Occupational Therapy Practices Guidelines for Early Childhood



Therapy Practices Guidelines for Early Childhood

The Clinical Practice Guidelines are highly critical for the health care system and families. The main point is that following them, people can make the right decision and choose the most appropriate option. Hence, Occupation Therapy Practice Guidelines for early childhood are crucial in the case of handling and treating children with developmental disorders. The main problem is that there is a lack of scientifically based high-quality CPG in this area. Hence, the paper is focused on the Occupational Therapy Practice Guidelines for early childhood, its global prevalence, and the implications of different theoretical frameworks for this area.

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CPG Importance

We intend to perform an update of the subject through the elaboration of clinical guidelines. The Clinical Practice Guidelines (CPG) are a set of "recommendations developed systematically to help professionals and patients make the most appropriate decisions about health care, and to select the most appropriate diagnostic or therapeutic options when you have to tackle a health or specific clinical condition" (Institute of Medicine Committee to Advise the Public health Service on Clinical Practice Guidelines, 1990).

Although in Spain and other European countries in recent years, there has been developed CPG with better quality, there are still a few guidelines made with a systematic methodology based on the best scientific evidence available. This situation that is reflected in the study by Redeguias (REDEGUIAS, 2003) and other authors (March, Alonso & Bonfill, 2002) has been observed in the work conducted as well as it is included in the catalog CPG GuiaSalud (GuiaSalud, 2005). The quality criteria of the CPG have been refined in recent years, especially after the appearance of the instrument known as AGREE (Appraisal of Guidelines Research and Evaluation Instrument for the evaluation of the quality of CPG). This instrument has been a useful tool for evaluating the quality of the guidelines for their development (The AGREE Collaboration, 2001).

There are prestigious institutions to normalize from the methodological point of view of the CPG. SIGN (Scottish Intercollegiate Guidelines Network, Red Scottish Intercollegiate Network about Clinical Practice Guidelines) and NICE (National Institute for Clinical Excellence, National Institute for Clinical Excellence in the UK) are two key agencies internationally for their extensive experience in developing CPG based on scientific evidence.

For the preparation of the CPG as well as the management and prevention of the Occupational Therapy Practices Guidelines for early childhood, we will take into account the materials developed by SIGN (Scottish Intercollegiate Guidelines Network, 2004), NICE (National Institute for Clinical Excellence, 2004) and AGREE on instruments. The Clinical Practice Guidelines address a wide range of health interventions. The implementation of the recommendations in clinical practice makes it necessary for the CPG to be of quality and follow a rigorous methodology.

Clinical Practice Guidelines were developed by doctors within the scope of primary care, while investing the experience of their long professional work and dedication in them, to specialists practicing to achieve the same medium target. Thus, its content is eminently practical and translates what the professional knows firsthand, helping to perform more efficient decision-making. The purpose of our project is to develop and validate a CPG, including language and actions of physicians, who will use them with a practical character on prevalent diseases, while unifying criteria to be more efficient in practice performance. Therefore, Occupational Therapy Practice Guidelines of high quality are critical for the health care system and communities to make the most appropriate decisions.

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Definition, Concept and General Guidelines

CPG are statements that are systematically developed to help practitioners to make appropriate decisions in specific clinical circumstances. The main aim of CPG in early childhood is to improve the developmental situation of children and infants by ensuring that they receive evidence-based care. CPG is one of the main sources of care quality improvement. However, there is a great gap between what was shown by medical science as an effective practice and what was done. The concerns arise from differences in recommendations in the guidelines and their quality. Moreover, there is a question about ways to define the guidelines’ quality. The appropriate guidelines have to be reliable, usable, and valid, and they have to improve the patients` outcomes (Vecchio et al., 2011).

CPG evaluation has to include the methods that were used for the development of the recommendations, as the recommendations` applicability, particularly costs, adverse effects, and benefits. In this paper, the CPG will focus on occupational therapy for early childhood. Occupational therapy can be defined as client-centered health care aimed at well-being and health promotion through the occupation. Occupations mean everyday activities, which people perform in their communities and families to occupy time and bring some purpose of life (Dall'Albaa et al., 2014).

Moreover, occupations include things that people are expected to do, want to do, and need to do. The guideline in this area for early childhood is critical for the caregivers and communities because it leads to an understanding of what must be done to efficiently treat children with disorders. Occupational therapy handles developmental disorders that can be defined as the chronic and severe disability originated during childhood or at birth that is expected to continue indefinitely and substantially restricts the individual’s functioning in several major life activities (Dall'Albaa et al., 2014).

In general, developmental problems in early childhood can be diagnosed through developmental monitoring. In the case of any developmental difficulties, developmental screening has to be used. Developmental screening can be defined as a short test that aims to show if a child can learn basic skills or if there are some delays (CDC, 2016). Parents can be asked to play or talk with children so that it becomes clear how they move, behave, speak, learn, and play. It is recommended for children to be screened for developmental disorders at 9, 18, 24, or 30 months (CDC, 2016). Therefore, by developing the Occupational Therapy Practice Guideline for early childhood, caregivers and communities increase their confidence and effectiveness.

Prevalence in Europe, Spain, and Australia

The prevalence of the Occupational Practice Guidelines for early childhood is dependent on the countries` contribution to the early intervention area. The main point is that the more countries are focused on early intervention, particularly occupational therapy for early childhood, the more chances there are that the needed researches would be done to develop high-quality CPG.

Therefore, in countries with low and middle income, the prevalence of the Occupational Practice Guidelines for early childhood is lower in comparison with countries with high income. Developmental disorders constitute a great proportion of childhood diseases across all countries. Some factors affect the children's development such as poverty, poor caregiver interaction, stigma and discrimination, limited access to services and programs, institutionalization, neglect, abuse, and violence (World Health Organization, 2012a).

Hence, poverty is among the most influential factors in developmental disorders. Pregnant women that live in poverty can experience exposure to environmental pollutants and toxins, restricted diet, and poor health. Moreover, children living in poverty can have developmental delays in comparison to children with higher socioeconomic backgrounds due to the higher exposure to a wide range of risks (World Health Organization, 2012a).

At the same time, children with disabilities experience strong discrimination. In many cultures, shame, guilt, and fear are associated with the birth of a child with disabilities. Another factor is child-caregiver interaction. The main problem is that therapists and caregivers can be isolated from communities that trigger negative beliefs and attitudes toward disorders. They can experience a lack of needed economic support and have limited social support and limited access to information that is needed to provide appropriate care for children (World Health Organization, 2012a).

These issues can impact seriously the mental and physical health of parents and their abilities to respond to children's developmental needs. The next factor is institutionalization, and it means that many children with disabilities are placed in residential care institutions that can be damaging to their development. The main problem is that the institutional environment can lead to developmental delay due to lack of rehabilitation, consistent caregiving input, poor nutrition, and inadequate stimulation (World Health Organization, 2012a).

Other critical issues are neglect, exploitation, abuse, and violence. It was stated that in some OECD countries, infants who are under 1 year are around three times more at homicide risk than children from 1 to 4 years old, and are two times more at risk compared to those aged from 5 to 14 (World Health Organization, 2012a). Children with disabilities are more vulnerable to psychological, sexual, and physical exploitation and abuse than healthy children. The last factor is limited access to services and programs that plays a great role in providing health, development, and inclusion of children. Therefore, it is possible to note that children from low- and middle-income countries are more prone to suffer from developmental disorders.

Hence, it was found that only twelve countries have a law guaranteeing access to early intervention services, including occupational therapy for young children with developmental difficulties. Among high-income countries, there are the US, the UK, Saudi Arabia, Israel, and France (World Health Organization, 2012b). Among low- and middle-income countries, there are Viet Nam, Turkey, Kyrgyzstan, Lebanon, Jordan, Ecuador, and Bulgaria (World Health Organization, 2012b).

Such countries meet many problems in treating children with developmental delays that were mentioned earlier, which means that having not enough income to treat these children properly, the situation with the practical guidelines development for their treatment is highly negative. At the same time, it is critical to analyze the prevalence of the Occupational Therapy Practice Guidelines in all countries to control their quality.

The prevalence of the Occupational Therapy Practice guidelines in Europe is not as positive as it could have been. However, the situation with CPG in recent years was slightly improved due to the instrument known as AGREE (Appraisal of Guidelines Research and Evaluation Instrument for the evaluation of the quality of CPG). AGREE is a validated and developed specific instrument the main goal of which is to assess the CPG quality taking into account the theoretical assumptions. Another controlling international agency is the Scottish Intercollegiate Guidelines Network (SIGN) that was formed in 1993. Its main goal is to improve the health care quality in Scotland through efficient and evidence-based clinical guideline development.

Taking into consideration the provided guidelines on the SIGN website, it is possible to analyze the prevalence of the Occupational Therapy Practice Guideline for early childhood. It is possible to notice that out of the presented guidelines only one is focused on the early intervention for children with developmental disorders, particularly autism (SIGN, n.d.). Another famous agency is the National Institute for Health and Care Excellence (NICE) which is focused on providing health care through evidence-based and scientifically grounded clinical guidelines in England. Despite a great number of published guidelines, none of them was focused on occupational therapy for the early childhood area. Some of the guidelines were focused on developmental delay therapy, but they were aimed at adults only (NICE, n.d.).

In Spain, the rate of children with disabilities reached 2.2% in the group aged from 0 to 6 years of age (Robles-Bello & Sanchez-Teruel, 2013). Early intervention, including occupational therapy for developmental disorders, is provided through center-based and family-focused activities. Early childhood services are provided for them. Only Andalusia has 129 Early Childhood Intervention Centers, 799 Special Education Classrooms, 892 Hearing and Language Professionals, 60 Special Education Centers, 156 Therapeutic Education Professionals, and 49.292 openings in schools (Robles-Bello & Sanchez-Teruel, 2013).

However, the situation with clinical guidelines is not so positive because many issues have to be improved. In general, clinical guideline development is an expensive process, and the existing guidelines require evaluation, research, and logistic support. The main problems connected with the CPG in Spain are terminology confusion, poor scientific research, few initiatives, and funding that is mostly received from the pharmaceutical companies (Robles-Bello & Sanchez-Teruel, 2013).

Hence, it is possible to note that Occupational Therapy Practice Guidelines for early childhood have a lower prevalence in Spain. The situation has been slightly improved with the AGREE appearance from the quality perspective, but still, many challenges have to be faced.

In Australia, developmental disorders quite often occur among children. It was indicated that 4% of children from birth to four years suffer from disorders, while the majority of these children have the severe limitation in the daily living activities, which include schooling, communication, mobility, and self-care (Dall'Albaa, Grayb, Williamsc, & Lowed, 2014). According to the data, 64400 children between the age of 5 and 20 have communication developmental disorders, while 99 600 children of the same age have sensory and speech developmental disabilities (Senate Community Affairs References Committee, 2014).

At the same time, children suffer from many other types of developmental disorders. In response, the Australian government provided the needed support and help through early interventions, particularly occupational therapy. National guidelines aimed at early intervention can also be described as quite effective. They are grounded in such core areas as teamwork, family, universal principles, and inclusion (ECIA, 2016). However, at the National Health and Medical Research Council (NHMRC) of Australia, no clinical guidelines for occupational therapy for early childhood areas were found. Hence, despite a better situation in comparison with Europe, the prevalence of the Occupational Therapy Practice Guidelines in Australia could have been better.

Prevalence in Latin America

In Brazil, 624 children aged between 2 and 3 suffer from developmental disorders. 24% of children have behavioral problems (Inter-American Development Bank, 2015). Studies showed a lack of knowledge among health care providers on developmental disorders area among children (Inter-American Development Bank, 2015). In general, in Latin America, around 93 million people, including children, have some developmental disorders. For instance, in Brazil, it was found that around 37% of children were at risk of developmental problems (Inter-American Development Bank, 2015).

Early childhood development is a critical issue nowadays in Latin America. This area must be invested, and the emphasis has to be put on the improvement of the developmental program. The main problem is that spending on early childhood programs and services is less than six percent of the social spending in general that includes social protection, housing, health, and education. Hence, it is possible to see that developmental disorders are a serious problem among children, and early childhood intervention, particularly occupational therapy, is not on a high level.

The same situation is with Occupational Therapy Practice Guidelines for early childhood. As it was already mentioned, clinical guideline development is highly expensive, and it is a great problem in low-income countries. Therefore, the quality guidelines’ prevalence in this area is extremely low.

Prevalence in the US, Florida

According to the National Early Intervention Longitudinal Study (NEILS), around 71%-76% of children that received early intervention in the US showed great developmental delays (The National Early Childhood Technical Assistance Center, 2011). As a result, some occupational therapy guidelines have been published by National Guideline Clearinghouse that is focused on controlling, reviewing, and developing clinical guidelines. However, only several of them, for example, Florida, were focused on early childhood intervention.

In Florida, early childhood intervention is provided through the Early Steps that support children from birth to thirty-six months in handling serious developmental delays (Florida Health Department, n.d.). It helps caregivers and families to develop confidence and competence in handling children`s learning and development. This program uses a specific approach that is aimed at providing families with a comprehensive professional team. Services are provided in places where families play, learn, and live with children to promote developmentally appropriate learning opportunities in daily routines and activities. The program brings services in the children`s lives instead of making children engage in the process.

Also, it increases the chances of children`s participation in community and development, provides families with service options, supports children with the professional team, and maximizes children`s daily natural learning opportunities. This program is a part of Florida`s Children`s Medical Services Managed Care Plan (CMS Plan) that guides caregivers and communities to provide children with special needs with specific family-centered and comprehensive care services (Florida Health Department, n.d.).

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Meaning for the Community and Health Care Area

Occupational therapy for early childhood plays a great role in the community and the health care area. The main point is that based on the IDEA, occupational therapy is designated as a primary service through which practitioners are trying to build the family`s ability to take care of their children and promote their growth and development in natural environments, where families play, work and live (American Occupational Therapy Association, n.d.). The main point is that children with developmental disorders are learning through occupational therapy how to become independent community members. Due to such early intervention, the community receives strong members, making the situation better for the children themselves as well as for the community in general.

Therefore, Occupational Therapy Practice Guidelines for early childhood are highly important to the community because, with their help, people will be able to make the most appropriate decision about children`s health. Occupational Therapy Practice Guidelines are essential for families to correctly support their children. They are also critical for nurse practitioners because due to the efficient occupational therapy practice guidelines for early childhood, they can provide effective support for children with developmental disorders. Such diseases are quite difficult to handle and to succeed in these cases, it is critical to apply effective practice guidelines.

Theoretical Framework

In general, developmental disabilities include motor development, cognitive development, social-emotional development, and feeding, eating, and swallowing disorders. Through occupational therapy, feeding, eating, and swallowing disorders include such interventions as physiological, parent-directed educational-based, and behavioral-based interventions, while cognitive disorders involve joint attention promotion, neonatal intensive care unit, and home-based intervention (American Occupational Therapy Association, 2013).

At the same time, social-emotional disorders include relationship-based, naturalistic, touch-based, interactional and play-based, instruction-based, therapist-selected objects and toys interventions, while the motor disorders treatment involves visual-motor interventions, developmental intervention for at-risk infants, and interventions for children with cerebral palsy risk, particularly constraint-included movement therapy (American Occupational Therapy Association, 2013). Despite the lack of consensus about developmental disabilities’ prevalence among children in general, many studies have estimated the prevalence that ranges from 3.34% to 5% (Dall'Albaa, Grayb, Williamsc & Lowed, 2014).

In the US, when learning and behavioral disorders are included in the statistics, the developmental disorder becomes more common than other chronic childhood conditions (Dall'Albaa, Grayb, Williamsc & Lowed, 2014). Hence, early intervention through occupational therapy has been found beneficial to support children in their developmental disabilities. Therefore, occupational therapy is highly crucial for children, while for effective Occupational Theory Practice Guideline for early childhood development, it is critical to analyze different theoretical approaches that can be efficiently applied.

Theoretical frameworks and models are crucial for effective clinical practice, education, and research. The occupational therapy practice framework emphasizes the symptoms and holistic intervention related to underlying health conditions that have to be consistent with the ICF model that was provided by the World Health Organization (WHO) (Bendixen & Kreider, 2011). In the Children and Youth Version of the ICF, it is possible to find the pathophysiology treatment and exploration as one of the actions that are directed on the enhancement of disabled children`s participation. Such a health biopsychosocial model underlines that needs of children with disabilities have to be analyzed not only on the medical or individual levels but also on more broad functional, educational, and social levels (Bendixen & Kreider, 2011).

The ICF is applied in different areas in rehabilitation and medicine and provides a comprehensive basis for interrelationships between people, participation, health, and the environment. The occupational therapy framework alignment with the ICF can provide the occupational language understanding by society`s border context, including public policy, research areas, and reimbursement (Bendixen & Kreider, 2011).

The main point is that occupational therapy has to provide the support that has to lead to success in children`s occupational roles. To reach such a result, occupational therapy has to include transition periods` critical analysis, social isolation prevention, children's participation in daily activities in various environments, and support of the development of children`s roles. Understanding how to provide such issues from social, educational, and functional perspectives can be obtained through the ICF theory implication. Therefore, the ICG can be defined as the international framework that provides occupational therapy areas with opportunities to become known and understood across the world (Bendixen & Kreider, 2011).

Moreover, it provides occupational therapists with the global language that helps to describe their expertise to the bigger international health care community. The main idea is that to develop an effective intervention, it is crucial to consider children`s environmental and personal occupational factors. However, this is not the only theory that can be applied to this practice guideline.

Another theory that can be applied to the occupational therapy practice guidelines for early childhood is the adaptation model of nursing that was provided by Callista Roy (Masters, 2012). She was born in 1939 in California, and in 1963, she received a bachelor’s degree in nursing at Mount Saint Mary`s College. In 1966, Roy received a master’s degree in nursing at the University of California. In addition, she got in 1973 a master’s degree in sociology and continued her education to acquire the doctorate (Masters, 2012). Roy managed to develop her model`s basic concepts while she was a graduate student at California University. Her adaptation model was published in 1970 (Masters, 2012).

Since then, she has published many works and papers that were focused on the model used in nursing practice. In response, she was awarded many honors for her contribution to nursing theory. Nowadays, Roy`s adaptation model is one of the most used frameworks in the nursing practice that was applied by thousands of nurses in all countries over the world. In the adaptation model, the person is presented as an adaptive system that always provides interaction with both external and internal environments. The major human system`s task is to maintain integrity in the face of environmental stimuli (Masters, 2012). Hence, the nursing goal is to foster a successful adaptation.

Roy`s adaptation model is grounded on such four components as nursing, environment, health, and person (Masters, 2012). The person in this theory is defined as a biopsychosocial being that is in constant interaction with the changing environment. The person uses acquired and innate mechanisms for adaptation purposes. This model considers people as a society, as groups, particularly communities, organizations, and families, and as individuals. Moreover, the person is the main nursing focus that can be defined as the adaptive system with regulator and connector subsystems that are acting to reach adaptation to four adaptive modes (Masters, 2012).

Health is represented in the model as the person`s life's inevitable dimension that is supported by a health-illness continuum. Also, it is described as being`s process or state that becomes integrated into the whole system (Masters, 2012). The environment can be defined as the world within and around humans as adaptive systems. It is an exactly changing environment that stimulates the person to make some adaptive responses. At the same time, environmental changes require increasing energy to adapt to the situation, and factors that impact the person are divided into residual, contextual, and focal stimuli (Masters, 2012).

Nursing can be defined as the health care profession focused on human life processes and people`s patterns with a commitment to promoting full life potential and health for societies, groups, families, and individuals (Masters, 2012). Its main goal is to promote the groups or individuals` adaptation to four adaptive modes to contribute to dignity dying, life quality, and health by assessing factors and behaviors that influence adaptive abilities.

In the model, adaptation is associated with the outcome and process in which feeling and thinking people as groups or individuals can use conscious awareness and choice to create environmental and human integration (Masters, 2012). In general, adaptation leads to the death of dignity, life quality, well-being, and optimal health. The adaptation model is divided into two subsystems such as the regulator subsystem and the cognate subsystem (Masters, 2012). The regulator subsystem can be defined as the main type of adaptive process that responds automatically through endocrine, chemical, and neural coping channels. At the same time, the connector subsystem can be defined as a basic coping process that involves four cognitive-emotive channels as emotion, learning, judgment, and processing (Masters, 2012).

The adaptation model represents four behavioral adaptive modes. The first physiologic-physical behavior mode is the physiologic organs, tissues, and cell activities manifestation. It includes such basic needs as protection, rest, activity, nutrition, elimination, and oxygenation. Additional processes that are involved in the physiologic adaptation are the endocrine function, neurologic function, electrolyte, fluid, senses, and acid-base balance (Masters, 2012). The next self-concept-group identity mode involves components of the physical self, which means body image and sensation, and personal self that includes moral-ethical-spiritual self, self-ideal, and self-consistency.

The third role functioning mode is focused on the person`s role in society and within the group. The basic need here is social integrity that means the understanding of the relation to each other to better understand how to act (Masters, 2012). The last interdependence mode is related to interdepended relationships. It is focused on the interactions that are related to the receiving and giving of value, respect, and love (Masters, 2012).

This theory can be successfully implemented in the Occupational Therapy Practice Guideline for early childhood and become a great contribution to children`s treatment. A person`s life is dependent on the energy and ability to adapt positively to simulations. Exactly adaptive responses reduce the energy that is needed for handling developmental delay conditions. When the adaptation efforts are weak and ineffective, nurse care is required. Hence, the guidelines must be developed taking into account this theory because, in this way, children will be able to adapt to their disabilities and survive.

In all adaptive model dimensions, the adaptive responses must be as high as possible. Due to the practice guide development based on Roy`s model, children through the nursing manipulation and intervention will improve their adaptive behavior that will lead to better psychological and physiological adaptation to the developmental problems.

Proposal and Validation of a Clinical Practice Guideline

Among developmental disorders, motor developmental delays are one of the most problems that most frequently occur. An example of a motor development disorder can be cerebral palsy (CP). Babies of less than six months can have such signs as poor posture, reflexes, muscle control, muscle spasms, low muscle tone, swallowing and feeding difficulties, and disability to hold their head still while lying on the back. For example, when a baby is a lifter, the legs can be crossed. Babies older than six months are not able to bring their own hands together, to roll in some direction, and have difficulties with bringing their own hands to the mouth. Furthermore, babies older than ten months usually have such signs as the disability to stand with support and a lopsided crawling manner (NINDS, 2016).

Several recommendations can be considered to reduce the effect of the signs. The first recommendation is the cognitive orientation to daily occupational performance (CO-OP) for early childhood. This therapy can be defined as client-centered, problem-solving, and grounded on the performance approach that provides skills acquisition through the guided discovery and strategy use process. This therapy is admitted as quite effective in handling children who suffer from CP. It can be proved by the study focused on the effect of CO-OP on children with CP in comparison with the usual practice approach.

18 children participated in the study, and they were divided into equal groups. They got 10 sessions by one hour at home once per week. As a result, it was found that both approaches provided skills maintenance and acquisition, but CO-OP showed some advantages in comparison with a usual approach (Cameron et al., 2016). Hence, it is possible to note that this method is quite effective and can be used to handle cerebral palsy signs.

Another recommendation is hydrotherapy, and it includes some therapeutic activities in the heated water. In this case, water provides weightlessness for the movement's ease, but at the same time, it creates resistance for muscle strengthening. This therapy is critical for the physical state improvement, and it can be proved by the research that was focused on studying the aquatic intervention effect of aquatic abilities and the gross motor function of children with CP.

In the research, 29 children with CP participated, and 14 of them finished the aquatic intervention that lasted for six weeks. The results showed that with the help of such theory, children with CP can improve their skills and muscle state, but time is highly critical for success (Dimitrijevi et al., 2016). Such therapy is good because it can be child-active when children are swimming by themselves, and it can be child-passive when children are moved passively by adults.

At the same time, CP has several symptoms. Among the CP symptoms can be learning difficulties, language and speech disorder, intellectual disability, drooling, anxiety, distress, and others. To relieve some of the symptoms, it is critical to apply cognitive behavior therapy. It is a child-active approach the includes identifying unneeded behaviors and thoughts, teaching constructive actions, thinking self-management, and cognitive restructuring. For example, it was found that this therapy decreases anxiety disorders for less than six months. The research which included 55 studies proved that the effect of non-cognitive behavior therapy interventions was not significant, while cognitive behavioral therapy showed impressive results (Reynolds, Wilson, Austin, & Hooper, 2012).

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Another recommendation is alternative and augmentative communication. Due to this approach, alternative communication methods can be used to handle speech disabilities of children with CP. For instance, one research studied the relation of the Communication Function Classification System (CFCS) to the CP cognitive function and manual ability among others. In the study, 28 children with CP participated, and it was noted that only half of the children used speech, while 32% used communication books, and 16% used sounds, gaze, and body movements. It was proved that communication functions can be taken from CFCS that in turn correlate with cognitive, fine motor, and gross functions (Himmelmann, Lindh, & Hidecker, 2013). Hence, alternative tools are critical for children with communication problems.

The best way to treat children with CP diagnosis is a general movement assessment (GMA). It is used to predict CP among infants who are at high developing neurological dysfunctions risk. It was proved by the research that focused on the CP diagnosis and included a neurological examination, MRI, cranial ultrasound, and GMA. It stated that the best method is GMA due to its predictive accuracy strength and best evidence (Bosanquet, Copeland, Ware, & Boyd, 2013). GMA is critical to use despite the difficulties with access owing to strong evidence.

One of the most frequently used medicines among children with CP is Baclofen. It helps to reduce pain and decrease hypertonia, and it is believed to be one of the most effective ways to improve daily functions. The dose of this medicine has to be 20 mg daily, and it has to be given every eight hours. However, it can provoke chest pain, fatigue, swallowing difficulties, urinary retention, sleep problems, and irritability. Moreover, this medicine can be confused with Bactroban (Ben-Pazi et al., 2016).

Also, it is critical to understand how to prevent such diseases. The CP prevention among children can be provided during pregnancy, during birth, and after birth. In general, it is critical to avoid infections, to have regular visits to doctors, to keep children safe from infections and simply to be careful. One of the most widely spread ways to decrease CP is magnesium sulfate. It is believed that it can prevent CP among children that were born to women at high early preterm delivery risk. The research showed that this treatment decreases the CP rates by 37% (Rouse & Gibbins, 2013). Therefore, it is well-known from the historical prospective method, and it provides great results in decreasing the CP level among children.

Overall, it is critical to note that the high-quality and evidence-based Occupational Therapy Practice Guideline for early childhood development is a great problem around the world because its prevalence is not impressive. Moreover, despite the presence of good guidelines in some countries, most of them are aimed at adults but not children. It is possible to improve such a situation because occupational therapy showed great results in treating children with developmental disorders.

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