Date Presented 04/05/2025
Enriched environment (EE) is a model with known positive outcomes in animal studies. It is a new area of interest in OT. Recent results from emerging EE models support the use of a novel EE intervention approach in early intervention settings.
Primary Author and Speaker: Aymen Balikci
Additional Authors and Speakers: Teresa A. May-Benson
Contributing Authors: Gamze Çağla Sirma
BACKGROUND: Early intervention for developmental difficulties is vital. Multiple intervention approaches are influenced by environmental enrichment (EE) paradigms which demonstrate significant favorable outcomes on sensory and motor performance in animal research. The Homeostasis-Enrichment-Plasticity (HEP) approach incorporates essential features of EE and sensory integration of physiological homeostasis, safety, sensory experiences, spatial features of the environment, environmental and object novelty, challenge, enjoyment, continuous engagement, social opportunities, and active engagement in and exploration of the environment in a novel early intervention program. This study examined the use of the HEP Approach on sensory functions, motor development and parental goals of premature infants at risk for developmental delays.
METHODS: A pre-post experimental feasibility study design was used. 18 premature infants (corrected ages of 4-10 months, born before 33 weeks 6 days of gestation) without any systemic disease or congenital defects were included. Parental informed consent was obtained. The Peabody Developmental Motor Scales-2 (PDMS-2), Test of Sensory Functions in Infants (TSFI), and Affordances in the Home Environment for Motor Development (AHEMD-IS) were used for pre-post assessment. Goal Attainment Scaling (GAS) measured progress on parent-determined goals and objectives. The HEP intervention consisted of 12 one-hour sessions implemented for 3 months.
RESULTS: Significant improvements were found on five parental GAS goals, t-scor.e = 66.5. Multiple t-tests found significant improvement after HEP intervention (p <.001) on the PDMS-2, TSFI, and AHEMD-IS scores.
CONCLUSIONS: Results offer preliminary support for positive effects of the HEP intervention on sensory functions, motor skills, modification of home environments and achievement of parental goals in preterm infants. OT’s may find HEP a useful novel EI intervention framework to promote these skills.
References
*Natali F, Difranco C, Gatti R. Enriched environment or enriched therapy? Time for clarification. Physiother Theory Pract 2020; 36 (11) 1175–1178. https://doi.org/10.1080/09593985.2020.1827706
*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.
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. https://doi.org/10.3389/fpsyg.2019.00466
