Two-year motor outcomes associated with the dose of NICU based physical therapy: The Noppi RCT

Background - Interventions involving both the parent and the preterm infant have demonstrated lasting effects on cognitive outcomes, but motor effects are less salient. It remains unclear when to commence early intervention and if dosages have impact on motor outcomes. Aims - To examine the effect on motor performance at 24-months corrected age following a parent-administered intervention performed with infants born preterm in the NICU. Intervention dosing and longitudinal motor performance were also analyzed. Study design - Single-blinded randomized multicenter clinical trial. Subjects - 153 infants born, gestational age ≤ 32 weeks at birth, were randomized into intervention or control group. Outcome measures - Infant Motor Performance Screening Test, Test of Infant Motor Performance, Peabody Developmental Motor Scales-2. Results - No significant difference was found between the intervention and the control group assessed with the PDMS-2 at 24-months CA. However, a significant positive association was found between dosing and the Gross Motor and Total Motor PDMS-2 scores. Analysis of longitudinal motor performance showed a decreasing motor performance between 6- and 24-months corrected age in both groups. Conclusions - There was no difference in motor performance between groups at 24-months corrected age. However, increased intervention dosage was positively associated with improved motor outcome

Behavior During Tethered Kicking in Infants with Periventricular Brain Injury

Purpose: To describe behavior of children with periventricular brain injury (PBI) in a tethered-kicking intervention. Methods: Sixteen infants with PBI were randomly assigned to exercise or no-training in a longitudinal pilot study. Frequencies of leg movements and interlimb coordination were described from videos at 2 and 4 months\u27 corrected age (CA). Results: Eight of the 13 children (62%) with longitudinal data increased the frequency of leg movements while tethered to a mobile between 2 and 4 months\u27 CA. Movement frequency was correlated with scores on the Test of Infant Motor Performance, but no differences between experimental groups were found. Children with typical development at 12 months\u27 CA increased the proportion of leg movements that were synchronous between 2 and 4 months, as did a child with cerebral palsy in the experimental group. Conclusions: The tethered-kicking intervention facilitates movement in infants with PBI, but effects on development remain to be demonstrated

Study protocol: an early intervention program to improve motor outcome in preterm infants: a randomized controlled trial and a qualitative study of physiotherapy performance and parental experiences

Background Knowledge about early physiotherapy to preterm infants is sparse, given the risk of delayed motor development and cerebral palsy. Methods/Design A pragmatic randomized controlled study has been designed to assess the effect of a preventative physiotherapy program carried out in the neonatal intensive care unit. Moreover, a qualitative study is carried out to assess the physiotherapy performance and parents' experiences with the intervention. The aim of the physiotherapy program is to improve motor development i.e. postural control and selective movements in these infants. 150 infants will be included and randomized to either intervention or standard follow-up. The infants in the intervention group will be given specific stimulation to facilitate movements based on the individual infant's development, behavior and needs. The physiotherapist teaches the parents how to do the intervention and the parents receive a booklet with photos and descriptions of the intervention. Intervention is carried out twice a day for three weeks (week 34, 35, 36 postmenstrual age). Standardized tests are carried out at baseline, term age and at three, six, 12 and 24 months corrected age. In addition eight triads (infant, parent and physiotherapist) are observed and videotaped in four clinical encounters each to assess the process of physiotherapy performance. The parents are also interviewed on their experiences with the intervention and how it influences on the parent-child relationship. Eight parents from the follow up group are interviewed about their experience. The interviews are performed according to the same schedule as the standardized measurements. Primary outcome is at two years corrected age. Discussion The paper presents the protocol for a randomized controlled trial designed to study the effect of physiotherapy to preterm infants at neonatal intensive care units. It also studies physiotherapy performance and the parent's experiences with the intervention

Physical therapy for children, 4th ed./ Campbell

xiv, 1090 hal.: ill, tab.; 28 cm

Physical therapy for children, 4th ed./ Campbell

xiv, 1090 hal.: ill, tab.; 28 cm

Physical therapy observation and assessment in the neonatal intensive care unit

This article presents the elements of the Observation and Assessment section of the Infant Care Path for Physical Therapy in the Neonatal Intensive Care Unit (NICU). The types of physical therapy assessments presented in this path are evidence-based and the suggested timing of these assessments is primarily based on practice knowledge from expert therapists, with supporting evidence cited. Assessment in the NICU begins with a thorough review of the health care record. Assessment proceeds by using the least invasive methods of gathering the behavioral, developmental, physiologic, and musculoskeletal information needed to implement a physical therapy plan of care. As the neonate matures and can better tolerate handling, assessment methods include lengthier standardized tests with the psychometric properties needed for informing diagnosis and intervention planning. Standardized tests and measures for screening, diagnosis, and developmental assessment are appraised and special considerations for assessment of neonates in the NICU are discussed

Psychometric Properties of the Pediatric Balance Scale Using Rasch Analysis

© 2015 Wolters Kluwer Health, Inc. Purpose: The Pediatric Balance Scale (PBS) is a 14-item measure of functional balance for children. This study examined PBS dimensionality, rating scale function, and hierarchical properties using Rasch analysis. Methods: The PBS data were analyzed retrospectively for 823 children, aged 2 to 13 years, with uni-and multidimensional Rasch partial credit models. Results: The PBS best fits a unidimensional model based on the Bayesian information criterion analysis (12 400.73 vs 12 404.48), strong correlations between 3 proposed dimensions (r = 0.946-0.979), and high internal consistency (Cronbach α = 0.94). Analysis of rating scale functioning is limited by small numbers of children achieving low scores on easy items. Item maps indicated a ceiling effect but no substantive gaps between item difficulty estimates. Conclusion: The PBS items are best targeted to preschool-age children; additional children with known balance dysfunction are required to fully assess functioning of the easiest PBS items. Revisions may improve PBS utility in older children

A (2008) A comparison of the general movements assessment with traditional approaches to newborn and infant assessment: concurrent validity. Early Hum Dev 84(5):297–303

Abstract Background: Assessment of the quality of general movements (GMs) is an early clinical marker for prediction of cerebral palsy. Aims: To explore how the General Movements Assessment (GMsA) relates to traditional newborn and infant measures currently in use. Study design: A prospective cohort design was used to examine concurrent validity of the GMsA in Neonatal Intensive Care (NICU) survivors (n = 100) at three age points: preterm (34 weeks gestational age GA), term (38-40 weeks GA), and post term (12 weeks adjusted age [AA]) with traditional assessments (see below). Correlation analysis was used to determine the strength of the associations between tests at each age point. Subjects: Preterm infants born at ≤ 32 weeks gestational age and birth weight b 1500 g (n = 108) were recruited sequentially from the NICU of a large teaching hospital and referral centre. Infants with diagnoses of metabolic disorders, cardiac, chromosomal, or congenital abnormalities were excluded