Infant Stimulation Programs Research Articles

Down syndrome is not disappearing in Taiwan

1016-3190/$ e see front matter Copyright 2011, Bu doi:10.1016/j.tcmj.2011.07.004 Trisomy 21 [Down syndrome (DS)] is the most common chromosome anomaly in live births and the most frequent form of intellectual disability caused by a numeric chromosomal disorder. In 1985, Taiwan started a prenatal DS screening program by means of amniocentesis for pregnant women more than 35 years old. Tests of maternal serum alpha-fetoprotein and human chorionic gonadotropin during the second trimester were begun in 1994.During the past 10 years, the rate of babies with DS born alive has decreased from 76% to 32.2%, and the rate of those stillborn by therapeutic abortion has increased from 23.1% to 73%. Most pregnant women in Taiwan select therapeutic abortion when DS is diagnosed prenatally. The mother of our patient was a 36-year-old woman, gravida 3 previa 3, who gave birth at full term with no known perinatal insult. The woman had received maternal serum screening at 18 weeks gestational age, and the risk was 1:87. The woman was also found to have a thick nuchal fold on prenatal fetal ultrasonography, and refused amniocentesis for religious reasons. The mother was looking forward to the birth and the parents said that the baby was one of nature’s gifts and they respected and were willing to follow the diversity of life. The peripheral blood chromosome count was 47, XX, þ21; a female infant with DS was thus confirmed. (Fig. 1). Our patient is now 3 years 6 months old. The patient’s parents have become active lifelong learners and public educators. They learned the techniques of an early infant stimulation program, and are very familiar with health care systems from different

KBG syndrome

KBG syndrome is a rare condition characterised by a typical facial dysmorphism, macrodontia of the upper central incisors, skeletal (mainly costovertebral) anomalies and developmental delay. To date, KBG syndrome has been reported in 45 patients. Clinical features observed in more than half of patients that may support the diagnosis are short stature, electroencephalogram (EEG) anomalies (with or without seizures) and abnormal hair implantation. Cutaneous syndactyly, webbed short neck, cryptorchidism, hearing loss, palatal defects, strabismus and congenital heart defects are less common findings. Autosomal dominant transmission has been observed in some families, and it is predominantly the mother, often showing a milder clinical picture, that transmits the disease. The diagnosis is currently based solely on clinical findings as the aetiology is unknown. The final diagnosis is generally achieved after the eruption of upper permanent central incisors at 7–8 years of age when the management of possible congenital anomalies should have been already planned. A full developmental assessment should be done at diagnosis and, if delays are noted, an infant stimulation program should be initiated. Subsequent management and follow-up should include an EEG, complete orthodontic evaluation, skeletal investigation with particular regard to spine curvatures and limb asymmetry, hearing testing and ophthalmologic assessment.

Music therapy for the neonate

Abstract Surviviors of extreme prematurity (less than 26 weeks gestational age) may have long-term impairment, including developmental disabilities and neurological deficits that become evident as the child matures. Music has been used as an intervention purported to facilitate development in young, at-risk children in infant stimulation and early intervention programs. Over the past decade, music has been introduced into the neonatal intensive care unit as a therapy designed to enhance treatment and facilitate growth and development of premature infants. This report summarizes extant research on music therapy in the neonatal intensive care unit. Copyright © 2001 by W.B. Saunders Company

Cerebral Palsy.

The neurorehabilitation program for cerebral palsy changes over time. During the first 2 years of life, an infant stimulation program with an emphasis on more than just improving motor deficits is emphasized. The importance of involvement of a knowledgeable therapist cannot be overemphasized. Realistic expectations must be articulated firmly. Rather then cautiously attempting to correct a dysfunction that cannot be corrected, the therapist should help the patient develop compensation techniques; the severity of the disability frequently militates against the development of "normal" motor control. Educating the parents about cerebral palsy, showing how positioning can be an effective way of helping the child be mobile, and encouraging parent-child interaction are aspects of an infant stimulation program. The therapist should serve as a coach to the parents, who implement much of the actual treatment on a daily basis at home. From 2 to 5 years of age, rapid growth occurs, and muscle tone will either develop or worsen--the latter leading not only to the development of contracture but also to a decrease in mobility. In developing a program to control this muscle tone, the most important question to be answered is, Can I improve the patient's function and decrease the patient's disability by altering muscle tone? It is not uncommon for the real problem preventing the patient from performing certain functions to be lack of motor control or lack of sensation and not the abnormal muscle tone. Between 5 and 10 years of age, the child begins to approach adult height. At this time, definitive orthopedic intervention can be considered; as already noted, contracture development occurs as a result of abnormal muscle tone in combination with growth. Finally, as the child approaches the teen years, issues of sitting and hygiene are important considerations, especially in the nonambulatory patient. The problem of pain secondary to spasticity or dystonia must be addressed.

Meta-Analysis of Physiological Outcomes of Hospital-Based Infant Intervention Programs

A meta-analysis of 37 studies on the effects of an intervention program on physiological development of the premature infant was conducted using multidisciplinary research reported since 1979. Two homogeneous populations based on mean infant birth weight were found in which infant stimulation programs were shown to be effective in enhancing physiological development (Group I: mean birth weight = 1,260 g, mean combined effect size = 1.54, SD = 0.54, 95% confidence interval = 1.22-1.86; Group II: mean birth weight = 1,524 g, mean combined ES = 0.51, SD = 0.30, 95% confidence interval = 0.39-0.63). The robustness of Group I was tentative based on the lack of small sample-small effect nonsignificant result studies discovered in the funnel plot. Group II results (based upon 1,306 infants) are a stronger indication that, in general, infants with birth weights greater than 1,500 g are positively affected by the initiation of a stimulation program during hospitalization.

Maternal sensitivity and infant-mother attachment in a developmentally delayed sample

Nineteen mothers and their developmentally delayed infants, participants in an infant stimulation program, were observed in their homes. Observers described the infants' behavior using the Waters and Deane (1985) Attachment Behavior Q-sort and the mothers' interactive behavior with the Pederson and Moran (Pederson et al., 1990) Maternal Behavior Q-sort. The infants' therapists completed ratings of maternal sensitivity and involvement using the Ainsworth ( Ainsworth, Bell, & Stayton, 1971 ) sensitivity scales, the Caldwell and Bradley (1984) HOME inventory, and the Bromwich (1981) Parent Behavior Progression. Maternal sensitivity scores derived from the observers' Q-sorts correlated significantly with ratings of sensitivity provided by the infant therapists and with assessments of other aspects of the mothers' behavior reflecting the intellectual quality of interactions. A significant relation with security of attachment was found only with measures of maternal sensitivity, assessed either by the same observers using the Q-sort, or as judged independently by the therapists using the Ainsworth rating scale. Thus, the mother may play distinctive roles in her infant's emotional and intellectual development. Mothers of developmentally delayed children reported that their infants presented substantial parenting difficulties, but at the same time, self-reports of stress associated with parenting were not different from normative levels. This population may provide unique opportunities for the study of the relation of parenting stress to early interaction and social development.

Early prevention of childhood disability in developing countries

The concept of prevention, while implicit in most early intervention efforts, has not been comprehensively articulated as a basis for conceptualizing early intervention services. The growing recognition of the importance of early identification and intervention for infants and young children, and involvement of the family, are factors which contribute to conceptualizations of services which are preventive in nature. This recognition parallels broader concerns for family support programmes which have a preventive focus and seek to enhance the development of children and families. The purpose of this paper is to present a comprehensive framework for the provision of child and family service by conceptualizing early intervention in terms of levels of prevention. Specifically, the concept of primary, secondary, and tertiary levels of prevention will be presented as a framework suitable to encompass the preventive function of community based rehabilitation. The relevance of early prevention is based on the premise that the condition of childhood disability can be prevented at primary, secondary, and tertiary levels. Viewed in this way, the problem or condition of developmental delay or disability in children can be addressed at each of the three levels to effect a reduction of its expression, its duration or extended impact. Primary, secondary, and tertiary prevention can be implemented in the context of community based rehabilitation to address these goals: (a) enhance development and minimize the potential for delay; (b) minimize the need for special education and related services; and (c) minimize the likelihood of institutional or other restrictive care outcomes.

Motorically impaired infants: Impact of a massage procedure on caregiver-infant interactions

The capacity of both the infant and the caregiver to elicit and respond to behaviors in mutually pleasurable ways is vital for the development of attachment behavior and early social development. The objective of this study was to observe interactions between neuromotor-handicapped infants and their caregivers to determine if specialized handling procedures could be utilized by caregivers to enhance appropriate reciprocal attachment-separation behaviors. An attachment-separation behavior observation scale (A-S) was used to measure infant behaviors and contingent caregiver responses relative to attachment behaviors. A massage technique was taught to the caregivers of one-half of a matched group of neuromotor-delayed infants enrolled in an infant stimulation program. Data analysis indicates that while both groups progressed in appropriate contingent attachment-separation behaviors, only the experimental group showed significant change in the caregiver-infant discrepancy score, suggesting that the handling procedures may have facilitated the development of more compatible and positive interactions between caregivers and their infants.

Preterm infant stimulation: The analysis of a concept

Abstract A universal theoretic framework for preterm infant stimulation programs is nonexistent. Many programs are developed on the basis of unsupported assumptions, capitalizing on chance relationships. A theoretic foundation can only be developed when the concept of stimulation is studied analytically. The purpose of this article is to analyze the concept of preterm infant stimulation by identifying definitions, delineating assumptions, developing antecedents and consequences, and designing a model case. Theoretic and methodologic issues are discussed with recommendations designed to provide guidance for future development of a theoretic framework for infant stimulation.

Occupational therapy in mother and child health care centers.

This paper describes the results of an infant stimulation program that involved mothers and their infants registered at Mother and Child Health Care centers in Jerusalem. A questionnaire was used to evaluate the mothers' knowledge, attitudes, and practices regarding the developmental needs of their infants. A developmental assessment was used to evaluate the infants' reaching and grasping abilities at 4 months of age. The questionnaire was completed by 175 mothers in the program (the experimental group) and a control group of 124 mothers. The results showed that, despite demographic differences that were likely to positively affect the control group's scores, the experimental group's scores were significantly higher. The results of the developmental assessment administered to 107 infants in the experimental group and 74 infants in the control group also indicated that, on 4 out of 5 reaching and grasping items, the experimental group performed significantly better. This study emphasizes the value of structuring a developmental curriculum for newborn infants and their mothers within an occupational therapy program.

Effects of an Infant Stimulation Program on the Child and the Family

A follow-up study of the graduates of an infant stimulation program was conducted in order to determine (1) the subsequent educational placements of the children, (2) the subsequent medical histories of the children, and (3) the parents' perceptions concerning the efficacy of the early intervention program. Forty-two primary caregivers of graduates of an infant stimulation program were intervlewed by means of an orally administered questionnaire. Question categories included medical and educational diagnoses and history, parents' perceptions of the child's effect on the family, the degree to which family members were involved in the program, and an open-ended question designed to explore the parents' feelings about their life with their handicapped child. Results indicated that children's medical diagnoses tended to be serious, ranging from Down syndrome to brain damage, and approximately two-thirds of the children remained in some kind of special education program full-time. About 20% were mainstreamed, and another 15% were placed in regular classrooms full-time. Parents generally were very positive about their infant's participation in the stimulation program. Mothers were involved in the program to a significantly greater extent than fathers.

Early educational intervention in the maternal and child health services‐‐long‐term evaluation of program effectiveness∗

∗ This is the second paper in the study series. An earlier paper appeared in ECDC in 1984. The program's effectiveness justifies the integration of early infant stimulation programs into the existing health services, by the existing health personnel, thus modifying the pediatric health care which mainly focuses on physical health, by adding to it the developmental promotive aspect of child care. An early stimulation program aimed at promoting cognitive development of infants and young children was integrated into the routines of the Maternal and Child Health services. The program was implemented by nurses, at each visit of the mother with her infant at the centers, from birth to two years of age. The program focused on verbal and play interaction. At five years of age, three years after cessation of the intervention, evaluation was carried out on 59 pairs of exposed and control children matched for maternal ethnic group education and birth order and found to be similar on seven additional characteristics....

Are infant stimulation programs useful?

Infant stimulation programs, as defined by Denhoff, 1 are organized programs of enrichment designed to provide developmentally appropriate activities to babies and toddlers who have, or who are at risk for a variety of conditions (environmentally or biologically caused) that might interfere with their ability to ultimately have a full and productive life. The origins of infant stimulation programs for the environmentally deprived child can be traced to two types of observations: supporting the concept that intelligence is malleable . (1) The first intelligence test was established by Binet in the early 1900s. The examination was developed to demonstrate that intelligence was not a genetically fixed quantity but an ability that could be altered positively through a formal education program. In 1964, Project Head Start was launched and successfully has improved reading and mathematic skills for the participating children, at least through the fourth grade. 2 (2) Animal studies have

Infant stimulation programs. A neurologic shell game?

Neurologists have long been plagued by the specter of unproven remedies for various neurologic disorders. It is only natural. Neurologic diseases tend to be disabling and irreversible. When they afflict children, the situation is even more grim. Developmental progress may be drastically slowed, improvement in function minimal, and residual deficits increasingly apparent. Parents see their dreams of a normal, healthy child shattered. In light of this enormous emotional pain, it is not surprising that early intervention programs have emerged as a major treatment modality in pediatric neurology. A recent review article noted, 1970's may be recorded as the decade that early intervention became accepted as an appropriate way of helping potentially handicapped or developmentally delayed infants and their families. 1 The programs are generally viewed as educational success stories. 2 At a recent meeting of the American Academy of Pediatrics, a speaker said, question in the 1980s

Infant stimulation programs.

Nothing evokes more painful empathy than an impaired infant, inspiring feelings of innocence, unfairness, and helplessness. It is natural that caring physicians should emphasize the comfort and practical guidance that infant stimulation programs provide to parents and child; both of the contributors to this controversy do so. However, they also acknowledge, to different degrees, that scant data sustain the objective value of these programs as neurologic therapy. While caring, support, and practical advice should be part of the management of all infants, a stimulation program should not become a ritualistic substitute for scientific evaluation. The magnitude of the problem is such that properly controlled studies, where a specific stimulation program is the only variable, are not only desirable but feasible. The widespread and well-intentioned, but unproven, use of stimulation programs can only delay the time when more effective therapies can be found through a systematic search; or if no

Policy and planning implications of home-based infant stimulation programs for native Indians in North America

Multidisciplinary infant stimulation programs for native Indian children and their parents in North America have been developed in response to serious health, educational and social conditions. The common characteristics of the programs typically include local initiation and development in response to local needs, a preventive rather than compensatory focus, multidisciplinary content, use of para-professional staff, and the active involvement of parents and community elders. The implications of these programs and their development for policy-making and early childhood program planning are discussed in terms of the use of community initiation and involvement, the problem of conflicting administrative jurisdiction, the need for adequate funding, the difficulty in disseminating information about the programs, and the nature and role of evaluation. Locally-initiated multidisciplinary programs for Native Indian children are one option for fostering the optimal development of children in their earliest years.

Infant and/or Toddler Stimulation Program for Pediatric Burn Patients

Infant and/or Toddler Stimulation Program for Pediatric Burn Patients

Infant Stimulation and Development

Abstract The last several years have witnessed a growing interest in infant development, and growing concern about infant stimulation. This discussion examines the assumptions about development that underlie the premise that developmental outcomes can be significantly improved by providing early environmental stimulation. Those assumptions include: (a) that infant development is more influenced by environmental factors than by biological/genetic factors; (b) that development is linear and continuous, and that infant development is predictive of later function; (c) that early experiences determine later development; (d) that the normal social environment may be inadequate for optimal development and require improving. Research and theory from developmental psychology provide a different perspective, and a different set of assumptions. Implications for infant intervention and stimulation programs are discussed.

Early Intervention for the Biologically Handicapped Infant and Young Child: Is It of Value?

Early intervention or infant stimulation programs have been developed for those children who are at risk for not achieving normal developmental milestones because of environmental or biologic problems. The high-risk children who have organic deficits can be identified by in utero, neonatal, or postnatal difficulties that have been correlated with specific diagnostic categories such as cerebral palsy, mental retardation, and learning disabilities. Whether early recognition and initiation of stimulation for this group of infants enhance neurologic development is unproven. On the other hand, there is no doubt that families of these children, and especially their mothers, have a much greater degree of stress compared with that experienced by families from the same socioeconomic backgrounds and whose children do not have such problems. Because of this observation, the programs must offer not only motoric, cognitive, and language stimulation, but also supportive psychological services. The pediatrician should take a leadership role in helping families understand the purpose of infant stimulation programs in order to prevent disappointments when the infants involved with these programs make minimal gains. The pediatrician's ongoing support to the family is necessary, not only during the first few years of the child's life but even through the school-age years. It is also encumbent upon the pediatrician to develop a knowledge of programs available as well as a knowledge of the law as it pertains to the handicapped child.

Early Intervention for the Biologically Handicapped Infant and Young Child: Is It of Value?

Early intervention or infant stimulation programs have been developed for those children who are at risk for not achieving normal developmental milestones because of environmental or biologic problems. The high-risk children who have organic deficits can be identified by in utero, neonatal, or postnatal difficulties that have been correlated with specific diagnostic categories such as cerebral palsy, mental retardation, and learning disabilities. Whether early recognition and initiation of stimulation for this group of infants enhance neurologic development is unproven. On the other hand, there is no doubt that families of these children, and especially their mothers, have a much greater degree of stress compared with that experienced by families from the same socioeconomic backgrounds and whose children do not have such problems. Because of this observation, the programs must offer not only motoric, cognitive, and language stimulation, but also supportive psychological services.The pediatrician should take a leadership role in helping families understand the purpose of infant stimulation programs in order to prevent disappointments when the infants involved with these programs make minimal gains. The pediatrician's ongoing support to the family is necessary, not only during the first few years of the child's life but even through the school-age years. It is also encumbent upon the pediatrician to develop a knowledge of programs available as well as a knowledge of the law as it pertains to the handicapped child.