Rapid-Cycle Evaluation in an Early Intervention Program for Children With Developmental Disabilities in South India: Optimizing Service Providers' Quality of Work-Life, Family Program Engagement, and School Enrollment.

Background: This paper explores how implementation and refinement of an early intervention (EI) program for children with delayed development was informed by an iterative, intentional and structured process of measurement. Providing access to early intervention therapy for children in rural areas of India is challenging due to a lack of rehabilitation therapists and programs. Following a biopsychosocial framework and principles of community-based rehabilitation, a non-governmental organization, Amar Seva Sangam (ASSA), overcame those barriers by designing a digital technology supported EI program in rural Tamil Nadu, India. Program objectives included providing service access; supporting program engagement, child development and school enrollment; and positioning the intervention for scale-up. This paper contributes to a growing body of literature on how program design and implementation can be informed through a cyclical process of data collection, analysis, reflection, and adaptation. Methods: Through several strands of data collection, the design and implementation of the EI program was adapted and improved. This included qualitative data from focus groups and interviews with caregivers and service providers, and a mobile application that collected and monitored longitudinal quantitative data, including program engagement rates, developmental progression, caregiver outcomes, and school enrollment status. Results: Measurements throughout the program informed decision-making by identifying facilitators and barriers to service providers' quality of work-life, family program engagement, and school enrollment. Consultation with key stakeholders, including caregivers and service providers, and data driven decision making led to continual program changes that improved service provider quality of work-life, program engagement and school enrollment. These changes included addressing gender-related work challenges for service providers; forming caregiver support networks; introducing psychological counseling for caregivers; providing medical consultations and assistive devices; creating community awareness programs; improving access to therapy services; focusing on caregiver education, motivation and support; and advocacy for accessibility in schools. Conclusion: The process of using evidence-informed and stakeholder driven adaptations to the early intervention program, led to improved service provider quality of work-life, greater program engagement, improved school enrollment and positioned the intervention for scale-up, providing lessons that may be beneficial in other contexts.

Increase in post activation potentiation in females following a cycling warmup.

Post activation potentiation (PAP) is a phenomenon in which muscular force is acutely enhanced as a result of prior contractile activity. The net augmentation is dependent upon the intensity of the preceding conditioning contraction influencing calcium release and phosphorylation of the regulatory myosin light chain. This phenomenon has been recorded after various types of conditioning contractions, however the interaction of a warmup on PAP remains uncertain and whether this differs between males and females requires consideration. We investigated the effect of a cycling warmup on twitch contractile properties and PAP of the plantar flexors on males and in females using oral contraceptives. A maximal voluntary contraction (MVC) of the plantar flexors preceded and followed a 10-min cycling warmup, where supramaximal twitches were administered prior to, during and after the conditioning contractions. Twitch contractile properties of peak tension (PT), time to peak tension (TPT), half relaxation time (HRT) and contraction duration (CD) were compared between resting and potentiated twitches before and after the warmup. Ultrasonography was used to measure in vivo Achilles tendon architecture. Males were ∼30% stronger, but voluntary activation did not differ from females (p = .37). In males and females PT increased following the conditioning MVC (p = .03). The degree of potentiation was higher following the warmup in females (25.01%, p = .02) but not males (p = .24). TPT, HRT and contraction duration (p < .05) were faster after the warmup and in males (p < .001). Achilles tendon elongation was unchanged by the warmup (p = .11). Ten minutes of a cycling warmup reduced TPT, HRT, and CD in both males and females without altering the tendon. The degree of PAP was higher in females than males following the warmup. This difference might be associated with altered calcium kinetics of females on oral contraceptives as well as higher proportion of type I fibres in the active muscles.