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Morgan C, Novak I, Dale RC, Guzzetta A, Badawi N. Single blind randomised controlled trial of GAME (Goals – Activity – Motor Enrichment) in infants at high risk of cerebral palsy. Res Dev Disabil. 2016;55:256-67.
Background: Cerebral palsy (CP) is the most prevalent physical disability in children and is caused by a brain lesion during early development. There are several treatment options for older children with CP, but few exist for infants. It is hypothesized that interventions provided earlier in development may be very effective as they may assist the adaptive nature of a newly developing brain during infancy. Little research has been done on infants with CP because CP is usually not diagnosed until after 18 months of age.
Purpose: This study aimed to determine if an intervention called GAME (Goals, Activity, Motor Enrichment) that focused on motor learning and environment, could effectively improve motor function in infants at “high-risk” of developing CP.
Study Population: Thirty participants came from 6 NICU’s in Sydney Australia, and were included if any of the following three inclusion criteria were met
- Corrected age of 3-4 months, and were “absent fidgety” on General Movements Assessment
- Age of 5-6 months with CP diagnosis
- An extremely likely CP diagnosis as suggested by neuro-imaging
Methods/Interventions: participants were randomized into a Standard Care group or a GAME Intervention group and received their chosen intervention until they were 12 months corrected age. GAME is an intervention that focuses on active motor learning, family centered care, parent coaching and environmental enrichment. Standard care includes the expected normal interventions provided for high-risk CP infants. At baseline there was no significant difference between the groups regarding motor function, although the GAME infants were 4 weeks younger. Multiple regressions were used to determine between group differences for child outcomes.
- Peabody Developmental Motor Scales – Second Edition, was used to measure motor skills
- Bayley Scales of Infant and Toddler Development – Third Edition, was used to assess cognitive skills
- Affordances in the Home Environment for Motor Development – Infant Scale, was used to assess enrichment of the home environment
Results: On average infants in the GAME group did not fall behind their healthy peers as far as those receiving standard care. This implies that there may be a “protective” aspect to the GAME treatment, but statistically there was no difference between the two groups Peabody Developmental Motor Scale scores.
- Large number of participants
- Randomized and controlled
- Disparity within sample population’s age
- Wide range in severity of brain injury
- Interventions stopped at 12 months of age, regardless of what age treatment began
- Limited information on the specific treatments each group received
Conclusion: This article states that 6-9 months of GAME intervention can advance motor functioning development, and that it is a “promising” intervention for infants. This is an exaggerated statement, as the results between groups were not statistically significant.