Hybrid Early Intervention for Infants at Risk of Cerebral Palsy

A 24-item Likert-type questionnaire was developed by the researcher to evaluate the feasibility, acceptability, satisfaction level, and safety of the intervention. The questionnaire items were grouped under four main categories: feasibility (items 1-7), acceptability (items 8-12), satisfaction (items 13-19), and safety (items 20-24). The five-point Likert-type scale included response options ranging from 1 (Strongly Disagree) to 5 (Strongly Agree).

Goal Attainment Scaling (GAS) is one of the most frequently recommended goal-setting methods used in clinical and research settings to measure changes that occur during and after an intervention. Research has shown that GAS is a reliable tool for children with developmental challenges.

GAS is a scale used to evaluate the extent to which individually set goals-established at the beginning of the intervention-are achieved, providing subjective information related to the infant's specific needs. The scale uses a five-point rating system ranging from -2 to +2 to score goal attainment. A score of 0 represents the expected level of performance; -1 indicates slightly below expectations, and -2 indicates much lower than expected. Similarly, +1 reflects slightly above expectations, and +2 represents much better than expected performance. The scores are converted into standardized scores for analysis, and T-scores are used as outcome measures for the targeted goals.

The Bayley-III is a widely used tool for assessing the developmental functioning of children between the ages of 1 and 42 months. Its primary purposes are to identify developmental delays, provide professionals with information about a child's strengths and areas in need of support when developing comprehensive intervention plans, and offer a systematic method for monitoring developmental progress.

The Bayley-III evaluates development across five domains: cognitive, language, motor, social-emotional, and adaptive behavior. The cognitive, language, and motor domains are assessed through direct testing with the child, while the social-emotional and adaptive behavior domains are evaluated through questionnaires completed by the caregiver.

The test consists of five subdomains: response to deep pressure touch, adaptive motor functions, visual-tactile integration, oculo-motor control, and response to vestibular stimulation. It includes a total of 24 items.

In the response to deep pressure touch subdomain, the infant's reactions to tactile stimuli applied to the arms, hands, abdomen, soles of the feet, mouth, and shoulders are assessed. Responses are scored as 0 (aversive), 1 (mildly defensive), or 2 (integrated).

The adaptive motor response subdomain evaluates the infant's motor planning ability and the skill to explore various objects with the hands. Scores range from 0 (no response), 1 (disorganized), 2 (partial), to 3 (organized).

In the visual-tactile integration subdomain, the infant's responses to objects placed on or touching the body are assessed. Scoring is as follows: 0 (hyperresponsive), 1 (hyporesponsive), 2 (normal).

The oculo-motor control subdomain examines visual tracking and lateralization of the eyes

The DASS-21 is a validated and reliable tool for screening depressive and anxiety disorders, and it effectively assesses the severity of three psychological states through 21 items. The scale consists of three subscales: depression (7 items), anxiety (7 items), and stress (7 items). Each item is rated on a 4-point Likert scale ranging from 0 (Did not apply to me at all) to 3 (Applied to me very much or most of the time). Lower scores on the subscales indicate better psychological well-being.