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S. Ahmad1, S. Ullah1, H. Habib2, M. Raza1, S. Khan1
1Akbar Kare Institute, Physical Therapy, Peshawar, Pakistan, 2Akbar Kare Institute, Administration, Peshawar, Pakistan
Background: International guidelines for infants with developmental disabilities is Early-Identification and Early-Intervention. EI constructs a crucial window of opportunity against neuromuscular plasticity of developing brain in life’s first two years. Early detection of developmental difficulties is challenge in most resource-poor settings. Data collected from 18,857 children at Akbar Kare Institute in Pakistan indicates that only 18% are 2 years or younger on their first visit. Evidence and our experience show that care-givers and care-users often prefer ‘wait-and-see’ approach for these children. Thus, missing this critical window of neuroplasticity during which targeted rehabilitation interventions may offer potential for neural reorganization.
Purpose: Assess the effect of early targeted interventions on neurodevelopmental outcome in children under 5 years who were identified to be at risk of developmental disabilities in infancy using Prechtl General Movement Assessment (GMA) at a family-centered service in Peshawar, Pakistan.
Methods: A pre-test and post-test non-randomized intervention study recruited at-risk infants to assess the effect of neurodevelopmental-specific early interventions on gross motor function. Validated Gross Motor Function Classification System (GMFCS) was administered at least 9 months post-intervention. GMFCS has five levels – level 1 being the least affected.
Infants from birth to 5 months were recruited through consecutive sampling on their first visit after being diagnosed with GMA to be at-risk for developmental disabilities. GMA is a gold-standard for an early neurological assessment of the “integrity of the young nervous system” in resource-poor countries. Trained assessors performed GMA. Infants who were preterm (<40 weeks gestation), older than 5 months, diagnosed with a medical/behavioral condition known to affect motor development (e.g., Down Syndrome) were excluded.
Descriptive statistics were used. Data was collected from 2018-2022.
Infants from birth to 5 months were recruited through consecutive sampling on their first visit after being diagnosed with GMA to be at-risk for developmental disabilities. GMA is a gold-standard for an early neurological assessment of the “integrity of the young nervous system” in resource-poor countries. Trained assessors performed GMA. Infants who were preterm (<40 weeks gestation), older than 5 months, diagnosed with a medical/behavioral condition known to affect motor development (e.g., Down Syndrome) were excluded.
Descriptive statistics were used. Data was collected from 2018-2022.
Results: Based on general movements, 106 at-term infants of mean age 12±03 weeks (range: 1–20 weeks) were recruited. Most infants 33 (31.1%) had poor-repertoire followed by fidgety 29 (27.4%), 13 (12.3%) had cramp-synchronized, 6 (5.7%) absent fidgety and 3 (2.8%) had abnormal fidgety movements. At birth, 27(25.4%) had asphyxia, 8.5% were jaundiced, 5.7% had HIE, 2.8% arthrogryposis while 23.5% had normal birth history.
At endline (≥9 months post-intervention), 13 (12.3%) children had died and 4 (3.8%) were lost to follow-up. Over three-fifths 57 (64%) children had achieved the most favorable GMFCS outcome levels 1 and 2 at endline.
Mothers were primary caregivers to more than half 49 (55.1%) of children versus only 7 (7.9%) caregiver fathers. Over one-third mothers 33 (37.1%) and quarter 22 (24.7%) fathers had no education. Almost four-fifths 46 (78%) caregivers followed their home plan 1-3 times daily while no or poor compliance was observed for 8 (8.9%) and 10 (11.2%) children.
At endline (≥9 months post-intervention), 13 (12.3%) children had died and 4 (3.8%) were lost to follow-up. Over three-fifths 57 (64%) children had achieved the most favorable GMFCS outcome levels 1 and 2 at endline.
Mothers were primary caregivers to more than half 49 (55.1%) of children versus only 7 (7.9%) caregiver fathers. Over one-third mothers 33 (37.1%) and quarter 22 (24.7%) fathers had no education. Almost four-fifths 46 (78%) caregivers followed their home plan 1-3 times daily while no or poor compliance was observed for 8 (8.9%) and 10 (11.2%) children.
Conclusions: Majority of infants had poor-repertoire and cramp-synchronized movements predictive of severe developmental disability,most achieved favorable GMFCS outcomes. When an infant at risk of developmental delay is identified, prompt intervention is warranted particularly when the brain is most adaptable to change
Implications: Need to evaluate longer-term outcomes that are expected to be achieved in 3–5-year follow-up and investigate feasibility, acceptability and compliance to early detection and EI services among care-users and care-givers in low-resource settings.
Funding acknowledgements: Akbar Kare Institute, Peshawar
ICRC, Pakistan
ICRC, Pakistan
Keywords:
Early Intervention
Developmental disabilities
General Movement Assessment (GMA)
Early Intervention
Developmental disabilities
General Movement Assessment (GMA)
Topics:
Paediatrics
Disability & rehabilitation
Globalisation: health systems, policies & strategies
Paediatrics
Disability & rehabilitation
Globalisation: health systems, policies & strategies
Did this work require ethics approval? No
Reason: This was a low risk non-interventional study. Prior to data collection informed consent was obtained from parents/caregivers after they were explained the objective and methodology of the study. Gathered data was anonymized and coded. The study was conducted in accordance with Helsinki Declaration.
All authors, affiliations and abstracts have been published as submitted.
