Objective Our objective was to evaluate the efficacy of the Sitting Together and Reaching to Play (START-Play) intervention in young infants with neuromotor disorders. Method This randomized controlled trial compared usual care early intervention (UC-EI) with START-Play plus UC-EI. Analyses included 112 infants with motor delay (55 UC-EI, 57 START-Play) recruited at 7 to 16 months of age across 5 sites. START-Play included twice-weekly home visits with the infant and caregiver for 12 weeks provided by physical therapists trained in the START-Play intervention; UC-EI was not disrupted. Outcome measures were the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley); the Gross Motor Function Measure; reaching frequency; and the Assessment of Problem Solving in Play (APSP). Comparisons for the full group as well as separate comparisons for infants with mild motor delay and infants with significant motor delay were done. Piecewise linear mixed modeling estimated short- and long-term effects. Results For infants with significant motor delay, positive effects of START-Play were observed at 3 months for Bayley cognition, Bayley fine motor, and APSP and at 12 months for Bayley fine motor and reaching frequency outcomes. For infants with mild motor delay, positive effects of START-Play for the Bayley receptive communication outcome were found. For the UC-EI group, the only difference between groups was a positive effect for the APSP outcome, observed at 3 months. Conclusions START-Play may advance reaching, problem-solving, cognitive, and fine motor skills for young infants with significant motor delay over UC-EI in the short term. START-Play in addition to UC-EI may not improve motor/cognitive outcomes for infants with milder motor delays over and above usual care. Impact Concepts of embodied cognition, applied to early intervention in the START-Play intervention, may serve to advance cognition and motor skills in young infants with significant motor delays over usual care early intervention. Lay Summary If you have a young infant with significant delays in motor skills, your physical therapist can work with you to develop play opportunities to enhance your child’s problem-solving, such as that used in the START-Play intervention, in addition to usual care in order to help your child advance cognitive and motor skills.

The development of sitting changes how much infants are able to explore objects. Infants who can sit with their arms free are likely to explore their environment more effectively than prop sitters, as their hands are free to explore. We sought to quantify how prop sitters differed in the amount of visual and manual exploration of objects from arms‐free sitters. Infants younger than 7 months (n = 31) were recruited at sitting emergence, either prop or arms‐free sitting without the ability to change positions. Infants were grouped into sitting stages at baseline: prop (n = 17) or wobbly/arms‐free (n = 14). Across three visits (baseline, 3 weeks later, 6–8 weeks later), researchers assessed the infants’ total gross motor skill, sitting skill, and object looking and active exploration. Infants’ gross motor and sitting skill was assessed using the Gross Motor Function Measure (GMFM)‐66 total scores and GMFM‐88 sitting dimension scores. While researchers supported infants in sitting, object looking and exploration were assessed using a series of three object exploration tasks and scoring modified slightly from the Early Problem Solving Indicator at each visit. Differences between trajectories of prop and wobbly/arms‐free sitters for the frequencies of two behaviors, looks and explores, were analyzed using longitudinal multilevel modeling. Prop sitters initially explored toys less frequently, but increased their exploration more quickly, than wobbly/arms‐free sitters. Sitting skill predicted minor changes in the development of looking; both stage and skill predicted changes uniquely in the development of exploration. These findings suggest that independent, arms‐free sitting changes how capable infants are of exploring objects visually and manually.

Infants’ developing motor skills—including mastery of new postures such as sitting and standing—affect opportunities for learning that facilitate cognitive development. But how infant posture affects caregiver behavior is largely unexplored. Moreover, we know little about effects of posture on learning opportunities in infants with motor delay. This study asked how infants with typical development and infants with significant motor delay use various postures during play, and whether posture is related in real time to caregiver‐provided cognitive learning opportunities. Infants were videotaped five times over the course of a year in a free play session with a caregiver, starting when they demonstrated initial sitting skills. Posture and cognitive opportunities were coded moment‐by‐moment to assess duration and temporal overlap. We found that infants with typical development and infants with motor delay displayed similar use of postures initially, but infants with typical development demonstrated more mature postures over time. We also found that for both groups of infants, caregivers were most likely to provide cognitive opportunities when infants were sitting independently, and least likely when infants were supine. Our findings highlight the importance of upright sitting in typical and atypical infant development and suggest potential areas of intervention for infants with motor delay.

Aims: To examine concurrent validity of inertial sensor (APDM ISway) versus force plate center of pressure (COP) measures of postural sway in cognitively impaired older adults. Methods: Participants, mean age 85.6 (SD 4.8), were tested in 4 static standing conditions: (1) eyes open/normal base, (2) eyes open/narrow base, (3) eyes closed/normal base, and (4) eyes closed/narrow base. ISway and COP measures were collected. Results: Strong correlations between ISway trunk sway smoothness [ISway JERK, (m 2 /s 5)] and COP path length (r = 0.67-0.85) and COP mean velocity (r = 0.77-0.87); also ISway total sway acceleration path length/trail duration [ISway PATH, (m 2 /s 2)] and COP path length (r = 0.77-0.87) and COP mean velocity (r = 0.77-0.91). Increased sway was detected in narrow versus normal base and eyes closed versus open conditions (P = .001). Conclusions: APDM ISway demonstrated concurrent validity to force-plate COP and changes in postural sway were detected between conditions.

Purpose: In early 2022, the Centers for Disease Control and Prevention (CDC) updated their developmental surveillance milestone checklists. The purpose of this article is to clarify and interpret the updates from a physical therapist perspective and to discuss implications of the new milestones for physical therapists. Summary of Key Points: The CDC's updated checklists provide clear, consistent, easy to use, and evidence-based developmental milestones to prompt discussion with families. The new checklists do not represent a lowering of standards and will likely increase, not decrease, referrals for screening, evaluation, and services. Crawling has been removed from the milestone checklists, as the current evidence suggests that crawling is highly variable and not essential for development. Conclusions and Recommendations for Clinical Practice: The updated milestone checklists will facilitate bringing vital services to children who need them. Physical therapists should support our primary care colleagues in implementing this useful program.