Over 275,000 infants are born very preterm in the US each year. Fifty percent of infants born very preterm will have some degree of neurological dysfunction limiting their ability to keep up with their typically developing peers. Clinical rehabilitation for these high-risk infants has not kept pace with advances in basic science or developmental theory. Objective: The aim of this project is to study the effect of a physical therapy intervention provided in the first months of life on developmental outcomes of infants born very preterm. Secondary aims are to investigate the impact of intervention timing on the efficacy and impact of the intervention on infants with and without cerebral palsy. Design: This study is a multisite longitudinal controlled trial comparing developmental outcomes from infants in the SPEEDI_Late or SPEEDI_Early group to a usual care group. Setting: Urban and rural areas surrounding 2 academic medical centers. Participants: There will be 90 preterm infants enrolled in this study born at < 29 weeks of gestation. Intervention: SPEEDI is a developmental intervention provided by a collaboration between a physical therapist and parent to support a child’s motor and cognitive development. Measurements: The primary outcome measure is the Bayley Scale of Infant and Toddler Development Cognitive and Gross Motor Scaled Scores. Secondary measures include behavioral coding of early problem solving skills, the Gross Motor Function Measure (GMFM), and Test of Infant Motor Performance (TIMP). Limitations: This study is powered to detect group differences between those receiving the study intervention and those receiving usual care. Conclusion: This study is a step towards understanding the impact of intensive developmental intervention in the first months of life.
Aim To conduct a systematic review and meta‐analysis on the effectiveness of physical therapy interventions to improve sitting ability in young children with or at risk for cerebral palsy (CP). Method A systematic literature search was performed using five databases. Study selection criteria were randomized controlled trials published in English on physical therapy interventions targeting sitting, reporting developmental or functional sitting outcomes, and focused on young children with or at risk for CP (mean age ≤5y). Risk of bias (ROB) was assessed using the Cochrane ROB 2.0 tool. Results Twelve unique studies met the inclusion criteria and were categorized into one of two categories: (1) comparison of two physical therapy interventions or (2) physical therapy plus adjunct versus physical therapy alone. The combined pooled effect size (g) for the 10 studies included in meta‐analysis was large (g=0.78) but non‐significant. Pooled effect for category 1 was small (g=–0.06) and non‐significant. Interventions in category 2 showed a large and significant effect (g=1.90, p=0.022). Interpretation There is a lack of strong evidence for physical therapy interventions targeting sitting in young children with or at‐risk for CP due to limitations in methodological rigor and sample sizes. Components of impairment remediation combined with functional balance training should be explored to improve sitting in children diagnosed with CP. Given the benefits of early achievement of sitting, strong evidence‐based research is needed. What this paper adds Strong evidence is lacking for physical therapy interventions to improve sitting ability in young children with/at risk for cerebral palsy (CP). Kinesio‐taping may be an effective adjunct to conventional physical therapy in improving sitting ability in children with spastic bilateral CP. Task‐specific, intensive, and child‐initiated intervention components show promise for improving sitting in young infants at risk for CP.
Introduction The purpose of this study was to quantify the relationship between early motor skills, such as sitting, and the development of problem‐solving skills in children with motor delays. Methods Motor (Gross Motor Function Measure) and problem‐solving (Assessment of Problem‐Solving in Play) skills of 134 children 7–16 months adjusted age at baseline with motor delay were assessed up to 5 times over 12 months. Participants were divided into two groups: mild and significant motor delay. Results Motor and problem‐solving scores had large (r’s = 0.53–0.67) and statistically significant (p’s > .01) correlations at all visits. Baseline motor skills predicted baseline and change in problem solving over time. The associations between motor and problem‐solving skills were moderated by level of motor delay, with children with significant motor delay generally having stronger associations compared to those with mild motor delay. Conclusions These findings suggest that overall baseline motor skills are predictive of current and future development of problem‐solving skills and that children with significant motor delay have a stronger and more stable association between motor and problem‐solving skills over time. This highlights that children with motor delays are at risk for secondary delays in problem solving, and this risk increases as degree of motor delay increases.
Infants born very preterm (VPT; ≤29 weeks of gestation) are at high risk of developmental disabilities and abnormalities in neural white matter characteristics. Early physical therapy interventions such as Supporting Play Exploration and Early Development Intervention (SPEEDI2) are associated with improvements in developmental outcomes. Six VPT infants were enrolled in a randomised clinical trial of SPEEDI2 during the transition from the neonatal intensive care unit to home over four time points. Magnetic resonance imaging scans and fixel-based analysis were performed, and fibre density (FD), fibre cross-section (FC), and fibre density and cross-section values (FDC) were computed. Changes in white matter microstructure and macrostructure were positively correlated with cognitive, motor, and motor-based problem solving over time on developmental assessments. In all infants, the greatest increase in FD, FC, and FDC occurred between Visit 1 and 2 (mean chronological age: 2.68–6.22 months), suggesting that this is a potential window of time to optimally support adaptive development. Results warrant further studies with larger groups to formally compare the impact of intervention and disparity on neurodevelopmental outcomes in infants born VPT.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.