Research
Current studies in Progress
Completed Studies
Balıkcı, A. (2022). Exploring Effects of the HEP (Homeostasis-Enrichment-Plasticity) Approach as a Comprehensive Therapy Intervention for an Infant with Cerebral Palsy: A Case Report. Journal of Child Science, 12(01), e182-e195.
Sirma G.C., Alpgozen A.Z., Balikci A. The HEP® (Homeostasis-Enrichment-Plasticity) Approach as a New Intervention for Infants with Developmental Delays: A Report of Four Cases. International Symposium on Child “Child in Interdisciplinary Perspective” Book of Abstracts /16-18 May 2022.
Balikci, A., May-Benson, T. A., Sirma, G. C., & Ilbay, G. (2024). HEP® (Homeostasis-Enrichment-Plasticity) Approach Changes Sensory–Motor Development Trajectory and Improves Parental Goals: A Single Subject Study of an Infant with Hemiparetic Cerebral Palsy and Twin Anemia Polycythemia Sequence (TAPS). Children, 11(7), 876.
The Homeostasis-Enrichment-Plasticity (HEP®) Approach for Premature Infants with Developmental Risks: A Pre-Post Feasibility Study
Implementation of the Homeostasis-Enrichment-Plasticity
(HEP®) Approach for an Infant at Risk for Autism Spectrum
Disorder: A Case Report
Effects of the HEP® (Homeostasis–Enrichment–Plasticity) Approach in preterm infants with increased developmental risk: a randomized controlled study
Suplemental Studies
- • Ball, N. J., Mercado III, E., & Orduña, I. (2019). Enriched environments as a potential treatment for developmental disorders: a critical assessment. Frontiers in psychology, 10, 466.
- • Zorlular, R., Akkaya, K. U., & Elbasan, B. (2024). The relationship between home environment affordances and motor development and sensory processing skills in premature infants. Infant Behavior and Development, 75, 101944.
- • Cheong, J. L., Burnett, A. C., Treyvaud, K., & Spittle, A. J. (2020). Early environment and long-term outcomes of preterm infants. Journal of Neural Transmission, 127(1), 1-8.
- • Morgan, C., Novak, I., & Badawi, N. (2013). Enriched environments and motor outcomes in cerebral palsy: systematic review and meta-analysis. Pediatrics, 132(3), e735-e746.
- • Kempermann, G. (2019). Environmental enrichment, new neurons and the neurobiology of individuality. Nature Reviews Neuroscience, 20(4), 235-245.
- Locomotion training contributes to 6-month-old infants' mental rotation ability
- https://www.annualreviews.org/content/journals/10.1146/annurev-psych-010418-102836
- An Ecological Approach to Learning in (Not and) Development
- Gahvora cradling in Tajikistan: Cultural practices and associations with motor development
- “Go, go, go!” Mothers’ verbs align with infants’ locomotion
- Bronfenbrenner’s Ecological Systems Theory
- Grounding Early Intervention: Physical Therapy Cannot Just Be About Motor Skills Anymore
- Movement Variability and the Use of Nonlinear Tools: Principles to Guide Physical Therapist Practice
- 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
- Development Through the Lens of a Perception-Action-Cognition Connection: Recognizing the Need for a Paradigm Shift in Clinical Reasoning
Key Findings
WHAT WE FOUND ?
- We evaluated the feasibility, safety, caregiver acceptance, and satisfaction of implementing the HEP® Approach intervention with 18 preterm infants with developmental risks. We found that the HEP® Approach intervention is safe, feasible, and acceptable to implement clinically, as well as for most preterm infant parents to participate in. Almost all participating parents reported that implementing the HEP Approach intervention strategies at home was simple and favorable for their infants.
What does this mean?
We demonstrate the feasibility of implementing the ten fundamental principles of the HEP Approach intervention with premature infants between the ages of 4 and 10 months who are at risk for developmental delays.
2. We investigated the effectiveness of the HEP® Approach intervention in preterm infants. One group received traditional treatment (TT), while the other received the HEP Approach intervention one hour a week for 12 weeks. Before and after the intervention, we evaluated the infants’ motor development and sensory functions, as well as the parents’ anxiety levels. We evaluated the infants’ motor development using the Peabody Developmental Motor Scale-2 (PDMS-2) and their sensory functions using the Test of Sensory Function in Infants (TSFI). We also examined the parents’ levels of anxiety using the Beck Anxiety Inventory (BAI).
After the intervention, significant improvements were observed within the HEP® Approach group on the standard scores of all PDMS-2 subtests. In the TT group, significant improvement was observed only in reflexes, stationary, grasping subtests, Gross Motor Quotient, and Total Motor Quotient, scores of PDMS-2. Significant gains were observed in favor of the HEP ® Approach intervention group in all PDMS-2 subtests scores except reflexes and stationary scores. Additionally, all PDMS-2 Gross Motor Quotient, Fine Motor Quotient, and Total Motor Quotient, scores were in favor of the HEP® Approach intervention. All of the TSFI scores improved significantly in both groups after the intervention. Significant gains were found in the Adaptive Motor, Visual-Tactile Integration subtests, and Total score in favor of the HEP ® Approach intervention group. The HEP ® Approach intervention group also showed significant improvements in caregiver BAI scores. However, no significant difference was found within the TT group or between groups.
What does this mean?
HEP Approach intervention was found to be more effective than TT intervention in improving the motor development and sensory functions of 4–10-month-old preterm infants and had positive effects on parental mental health.
Implications for practice:
- Core principles of enriched environment paradigms can be applied to early intervention.
- The HEP® Approach intervention is safe, feasible, and acceptable to implement clinically, as well as for most preterm infant parents to participate in.
- The HEP® Approach intervention may improve Locomotion in gross motor skills, and Visual-Motor Integration in fine motor skills of preterm infants more than traditional treatment (TT).
- TT may advance Reflexes and Stationary in gross motor skills, and Grasping in fine motor skills of preterm infants .
- The HEP® Approach intervention may improve Adaptive Motor, Visual-Tactile Integration and Total Sensory Functions in preterm infants more than TT.
- TT may may improve Reactivity to Deep Touch Pressure, Ocular-Motor Integrationa and Reactivity to Vestibular Stimulation.
- The HEP ® Approach may decrease the anxiety levels of parents.