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 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: 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.