Author ORCID Identifier

https://orcid.org/0000-0001-6844-8993

Date Available

5-22-2022

Year of Publication

2020

Document Type

Doctoral Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

Health Sciences

Department/School/Program

Rehabilitation Sciences

Advisor

Dr. Susan Effgen

Co-Director of Graduate Studies

Dr. Camille Skubik-Peplaski

Abstract

The literature supports the use of family-centered early intervention(EI) for young children with or at risk for cerebral palsy (CP) to promote the children’s motor development. Young children with or at risk for delayed motor development in their first three years of life are entitled to EI under Part C of The Individuals with Disabilities Education Improvement Act. Identifying current EI provided for young children with delayed motor development is essential to detect possible gaps and factors that could prevent therapists from providing the best EI. Understanding the parent’s perspective on the implementation of activities outside therapy to maximize the children’s motor outcomes during this sensitive period of development is also important. There are three studies in this dissertation that examined the current practices, and challenges in EI for young children with or at risk for CP, and parents’ implementation of home activities in EI across the United States. The first study explored practices physical therapists (PTs) and occupational therapists (OTs) use in EI for young children with or at risk for CP. A survey was disseminated nationally to EI providers. At least 50% of the survey was completed by 269 therapists. The General Movement Assessment was used to predict CP by 4% of the therapists, 57% reported infants at risk for CP receive therapy once a week, 89% identified parents’ goals as the most important factor in customizing the EI program, and 75% provided parents with home programs. However, 73% never or rarely used outcome measures to prioritize parents’ goals and only 31% provided parents with an individualized home program. Based on therapists’ report, they did not incorporate sufficient strategies for goal oriented interventions, comprehensive parental education, and optimum environmental enrichment. The second study identified challenges faced by the therapists through an open-ended question in the original survey. A total of 224 responses from 42 states were analyzed qualitatively. Analysis of the data revealed that the children’s surroundings, including the family, community, and mandated policies were the main barriers that could impede the provision of best practice. These results indicated that some principles of family centeredness were inefficiently practiced. Family engagement was one of the greatest challenges reported, that could be caused by a lack of team collaboration, restricted policy requirements, and lack of resources to address families’ and infants’ individual needs. The final study explored the application of early childhood coaching by PTs and OTs providing EI for young children with delayed motor development and parents reported adherence to home activities. A survey was distributed nationally to parents of young children with delayed motor development by an online anonymous link. The analysis included 446 participants from 49 states. Most of the parents reported high adherence and indicated that PTs and OTs apply the five coaching practices. Adherence was correlated with coaching practices, self-efficacy, educating parents about variable practice, repetitive daily practice, and appropriateness of the home activities to the home environment and daily routines. This dissertation provides further evidence that family centeredness is an essential element in EI provided for young children with delayed motor development by PTs and OTs and provides recommendations for best practice.

Digital Object Identifier (DOI)

https://doi.org/10.13023/etd.2020.247

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