PRINCIPLES & PRACTICE
Infant Stimulation: Modification of an Intervention Based on Physiologic and Behavioral Cues

https://doi.org/10.1111/j.1552-6909.1994.tb01924.xGet rights and content

Research involving developmental intervention with premature infants in the hospital has traditionally taken two paths: application of a sensory stimulation protocol and individualized assessment and treatment. This article describes a new method that combines some of the philosophical strengths of these two approaches. A decision tree is presented to standardize the modifications of a developmental intervention based on physiologic and behavioral cues.

Section snippets

Protocol Approach

One traditional approach, which has been used since the 1960s, examines the effects of supplemental stimulation protocols as a form of developmental intervention (Barnard … Bee, 1983; Field et al., 1986; Kramer, Chamorro, Green, … Knudtson, 1975; Kramer … Pierpont, 1976; Rausch, 1981; Rice, 1977; Scafidi et al, 1986). Researchers using this approach hypothesized that infants in the neonatal intensive-care unit (NICU) were deprived of sensory stimulation. Often, the underlying assumption of this

Individualized Approach

An alternative approach to infant stimulation opposes structured protocols in favor of an individualized approach. This approach requires a detailed assessment of the individual infant and prescribes a highly individualized method of care (Als, 1986; Als et al., 1986). In Als’s studies using this approach, experimental group infants have had significantly better short-term neurologic and developmental outcomes (Als et al., 1986). Although many of the same principles of stress reduction were

Combining Traditional Approaches

Both traditional approaches represent valid ways to develop interventions for premature infants and to study the effects of these interventions. However, each of these approaches has disadvantages. For example, when evaluating a stimulation approach based solely on the needs of each individual infant, it is difficult to discern whether characteristics of the infant or the protocol are responsible for the outcome (Korner, 1990) . On the other hand, rigid protocols may ignore the individual needs

Conclusion

The use of the decision tree in conjunction with the ATW intervention benefits research in a variety of ways. The decision tree allows for pauses, containment, and other necessary deviations from the ATW intervention to be standardized. By standardizing these decisions, experimental error is minimized, whereas the variance between experimental and control groups is maximized. This strengthens the internal validity of the research design.

Clearly, it is important to acknowledge the uniqueness of

Acknowledgments

Supported by the National Institutes of Health, National Institute of Nursing Research Grant #1R01 NR2328-01A2, Hewlett-Packard Company Grant #13580, The Harris Foundation, The Alcoa Foundation, The Gould Company, and The Campus Research, University of Illinois.

References (38)

  • K.E. Barnard et al.

    The impact of temporally patterned stimulation on the development of preterm infants

    Child Development

    (1983)
  • B. Beebe et al.

    Engagement‐disengagement early object experiences

  • S. Blackburn

    Fostering behavioral development of high‐risk infants

    Journal of Obstetric, Gynecologic, and Neonatal Nursing

    (1983)
  • S. Blackburn et al.

    Maternal, fetal, and neonatal physiology: A clinical perspective

    (1992)
  • S. Blackburn

    State‐related behaviors and individual differences

  • K. D'Apolito

    What is an organized infant

    Neonatal Network

    (1991)
  • B. DiVitto et al.

    The effects of newborn medical status on early parent‐infant interaction

  • F.H. Duffy et al.

    Neural plasticity: A new frontier for infant development

  • J. Eriks

    Infant ‘Talk

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