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

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

Physiotherapy in infants born preterm: Measurement tools for assessing motor function in infancy and a randomised controlled trial of early intervention to optimise motor function

Fysioterapi til for tidlig fødte barn. Måleredskap for vurdering av motorisk funksjon i spedbarnsalderen og en randomisert kontrollert studie av tidlig intervensjon for å optimalisere motorisk funksjon Barn som er født for tidlig er i risiko for en rekke senskader, for eksempel motoriske vansker og cerebral parese. I Norge blir barn som er født før 28. svangerskapsuke eller med fødselsvekt under 1000 gram rutinemessig henvist til fysioterapi. For å kunne skille mellom barn med normal motorisk utvikling og de som har motoriske vansker, og for å kunne rette oppfølgingen mot de med størst behov for tidlig intervensjon, trenger vi reliable og valide måleredskap. Målet med de to første artiklene i avhandlingen var å undersøke ulike egenskaper ved to måleredskap for barn under fem måneder. Den tredje artikkelen er fra en multisenter randomisert kontrollert studie, der foreldre gjennomførte intervensjon av sine barn før termin-alder. Målet var å undersøke effekten av intervensjonen ved å sammenligne endringen i motorisk funksjon etter en tre-ukers periode, mellom barn i en intervensjonsgruppe og en kontrollgruppe. I den første artikkelen ble test-retest reliabilitet av testen “Test of Infant Motor Performance Screening Items” undersøkt. Testen ble gjentatt to ganger på barn i høy til moderat risiko for motoriske vansker og vi fant stor grad av samsvar mellom testresultatet på de to testtidspunktene. Spedbarns spontane bevegelser, også kalt “general movements” (GMs), kan indikere normal eller avvikende utvikling. I den andre artikkelen ble validiteten mellom en detaljanalyse og en global analyse av GMs vurdert. Vi fant god korrelasjon ved termin-alder og de første ukene etter termin, i en liten gruppe for tidlig fødte barn uten hjerneskade. Men detaljanalysen kunne ikke predikere om barnet hadde normal eller avvikende motorisk funksjon ved tre måneder korrigert alder. Den tredje artikkelen omhandlet 150 barn født før 33. svangerskapsuke som ble randomisert til tidlig intervensjon eller til en kontrollgruppe. I intervensjonsgruppen var det foreldrene som gjennomførte intervensjonen, noe som anbefales når det gjelder tidlig intervensjon. Etter 3 uker var det en liten, men tydelig forskjell i endring i motorisk funksjon mellom barn som hadde fått intervensjon og barn i kontrollgruppen. Barna følges med motoriske vurderinger fram til de er to år korrigert alder. Vi kan da konkludere om intervensjonen har hatt en langtids effekt, og om mulig gi anbefalinger angående tidlig fysioterapi til barn i risiko for senskader

The parents` experiences with intensive physiotherapy to infants with CP: an interview study

Aim: To explore the experiences of parents of infants with CP, who took part in a program with periods of frequent physiotherapy. Material: Parents of five infants aged 6-9 months with CP (five mothers and two fathers), who had participated in two 4-weeks periods of physiotherapy five days a week, interrupted by eight weeks without therapy. Method: Semi structured and retrospective interviews. Result: Three themes emerged: Being parents of infants newly diagnosed with CP, Experiences with the participation in frequent periods of physiotherapy, and The childrens change in motor functions. Becoming parents of children with CP was described as a demanding process of adaptation. The parents had many questions about the future, and they did not know what to expect. They experienced the participation in periods with daily therapy as useful, they felt more confident and had learned much about handling and how to stimulate their children. The parents clearly experienced changes in their childrens motor function, without being able to link these changes to specific periods. Implication for praxis: The parents of children newly diagnosed with CP seem to need a lot of support and consulting both to increase parent-empowerment and to learn handling and stimulation. Frequent physiotherapy may provide the kind of support and knowledge they ask for

General movement optimality score and general movements trajectories following early parent-administrated physiotherapy in the neonatal intensive care unit

Background The Prechtl General Movement Assessment (GMA) is a reliable tool for the functional assessment of the young nervous system. It is based on a global assessment of the quality of infants' movements. In addition, detailed steps of assessment have been developed – one for preterm and term age, and one for use between 3 and 5 months. One potential benefit of such a detailed analysis is the documentation of subtle changes in the infants' spontaneous movements caused by early intervention. Aim To present detailed scores of the infants' general movements (GMs) at preterm age, and of the infants' motor repertoire at 3 months' postterm age (PTA), for infants having participated in a randomized controlled trial (RCT) of early intervention, and to examine possible group differences. In addition, the aim is also to present the GMA from preterm to 3 months' PTA, comparing the intervention and the control group. Study design A retrospective study on infants who had participated in an RCT of parent-administered early intervention. Subjects 141 infants born very preterm. Outcome measures GMA, “Detailed Assessment of General Movements During Preterm and Term Age” and “Assessment of Motor Repertoire at 3 to 5 months”. Results The GMA and the detailed assessments of GMs conducted at 36 weeks' post menstrual age (PMA) showed the same distribution of normal and abnormal movements in both the intervention and in the control group, as did the assessment of motor repertoire at 3 months' PTA. Conclusion Neither the GMA nor the detailed assessments of GMs at 36 weeks' PMA and of the motor repertoire at 13 weeks' PTA suggest that early intervention, performed before term, changes the GMs of very preterm-born infants

Validity of the General Movement Optimality List in Infants Born Preterm

Purpose: To examine concurrent and predictive validity of the optimality list "Detailed Assessment of General Movements (GMs) During Preterm and Term Age." Methods: Video clips of general movements were analyzed for 20 infants born preterm without severe brain lesions. Concurrent validity of the optimality list compared with the General Movement Assessment (GMA) was examined. The General Movement Optimality Scores (GMOSs) between infants with normal and poor repertoire GMA were examined. Estimates of diagnostic accuracy were calculated. Results: The GMOS correlated with the GMA and differed between infants with normal and poor repertoire GMA. The area under the curve was below 0.53 with respect to normal or abnormal general movements at 3 months' corrected age. Conclusions: Concurrent validity of the optimality list was moderate to high compared with the GMA, but its predictive validity for general movements at 3 months' corrected age was low

Does a parent-administrated early motor intervention influence general movements and movement character at 3 months of age in infants born preterm?

Background: Studies of preterm and term-born infants have shown absent fidgety movements and an abnormal movement character to be related to brain lesions and unfavourable neurological outcomes. Aims: The present study examines what effect a parent-administered early intervention program applied to preterm infants in a randomised control trial (RCT) between 34 and 36 weeks gestational age has on their fidgety movements and overall movement character at three months of age. Study design: The study was part of the RCT in an early intervention programme including preterm infants born between 2010 and 2014 at three Norwegian university hospitals. Subjects: 130 preterm infants participated in the study, with 59 of them in the control group and 71 in the intervention group. Outcome measures: Fidgety movements and overall movement character at three months corrected age. Results: No difference was found between the intervention group and the control group in terms of fidgety movements or movement character. Approximately half of the infants in both groups showed an abnormal movement character. Conclusion: No evidence was found in this RCT to suggest that an intervention at 34 to 37 weeks gestational age has a significant effect on the fidgety movements or overall movement character of preterm infants. This is in line with the assumption that absent fidgety movements and an abnormal movement character are due to permanent brain injury and are therefore good predictors for later neurological impairments

Concurrent and predictive validity of the Alberta Infant Motor Scale and the Peabody Developmental Motor Scales-2 administered to infants born preterm in Norway

The correlation between the Alberta Infant Motor Scale (AIMS) and the Peabody Developmental Motor Scales-2 (PDMS-2) has not previously been assessed in Norwegian infants. Our purpose was to investigate the concurrent validity of the AIMS and the PDMS-2 in a group of high-risk infants, and to investigate the predictive validity of the two tests for atypical motor function at 24 months post term age (PTA). Methods - This is a retrospective study of the AIMS and the PDMS-2 administered to infants born preterm with gestational age ≤ 32 weeks (n = 139) who had participated in a randomized controlled trial of early parent-administered physiotherapy. The infants’ motor development had been assessed using the AIMS and the PDMS-2 at 6- and 12-months. The primary outcome was PDMS-2 at 24-months PTA. To explore the correlation between the two tests we used Spearman’s rho. Bland Altman plots were used to detect if there were systematic differences between the measurements. Receiver-operating characteristics curves were used to calculate area under the curve as an estimate of diagnostic accuracy of the AIMS and the PDMS- with respect to motor outcome at 24 months. Results - The correlation between the AIMS and the PDMS-2 (total motor and locomotion subscale), at 6 months, was r = 0.44 and r = 0.76, and at 12 months r = 0.56 and r = 0.80 respectively. The predictive validity for atypical motor function at 24 months, assessed using the area under the curve at 6- and at 12- months, was for the AIMS 0.87 and 0.86, respectively, and for the PDMS-2 locomotion subscale 0.82 and 0.76 respectively. Conclusion - The correlation between the AIMS and the PDMS-2 locomotion subscale, at 6- and 12- months PTA, was good to excellent in a group of infants born preterm in Norway. And the AIMS and the locomotion subscale of the PDMS-2 were equally good predictors for atypical motor outcomes at 24 months PTA. These findings indicate that the AIMS and the locomotion subscale of the PDM-2, could be used interchangeable when assessing motor development in infants at 6- or 12 months of age