IYC Articles - Comments

Dear ISEI Members, Thanks so much to all of you who participated in the Infants and Young Children Articles and Comments Page on the ISEI Website.

The comments for Gerald Mahoney, Cordelia Robinson, and Frida Perales's article entitled "Early Motor Intervention: The Need for New Treatment Paradigms” can be found below.

Please note that two new articles have been placed on the Current IYC Articles. All previous articles will continue to be available by accessing the “IYC Previous Articles”

Best regards

Mike Guralnick
Chair, ISEI

unknown comment dateposted 10/14/2004

Two comments:
First a caveat: I'm not totally convinced that changes in rate of development are the best way to evaluate any intervention, motor development inparticular. I don't believe that there is any theoretical reason to believe that teaching one set of skills (sitting up, for example) should necessarily lead to an overall acceleration of acquisition of all subsequent motor skills. Having said that, I think that your finding that more consistent therapy led to better development is a positive finding that should be explored especially in larger samples of children. Another way to compare the modes of therapy to each other might be to consider time to criterion--given that the same skills are being supported. Do children without the skill attain it more quickly on one than another.

Second: Applause. I liked the closing emphasis on active approaches to therapy and the notion of practicing of appropriate component movements as suggested by Dynamic Systems Theory. This idea of active approaches is not totally new. Brinker and Lewis (1982) and others of that era were critical of interventions that focused on milestones and felt that intervention needed to focus on process. They argued that it was important find ways to allow the child to activate or even construct its own intervention. While they concentrated mostly on cognitive development, their ideas are equally valid for motor intervention. They are also consistent with Greenough's work on plasticity and work in the area of perceptual (visual)development which suggest that active behaviors is what promotes neural growth. For motor development, the key may be finding ways to get the child actively using their motor system and finding creative and appropriate ways to do this.

THE FOLLOWING IS A RESPONSE TO COMMENTS THAT WERE MADE REGARDING OUR ARTICLE “EARLY MOTOR INTERVENTION: THE NEED FOR NEW TREATMENTS PARADIGMS”. THROUGHOUT THE HISTORY OF EARLY INTERVENTION, PROFESSIONALS HAVE SPECULATED THAT EARLY INTERVENTION CAN BE EFFECTIVE AT ENHANCING CHILDREN’S RATE OF DEVELOPMENT IN THOSE DOMAINS IN WHICH CHILDREN HAVE SIGNIFICANT DELAYS. WHETHER WE PERSONALLY BELIEVE THAT “RATE OF DEVELOPMENT” IS AN APPROPRIATE METHOD FOR EVALUATING THE EFFECTIVENESS OF INTERVENTION, WE MUST BE AWARE THAT FUNDERS AND CONSUMERS OF SERVICES BELIEVE AND EXPECT THAT EARLY INTERVENTION WILL SOMEHOW INCREASE CHILDREN’S RATE OF DEVELOPMENT. IT IS THEREFORE, ENTIRELY LEGITIMATE TO INVESTIGATE WHETHER CHILDREN WHO RECEIVE MOTOR INTERVENTION SERVICES SHOW ANY EVIDENCE OF AN INCREASED RATE OF MOTOR DEVELOPMENT.

HOWEVER, IN DESIGNING OUR RESEARCH STUDY, WE WERE SYMPATHETIC TO THE VIEW THAT MOTOR INTERVENTION MAY BE MORE EFFECTIVE AT PROMOTING THE QUALITY OF CHILDREN’S GROSS MOTOR MOVEMENT. THIS IS AN EXTREMELY IMPORTANT OUTCOME FOR CHILDREN WITH CEREBRAL PALSY AND OTHER CONDITIONS WHOSE MOTOR SKILLS ARE NOT SIMPLY DELAYED, BUT ARE SERIOUSLY COMPROMISED IN TERMS OF QUALITY OF MOVEMENT AS WELL. FEW COULD ARGUE AGAINST THE LIFELONG BENEFITS OF ENHANCING THE QUALITY OF MOVEMENT OF YOUNG CHILDREN WITH CEREBRAL PALSY, EVEN IF THESE CHILDREN CONTINUE TO HAVE SUBSTANTIAL DELAYS IN THEIR RATE OF MOTOR ACQUISITION. FOR THIS REASON A MAJOR PORTION OF OUR STUDY WAS FOCUSED ON ASSESSING THE QUALITY OF CHILDREN’S MOVEMENT, USING A MODIFIED VERSION OF THE INFANT TODDLER MOVEMENT EVALUATION (TIME) (MILLER & ROID, 1994).

WE INCORPORATED THE TIME INTO OUR STUDY BECAUSE WE FELT THAT IT WAS THE BEST AVAILABLE TOOL FOR ASSESSING THE QUALITY OF YOUNG CHILDREN’S MOTOR MOVEMENT. UNFORTUNATELY, WHEN WE ANALYZED THE EFFECTS OF INTERVENTION ON THE QUALITY OF CHILDREN’S MOVEMENT, WE FOUND NO EVIDENCE THAT THIS OUTCOME WAS BEING ACHIEVED. WE WERE GREATLY DISAPPOINTED BY THESE FINDINGS, SINCE THEY CAST DOUBT ON WHETHER CONTEMPORARY MOTOR INTERVENTION METHODS ARE EFFECTIVE AT ENHANCING THE QUALITY OF CHILDREN’S MOVEMENT. HOPEFULLY, FUTURE STUDIES THAT EMPLOY MORE SOPHISTICATED MEASURES OF QUALITY OF MOVEMENT THAN THOSE THAT WE USED WILL PROVIDE EVIDENCE TO REFUTE THE FINDINGS WE REPORTED.

THERE WAS A LITTLE IN THE RESULTS FROM OUR RESEARCH STUDY THAT SHOULD COME AS A SURPRISE TO THOSE WHO ARE FAMILIAR WITH THE EFFICACY DATA ON EARLY MOTOR INTERVENTION. THE FACT IS, THERE IS LITTLE, IF ANY, SUBSTANTIVE RESEARCH DATA TO SHOW POSITIVE MOTOR INTERVENTION OUTCOMES FOR YOUNG CHILDREN WITH DISABILITIES (HARRIS, 1997). THAT WAS OUR REASON FOR WRITING THIS PAPER. WE AGREE WITH THE COMMENT THAT OUR RECOMMENDATION TO EXPLORE THE IMPLICATIONS OF DYNAMIC MOTOR THEORY FOR EARLY MOTOR INTERVENTION IS NOT NEW. UNFORTUNATELY, WOEFULLY LITTLE RESEARCH IS BEING DONE TO PURSUE THIS PROMISING AGENDA TODAY. THE RESULTS FROM OUR RESEARCH STUDY AS WELL AS THE PREPONDERANCE OF EVIDENCE THAT HAS BEEN PUBLISHED DURING THE PAST 20 YEARS SHOWS THAT THE FIELD OF MOTOR INTERVENTION IS IN DESPERATE NEED OF NEW IDEAS AND NEW MODELS AND PROCEDURES FOR ADDRESSING THE GROSS MOTOR NEEDS OF YOUNG CHILDREN. IT IS TIME FOR US TO GET SERIOUS ABOUT ADDRESSING THIS NEED.

HARRIS, S. (1997). THE EFFECTIVENESS OF EARLY INTERVENTION FOR CHILDREN WITH CEREBRAL PALSY AND RELATED MOTOR DISABILITIES. IN GURALNICK, M. (ED.). THE EFFECTIVENESS OF EARLY INTERVENTION. BALTIMORE, MD.: PAUL H. BROOKES, PP 327-347.

MILLER, L.J., ROID, G.H.(1994). THE T.I.M.E. TODDLER INFANT MOTOR EVALUATION. TUCSON, AZ, THERAPY SKILL BUILDERS

GERALD MAHONEY

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