ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Occupational Therapy
Volume 13 - 2025 | doi: 10.3389/fped.2025.1606490
Effects of the HEP® (Homeostasis-Enrichment-Plasticity) Approach in Preterm Infants with Increased Developmental Risk: A Randomized Controlled Study
Provisionally accepted
- 1Department of Occupational Therapy, Fenerbahçe University, Istanbul, Türkiye
- 2Graduate School of Education, Istanbul University-Cerrahpaşa, Avcılar, Istanbul, Türkiye
- 3Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpaşa, İstanbul, Türkiye
- 4Sense On Ltd., İstanbul, Türkiye
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Background 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. 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. 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*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*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.
Keywords: Early Intervention, environmental enrichment, development, prematurity, infants at risk
Received: 04 Jun 2025; Accepted: 28 Aug 2025.
Copyright: © 2025 SIRMA, ZENGIN ALPOZGEN and BALIKCI. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Gamze Cagla SIRMA, Department of Occupational Therapy, Fenerbahçe University, Istanbul, Türkiye
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