WoS İndeksli Yayınlar Koleksiyonu
Permanent URI for this collectionhttps://hdl.handle.net/20.500.14627/6
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Article Telehealth Delivery of the Homeostasis–Enrichment–Plasticity Approach for Premature Infants With Developmental Risks: Exploratory Feasibility Study(JMIR Publications, Inc, 2026) May-Benson, Teresa A.; Demirbag, Izgi-Miray; Sirma, Gamze Cagla; Sozen, Hatice Gulhan; Aracikul Balikci, Ayse Firdevs; Ilbay, Gul; Balikci, AymenBackground: Preterm delivery is an increasing worldwide health concern linked to increased neurodevelopmental risks. Early intervention is crucial for harnessing neuroplasticity to enhance developmental and functional performance outcomes; however, access to early intervention is frequently hindered by logistical, financial, and labor constraints. The Homeostasis-Enrichment-Plasticity (HEP) Approach is a family-centered early intervention model based on enriched environments, designed to improve infants' sensory-motor, cognitive, and socio-emotional development. Objective: This study aimed to assess the feasibility, safety, acceptability, and outcomessensitivity to change of implementing the HEP Approach through telehealth for premature infants at developmental risk. Methods: A pre-post exploratory feasibility study was performed, including 16 preterm infants (aged 4-12 months corrected age), of whom 14 completed the study. The 12-week intervention included weekly remote sessions focused on environmental enrichment, active exploration, and parental guidance. Thefeasibility and acceptability were evaluated using a 24-item questionnaire. Developmental outcomeswere assessed with the Young Children's Participation and Environment Measure, Ages and Stages Questionnaire (ASQ), Alberta Infant Motor Scale, Infant Motor Profile, and Depression Anxiety Stress Scales. Results: High adherence (14/14, 100%) and retention (14/16, 87.5%) rates demonstrated robust feasibility. Parents indicated 86%-100% agreement across all feasible criteria, affirming safety, satisfaction, and acceptability. No adverse incidents were reported. Changes were identified in participation (Young Children's Participation and Environment Measure), motor development (Alberta Infant Motor Scale, Infant Motor Profile, andASQ), communication and social-emotional domains (ASQ), and caregiver well-being (Depression Anxiety Stress Scales) (P<.05). Conclusions: The telehealth implementation of the HEP Approach demonstrated feasibility, safety, and strong acceptance among families, along with quantifiable developmental and psychosocial changes. These initial findings endorse the model's viability as an accessible, family-oriented telehealth framework for infants born preterm. Future randomized controlled and longitudinal studies are necessary to validate intervention efficacy and scalability.Article Implementation of the Homeostasis-Enrichment (Hep®) Approach for an Infant at Risk for Autism Spectrum Disorder: A Case Report(Necmettin Erbakan Univ, Fac Medicine-Neu Press, 2025) Balikci, Aymen; Balikci, Ayse Firdevs Aracikul; Demirbag, Izgi Miray; Sirma, Gamze Cagla; Beaudry-Bellefeuille, Isabelle; May-Benson, Teresa A.Background and Clinical Significance: This case report explicates the implementation and outcomes of the Homeostasis-Enrichment-Plasticity (HEP (R)) Approach in a 10-month-old male infant with an increased risk of Autism Spectrum Disorder (ASD) who exhibited challenges in sensory functioning and motor development. Case Presentation: The intervention was carried out utilizing the eleven-step HEP (R) Approach process. The Peabody Developmental Motor Scale-2 (PDMS-2), Test of Sensory Function in Infants (TSFI), Adaptive Behavior Assessment System-3 (ABAS-3), and Goal Attainment Scale (GAS) were used as outcome measures before and after the intervention. A pediatric physical therapist conducted an hour-long intervention weekly for 10 weeks using the HEP (R) Approach implementation guide. Post-intervention, the infant's fine and gross motor skill scores in the PDMS-2 and General Adaptive Composite in the ABAS-3 exhibited significant improvement, as determined by the 95% confidence interval overlap analysis. The TSFI total score also improved categorically. An overall GAS score of +1.6 corresponded to a t-score of 74.12, indicating significant progress towards the individualized intervention goals. Conclusions: The HEP (R) Approach enhanced motor development, sensory functioning, general adaptive skills, and parental goals in a 10-month-old infant at risk for ASD. The results support further examination of the HEP approach's effectiveness in infants at risk for ASD.Article Effects of the HEP® (Homeostasis-Enrichment Approach in Preterm Infants with Increased Developmental Risk: A Randomized Controlled Study(Frontiers Media S.A., 2025) Sirma, Gamze Cagla; Zengin Alpozgen, Ayse; Balikci, AymenBackground and objectives: This study investigated the effectiveness of the Homeostasis-Enrichment-Plasticity (HEP) Approach in preterm infants with increased developmental risk, compared to the Traditional Treatment (TT) intervention for physical and occupational therapy.<br /> Materials and methods: Twenty-nine preterm infants (adjusted age, 4-10 months) were randomly assigned to two groups: the HEP Approach group and the TT group. The Peabody Developmental Motor Scales-2 (PDMS-2), Test of Sensory Functions in Infants (TSFI), and Beck Anxiety Inventory (BAI) were administered pre-and post-intervention. The intervention was implemented weekly for 12 weeks.<br /> Results: The baseline characteristics of the infants were similar. At the end of the treatment, a significant time effect was observed in motor skills and sensory functions across both groups, with improvements in all PDMS-2 and TSFI subtests (p < 0.05). Significant time x group interactions showed greater improvements in the HEP Approach group compared to the TT group for Fine Motor Quotient: F = 10.818, p = 0.003; Gross Motor Quotient: F = 5.691, p = 0.024; and Total Motor Quotient: F = 21.109, p < 0.001. For TSFI, the HEP Approach group showed greater improvements in Adaptive Motor Functions (F = 13.794, p = 0.001), Visual-Tactile Integration (F = 7.410, p = 0.011), and Total score (F = 11.316, p = 0.002). No significant time*group interactions were found for Reactivity to Tactile Deep Pressure, Ocular Motor Control, and Reactivity to Vestibular Stimulation (p > 0.05). Parental anxiety, measured by BAI, decreased significantly in both groups (F = 8.72, p = 0.006), but no significant time x group interaction was found (p > 0.05), indicating similar reductions in both groups. Conclusion: The HEP Approach demonstrated superior outcomes compared to the TT intervention in improving motor skills and sensory functions in preterm infants, while both interventions reduced caregiver anxiety.Article Citation - WoS: 3Citation - Scopus: 2Hep® (homeostasis-Enrichment 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)(Mdpi, 2024) Balikci, Aymen; May-Benson, Teresa A.; Sirma, Gamze Cagla; Ilbay, GulBackground: Early intervention (EI) for infants identified as being at high risk for cerebral palsy (CP), or who have been diagnosed with it, is critical for promotion of postnatal brain organization. The aim of this study was to explore the effectiveness of the Homeostasis-Enrichment-Plasticity (HEP) Approach, which is a contemporary EI model that applies the key principles of enriched environment paradigms and neuronal plasticity from experimental animal studies to ecological theories of human development on the motor development, sensory functions, and parental goals of an infant with twin anemia polycythemia sequence (TAPS) and CP. Methods: An AB phase with follow-up single case study design which consisted of multiple baseline assessments with the Peabody Developmental Motor Scales-2 (PDMS-2) and the Test of Sensory Functions in Infants (TSFI) was used. Non-overlapping confidence intervals analysis was used for pre-post PDMS-2 scores. The measurement of progress toward goals and objectives was conducted using the Goal Attainment Scale (GAS). The HEP Approach intervention consisted of 12 one-hour sessions implemented over a period of 3 months, where a physical therapist provided weekly clinic-based parental coaching. Results: Results found a stable baseline during Phase A and improvement in response to the HEP Approach intervention during Phase B in both the PDMS-2 and TSFI according to 2SD Band analysis. The confidence intervals for the PDMS-2 scores also indicated a significant improvement after HEP intervention. The scores for both the PDMS-2 and the TSFI were consistent or showed improvement throughout the Follow-Up phase. A GAS t-score of 77.14 indicated that the infant exceeded intervention goal expectations. Conclusions: Although our findings suggest that the HEP Approach intervention has promise in enhancing sensory functions, motor skill outcomes, and parental goals in an infant with TAPS and CP, further research is required to validate and apply these results more broadly.Article Citation - WoS: 4Citation - Scopus: 3The Homeostasis-Enrichment (hep®) Approach for Premature Infants With Developmental Risks: a Pre-Post Feasibility Study(Mdpi, 2024) Balikci, Aymen; May-Benson, Teresa A.; Sirma, Gamze Cagla; Kardas, Ayten; Demirbas, Duygu; Balikci, Ayse Firdevs Aracikul; Beaudry-Bellefeuille, Isabelle; Aracikul Balikci, Ayse FirdevsBackground: The environmental enrichment (EE) framework has inspired several early intervention (EI) approaches. This study evaluated the feasibility, safety, caregiver acceptance, and satisfaction of implementing the HEP Approach intervention, a novel EI model based on the EE paradigm. Outcome measures for motor development, individual functional goals, sensory functions, caregiver-provided environmental affordances, and motivation for movement were examined. Methods: A pre-post-study design examined 18 premature infants (<33 weeks six days gestation) with a corrected age of 4-10 months. A 21-item Likert scale survey assessed the feasibility, safety, acceptability, and satisfaction of implementing the HEP Approach intervention. The Peabody Developmental Motor Scales-2, Test of Sensory Functions in Infants, Affordances in the Home Environment for Motor Development, and Infant Movement Motivation Questionnaire were used for outcomes. The goal attainment scale measured progress toward parent goals. The HEP Approach consisted of 12 one-hour sessions implemented over three months. Results: Most participating parents found the HEP Approach intervention feasible, safe, acceptable, and satisfactory. GAS scores demonstrated significant gains with a mean t-score of 67.75 (SD = 2.00). Results found significant improvement (p <= 0.05) in all outcome measures. Conclusions: Results suggest that the HEP Approach intervention is safe, feasible, and acceptable to implement. Outcome measures were meaningful and sensitive in identifying improved motor development, individualized parental goals, sensory functions, caregivers' use of environmental opportunities, and movement motivation in premature at-risk infants. Results suggest further studies on the HEP Approach are feasible, and highlight the potential of this intervention to inspire and guide future research in this field.Article Citation - WoS: 6Citation - Scopus: 4Exploring Effects of the Hep (homeostasis-Enrichment Approach as a Comprehensive Therapy Intervention for an Infant With Cerebral Palsy: a Case Report(Georg Thieme verlag Kg, 2022) Balikci, Aymen; Ballkcı, AymenCerebral palsy (CP) is a common non-progressive neurodevelopmental disorder which causes developmental disabilities in children. Varied interventions for CP exist to address medical and physical needs but with limited effectiveness evidence. Environmental enrichment (EE) is an animal model intervention for many neurodevelopmental disorders, including CP, with considerable positive effects. This case report defines the Homeostasis-Enrichment-Plasticity (HEP) approach, which is based upon principles of EE and ecological theories of development and describes its use to promote the developmental and functional skills of an infant with CP. Parent interviews and assessment data were completed before and after intervention. For the interested parameters data was gathered by developmental history, systematic observation of behaviors in the clinical setting and at home, Beck Anxiety Inventory (BAI), Infant-Toddler Symptom Checklist, the Sensory Profle Infant/Toddler, Peabody Developmental Motor Scales-2, Gross Motor Function Measurement-88 (GMFM-88), the Gross Motor Function Classification System (GMFCS), and Pediatric Evaluation of Disability Inventory (PEDI). The HEP approach intervention was implemented one time per week for 12 months. Following the HEP approach intervention, self-regulation and sensory processing scores improved. GMFM-88 total score improved from 45/264 to 123/264. The Peabody found all gross motor (54-110), fine motor (65-117), and total motor quotient (119-227) scores improved after intervention. Post-intervention observations showed obvious gross motor progress with movement from GMFCS Level IV to Level I. Performance on the Functional Skills Scales and Caregiver Assistance Scales of PEDI also demonstrated notable improvements. BAI scores revealed low anxiety scores for both the mother (13/63 points) and father (14/63) before intervention. These scores did not change after intervention. A definition and detailed description of the HEP approach intervention is presented here for the first time. The case report demonstrated preliminary evidence for the effectiveness of the HEP approach on self-regulation, sensory processing, motor development, functional skills, and caregiver assistance with an infant with CP. Additional studies are needed to validate the findings.