knowledge to each specific context [Seal, 2019 “What do people want to know about? Global Knowledge Translation and implications for research: Children’s, Families’ and Professionals’ knowledge priorities”]. Application of evidence-based interventions and new advances in the field need to reach every country! [Barton et al., 2020. “The efficacy of appropriate paper-based technology for Kenyan children with cerebral palsy”].
Children, families, and professionals continue building a true evidence-based Early Intervention [Hadders-Algra, M. (2021). Early Detection and Early Intervention in Developmental Motor Disorders: From Neuroscience to Participation. Mac Keith Press]. An Early intervention that offers the best opportunities —focusing on activity and participation— and leaves no one behind, regardless of diagnosis or place of birth. Together we are better: can we count on you? [Longo et al., 2019. “Let’s make pediatric physical therapy a true evidence-based field! Can we count on you?”].
Blog by Álvaro Hidalgo Robles