Physiotherapy intervention for 4-5 year old children born extremely preterm and/or extremely low birth weight

Abstract

Neurodevelopmental impairments amongst the extremely low birth weight (ELBW) or extremely preterm population are well recognised. However, support services for these children who have mild impairments are lacking. This research aimed to explore the performance of a group of non-disabled ELBW or extremely preterm children with minimal/mild impairments over a 12 month period at a critical time-point, coinciding with the commencement of formal education. Performance of these children was established, as well as whether impairments persist. Persistence of impairments may suggest a widening gap between performance of these children and expected performance of term born peers. Additionally, this research aimed to investigate the short term and longer term impact of group-based physiotherapy intervention compared to standard care. SubjectsFifty children born ELBW and/or extremely preterm (26 males; mean birth weight: 838.8g, SD 174.8g; mean gestational age: 27.0 weeks, SD 2.0 weeks) with minimal/mild motor impairments and a mean age (corrected for prematurity) of 50 months (SD 2.6 months) at baseline. Twenty-four children were randomised to intervention and 26 children to standard care. MethodsChildren were assessed by paediatric physiotherapists blinded to group allocation. A set testing protocol was used. Baseline assessment included: Movement Assessment Battery for Children second-edition (MABC-2), tests of postural stability and limb strength, Child Behavior Checklist (CBCL) and Beery Visual-Motor Integration Test 5 th Edition (Beery VMI). Following baseline assessment, children were randomly allocated to intervention or standard care. All children were assessed on motor and postural tests at the conclusion of the intervention. Goal Attainment Scaling (GAS) was utilised within the intervention group. At one year post baseline assessment, all children were assessed on baseline tests, as well as Peabody Picture Vocabulary Test 4 th Edition (PPVT-4). The group had low average motor co-ordination, lower than expected postural stability and strength, and acceptable behaviour. Mean percentile rank on MABC-2 was 31%.However, 30% of children had a score less than or equal to the 15 th percentile, indicating at risk of or having a definite motor problem and these children had poorer postural outcomes compared to children with normal motor performance. Behaviour was within normal range according to performance on CBCL, although between 11-15% of children had a score within the clinical range. Behaviour of males was poorer than that of females. Study IV: GAS to explore effect of group-based physiotherapy intervention on personal growth of non-disabled ELBW children Intervention was effective with GAS mean T score of the group exceeding the expected level (mean=58.17, SD=0.82). Goal attainment was associated with motor co-ordination 4 and children with better motor skills post intervention, were more successful in reaching goals. Females improved more than males on GAS. Study V: Behaviour of 4-5 year old non-disabled E...