Parent Experiences in the NICU and Transition to Home.

Families (n = 12) with infants born at <29 weeks gestation shared their experiences while in the NICU and transitioning home. Parents were interviewed 6-8 weeks after NICU discharge, including some during the acute phase of the COVID-19 pandemic. Findings regarding the parent experience in the NICU were focused around challenges navigating parent-infant separation, social isolation, communication difficulties, limited knowledge of preterm infants, mental health challenges. Parents also discussed supports that were present and supports they wished were present, as well as the impact of COVID-19 on their experiences. In the transition to home, primary experiences included the sudden nature of the transition, anxiety around discharge preparation, and the loss of the support from nursing staff. During the first few weeks at home, parents expressed joy and anxiety, particularly around feeding. The COVID-19 pandemic limited emotional, informational, and physical support to parents and resulted in limited mutual support from other parents of infants in the NICU. Parents of preterm infants in the NICU present with multiple stressors, rendering attending to parental mental health crucial. NICU staff need to address logistical barriers and familial priorities impacting communication and parent-infant bonding. Providing multiple opportunities for communication, participating in caretaking activities, and meeting other families can be important sources of support and knowledge for parents of very preterm infants.

Factors Influencing Receipt and Type of Therapy Services in the NICU.

Understanding the type and frequency of current neonatal intensive care unit (NICU) therapy services and predictors of referral for therapy services is a crucial first step to supporting positive long-term outcomes in very preterm infants. This study enrolled 83 very preterm infants (<32 weeks, gestational age mean 26.5 ± 2.0 weeks; 38 male) from a longitudinal clinical trial. Race, neonatal medical index, neuroimaging, and frequency of therapy sessions were extracted from medical records. The Test of Infant Motor Performance and the General Movement Assessment were administered. Average weekly sessions of occupational therapy, physical therapy, and speech therapy were significantly different by type, but the magnitude and direction of the difference depended upon the discharge week. Infants at high risk for cerebral palsy based on their baseline General Movements Assessment scores received more therapy sessions than infants at low risk for cerebral palsy. Baseline General Movements Assessment was related to the mean number of occupational therapy sessions but not physical therapy or speech therapy sessions. Neonatal Medical Index scores and Test of Infant Motor Performance scores were not predictive of combined therapy services. Medical and developmental risk factors, as well as outcomes from therapy assessments, should be the basis for referral for therapy services in the neonatal intensive care unit.

Effect of the START-Play Physical Therapy Intervention on Cognitive Skills Depends on Caregiver-Provided Learning Opportunities.

AIMS: This study evaluated whether caregiver-provided learning opportunities moderated the effect of START-Play physical therapy intervention on the cognitive skills of young children with neuromotor delays, and whether START-Play impacted caregiver-provided learning opportunities over time. METHODS: One hundred and twelve children with neuromotor delays (7-16 months) participated in a multisite randomized clinical trial evaluating the efficacy of START-Play. Children were assessed at baseline and 3 (post intervention), 6, and 12 months post baseline. Cognition was scored from the Bayley Scales of Infant & Toddler Development, Third Edition, cognitive scale. The proportion of time caregivers spent providing learning opportunities was coded from a 5-minute caregiver-child free play interaction. RESULTS: Baseline caregiver-provided learning opportunities moderated the 3- and 12-month effects of START-Play on cognition. Cognitive gains due to START-Play were more pronounced for children whose caregivers provided more learning opportunities. START-Play did not impact caregiver-provided learning opportunities over time. CONCLUSIONS: START-Play may have a lasting effect on children's cognition, but this effect is contingent on caregivers providing their child with ample opportunities to practice cognitive skills. Strategies for improving caregivers' uptake and transfer of START-Play principles to their daily routines should be evaluated. TRIAL REGISTRATION: ClinicalTrials.gov NCT02593825.

Infant posture and caregiver-provided cognitive opportunities in typically developing infants and infants with motor delay.

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.

Developing a fidelity measure of early intervention programs for children with neuromotor disorders.

AIM: To describe the development of an intervention-specific fidelity measure and its utilization and to determine whether the newly developed Sitting Together and Reaching to Play (START-Play) intervention was implemented as intended. Also, to quantify differences between START-Play and usual early intervention (uEI) services. METHOD: A fidelity measure for the START-Play intervention was developed for children with neuromotor disorders by: (1) identifying key intervention components, (2) establishing a measurement coding system, and (3) testing the reliability of instrument scores. After establishing acceptable interrater reliability, 103 intervention videos from the START-Play randomized controlled trial were coded and compared between the START-Play and uEI groups to measure five dimensions of START-Play fidelity, including adherence, dosage, quality of intervention, participant responsiveness, and program differentiation. RESULTS: Fifteen fidelity variables out of 17 had good to excellent interrater reliability evidence with intraclass correlation coefficients (ICCs) ranging from 0.77 to 0.95. The START-Play therapists met the criteria for acceptable fidelity of the intervention (rates of START-Play key component use ≥0.8; quality ratings ≥3 [on a scale of 1-4]). The START-Play and uEI groups differed significantly in rates of START-Play key component use and quality ratings. INTERPRETATION: The START-Play fidelity measure successfully quantified key components of the START-Play intervention, serving to differentiate START-Play from uEI.

Effect of neonatal therapy on the motor, cognitive, and behavioral development of infants born preterm: a systematic review.

AIM: To synthesize the existing literature and determine the efficacy of neonatal therapy, starting in the neonatal intensive care unit (NICU), on the motor, cognitive, and behavioral outcomes of infants born preterm. METHOD: Databases were searched for randomized controlled trials or quasi-randomized controlled trials of direct therapy early intervention for infants with a gestational age of less than 37 weeks, initiated in the NICU and delivered by a therapist or parent with therapist support. Quality was evaluated using the Cochrane standardized risk of bias assessment tool. Recommendations were made using the Grading of Recommendations, Assessment, Development and Evaluations approach. RESULTS: Fifteen studies met the inclusion criteria. Studies were categorized into four intervention categories: (1) parent-delivered motor intervention (PDMI); (2) therapist-delivered postural control intervention (TDPCI); (3) developmental care; and (4) oromotor intervention. Risk of bias varied from low (10 studies) to high (three studies) or was unclear (two studies). INTERPRETATION: Preliminary support indicates that daily PDMI improves motor and cognitive outcomes in the short-term and possibly long-term. TDPCI is effective in promoting short-term gains in motor development. Developmental care programs designed by a neonatal therapist appear to be effective in improving short-term behavior but are inconclusive for motor and cognitive outcomes or long-term behavioral outcomes. Regarding oromotor interventions, there is insufficient research to be confident in their efficacy on improving developmental outcomes. WHAT THIS PAPER ADDS: Parent-delivered motor interventions (PDMIs) are more effective in improving motor and cognitive outcomes than other interventions. Preliminary support indicates that daily PDMI improves motor and cognitive outcomes in the short- and possibly long-term. Therapist-delivered postural control interventions are effective in promoting short-term gains in motor development. Developmental care programs designed by a neonatal therapist are effective in improving the short-term behavior of infants born preterm. Oral motor interventions were found to have no effect on improving developmental outcomes.

Efectos de la terapia neonatal en el desarrollo motor, cognitivo y conducta de los niños nacidos pretérmino: una revisión sistemática OBJETIVO: Sintetizar la literatura existente y determinar la eficacia de la terapia neonatal, comenzando en la unidad de cuidados intensivos neonatales (UCIN), en el desarrollo motor, cognitivo y conducta de niños pretérmino. MÉTODO: En diferentes bases de datos buscamos ensayos aleatorios y controlados o ensayos cuasi aleatorios y controlados de intervención temprana en niños con edad gestacional menor a 37 semanas, iniciadas en UCIN y realizadas por un terapeuta o un padre con el apoyo de un terapeuta. La calidad se evaluó usando la herramienta de evaluación estandarizada de riesgo de sesgo de Cochrane. Las recomendaciones se realizaron utilizando el enfoque de Calificación de Recomendaciones, Valoración, Desarrollo y evaluaciones. RESULTADOS: Quince estudios reunieron los criterios de inclusión. Los estudios se dividieron en 4 categorías de intervención: (1) intervenciones motoras realizadas por padres (PDMI); (2) intervención de control postural administrada por terapeutas; (3) cuidados del desarrollo; y (4) intervención oromotora. El riesgo de sesgo vario de bajo (10 estudios) a alto (3 estudios) o no estaba claro (2 estudios). INTERPRETACIÓN: El soporte preliminar indica que el PDMI diario mejora los resultados motores y cognitivos a corto plazo y posiblemente a largo plazo. La intervención de control postural administrada por terapeuta es efectiva para promover ganancias a corto plazo en el desarrollo motor. Los programas de atención del desarrollo diseñados por un terapeuta neonatal parecen ser efectivos para mejorar el comportamiento a corto plazo, pero no son concluyentes para los resultados motores y cognitivos o los resultados conductuales a largo plazo. Con respecto a las intervenciones oromotoras, no hay investigaciones suficientes para confiar en su eficacia para mejorar los resultados del desarrollo.

Efeito da terapia neonatal no desenvolvimento motor, cognitivo e comportamental de lactentes nascidos prematuros: uma revisão sistemática OBJETIVO: Sintetizar a literatura existente e determinar a eficácia da terapia neonatal, iniciando na unidade de terapia intensiva neonatal (UTIN) nos resultados motores, cognitivos, e comportamentais de lactentes nascidos prematuros. MÉTODO: Bases de dados foram pesquisadas quanto a estudos clínicos randomizados ou quasi-randomizados sobre a intervenção precoce direta para crianças com idade gestacional menor do que 37 semanas, iniciada na UTIN e realizada por um terapeuta ou pai/mãe com suporte de terapeuta. A qualidade foi avaliada usando a ferramenta padronizada Cochrane para risco de viés. Recomendações foram feitas usando a abordagem Grade para Recomendações, Avaliação, Desenvolvimento e Acompanhamento. RESULTADOS: Quinze estudos atenderam aos critérios de inclusão. Os estudos foram categorizados em quatro categorias de intervenção: (1) intervenção motora realizada pelos pais (IMRP); (2) intervenção de controle postural realizada por terapeuta; (3) cuidado desenvolvimental; e (4) intervenção oromotora. O risco de viés variou de baixo (10 estudos) a alto (três estudos) ou não estava claro (dois estudos). INTERPRETAÇÃO: Estudos preliminares indicam que a IMRP melhora os resultados motores e cognitivos no curto prazo e provavelmente no longo prazo. Intervenção para controle postural realizada por terapeutas é efetiva em promover ganhos em curto prazo no desenvolvimento motor. Programas de atenção ao desenvolvimento traçados por terapeuta neonatal parecem ser efetivos para melhorar o comportamento em curto prazo, mas são inconclusivos para resultados motores e cognitivos, ou resultados comportamentais no longo prazo. Com relação às intervenções oromotoras, as pesquisas são insuficientes para dar confiança sobre sua eficácia em melhorar resultados desenvolvimentais.

A Physical Therapy Intervention to Advance Cognitive and Motor Skills: A Single Subject Study of a Young Child With Cerebral Palsy.

BACKGROUND: Physical therapy interventions for children with severe motor impairments do not address the relationship between motor and cognitive development. PURPOSE: Evaluate the potential of a physical therapy intervention focusing on enhancing cognitive and motor outcomes in a child with severe motor impairments. DESIGN: AB phase design without reversal. METHODS: One child participated in 8 assessments from 4 to 29 months of age. The START-Play intervention was provided for 3 months following 4 baseline assessments over 12 months. Total Gross Motor Function Measure (GMFM), Sitting, Reaching, and Problem Solving assessments were completed. Visual inspection, 2 standard deviation (SD) Band Method, and percent of nonoverlapping data methods evaluated change. RESULTS: This child had improved GMFM total and sitting scores, increased frequency of toys contacts, and increased rate of problem-solving behaviors following intervention. CONCLUSION: START-Play shows promise for children with severe motor impairments. Additional research is needed to evaluate efficacy.