Targeted Physical Therapy Combined with Spasticity Management Changes Motor Development Trajectory for a 2- Year-Old with Cerebral Palsy

Therapies for children with cerebral palsy (CP) often fail to address essential components of early rehabilitation: intensity, child initiation, and an embodied approach. Sitting Together And Reaching To Play (START-Play) addresses these issues while incorporating intensive family involvement to maximize therapeutic dosage. While START-Play was developed and tested on children aged 7–16 months with motor delays, the theoretical construct can be applied to intervention in children of broader ages and skills levels. This study quantifies the impact of a broader STARTPlay intervention combined with Botulinum toxin-A (BoNT-A) and phenol on the developmental trajectory of a 24 month-old child with bilateral spastic CP. In this AB +1 study, A consisted of multiple baseline assessments with the Gross Motor Function Measure-66 and the Assessment of Problem Solving in Play. The research participant demonstrated a stable baseline during A and changes in response to the combination of BoNT-A/phenol and 12 START-Play sessions during B, surpassing the minimal clinically important difference on the Gross Motor Function Measure-66. The followup data point (+1) was completed after a second round of BoNT-A/phenol injections. While the findings suggest the participant improved his gross motor skills with BoNT-A/phenol and STARTPlay, further research is needed to generalize these findings

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. Video Abstract: For more insights from the authors, access Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A273. (Pediatr Phys Ther 2019;31:347-352)

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. Video Abstract: For more insights from the authors, access Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A273. (Pediatr Phys Ther 2019;31:347-352)

Targeted Physical Therapy Combined with Spasticity Management Changes Motor Development Trajectory for a 2-Year-Old with Cerebral Palsy

Therapies for children with cerebral palsy (CP) often fail to address essential components of early rehabilitation: intensity, child initiation, and an embodied approach. Sitting Together And Reaching To Play (START-Play) addresses these issues while incorporating intensive family involvement to maximize therapeutic dosage. While START-Play was developed and tested on children aged 7-16 months with motor delays, the theoretical construct can be applied to intervention in children of broader ages and skills levels. This study quantifies the impact of a broader START-Play intervention combined with Botulinum toxin-A (BoNT-A) and phenol on the developmental trajectory of a 24 month-old child with bilateral spastic CP. In this AB +1 study, A consisted of multiple baseline assessments with the Gross Motor Function Measure-66 and the Assessment of Problem Solving in Play. The research participant demonstrated a stable baseline during A and changes in response to the combination of BoNT-A/phenol and 12 START-Play sessions during B, surpassing the minimal clinically important difference on the Gross Motor Function Measure-66. The follow-up data point (+1) was completed after a second round of BoNT-A/phenol injections. While the findings suggest the participant improved his gross motor skills with BoNT-A/phenol and START-Play, further research is needed to generalize these findings

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 a NICU to Home Physical Therapy Intervention on White Matter Trajectories, Motor Skills, and Problem-Solving Skills of Infants Born Very Preterm: A Case Series

Infants born very preterm (VPT; &le;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&ndash;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