Bayley Scales of Infant and Toddler Development, 3rd edition (BSID-III)
The previously posted information regarding the Bayley Scales of Infant and Toddler Development – III is up to date.
Article Reviewed
Title: Supporting play exploration and early developmental intervention versus usual care to enhance development outcomes during the transition from the neonatal intensive care unit to home: a pilot randomized controlled trial.
Authors: Stacey C. Dusing, Tanya Tripathi, Emily C. Marcinowski, Leroy R. Thacker, Lisa F. Brown and Karen D. Hendricks-Muñoz
Citation: Dusing et al. BMC Pediatrics (2018) 18:46 DOI 10.1186/s12887-018-1011-4
Purpose: Current developmental services intervention protocols for pre-term infants in the NICU utilizes the “wait and see” approach when determining an infant’s ability to participate in therapeutic services. Once determined eligible to participate, these “usual care” interventions are often low-intensity and often focus on one approach; motor, cognitive, or parent-child interaction. Consequently, this usual care administered has minimal lasting effects on motor and cognitive development. In comparison, Supporting Play Exploration and Early Development Intervention (SPEEDI) incorporates motor and cognitive development, as well parent-child interaction. SPEEDI aims to create an environment with increased opportunities for infant initiated movements through the combined efforts of the therapist, parent, and infant throughout the first months of life to foster improved development during and after the intervention period. The purpose of this study was to assess the short-term effectiveness of SPEEDI on motor and cognitive developments, evident in reaching and exploratory problem solving, compared to infants receiving usual care.
Study Population: Premature infants (<29 weeks of gestation) and/or a diagnosis of brain injury. Brain injuries included intraventricular hemorrhage (grades 3-4), periventricular leukomalacia (PVL), hydrocephalus requiring a shunt, or hypoxic ischemic encephalopathy.
Methods/Interventions: Fourteen infants were randomly assigned to SPEEDI or Usual Care.
The Usual Care included the referral to developmental therapy services within the NICU, at the discretion of the medical team. Parents were offered a referral to an Early Intervention (EI) program prior to discharge in which they could continue “usual care” in the outpatient setting if desired. The parents of the Usual Care group were asked to fill out a questionnaire at each assessment visit in order to document any outpatient services received.
The SPEEDI group consisted of 2 phases. Phase 1 was provided in-person within the NICU. It concentrated on assisting parents in identifying optimal times to provide developmentally appropriate interaction with their infant and to begin to plan how they will interact with their infant following discharge from the NICU. Discussions were implemented to allow parents to gain a full understanding of development and behavioral cues, with videos provided for parents to review between sessions. The parents reviewed an activity book during the last few sessions of phase 1 to properly prepare for phase 2 at home. Phase 2 involved parents implementing the skills learned in phase 1 to allow their infant daily opportunities for motor and problem-solving based play that promote motor skills and problem-solving capabilities. Parents were encouraged to progress the activities from easier to harder over the 12 weeks of Phase 2. Therapists met with the parents 5 times during the 12 weeks of phase 2 assure the parents’ abilities to progress the interventions and to address and questions or concerns.
Outcome Measures
Primary outcome measures were assessed at the end of the intervention, 1 and 3 months after the intervention ended. Primary outcome measures in included reaching skill and exploratory problem-solving behaviors. Reaching was assessed in an infant chair with the infant’s trunk supported and reclined to 20deg. Reaching skill was quantified using four 30 s trials during which the infant was prompted to reach for a rattle presented at midline and a distance of 75% the length of infant’s arm. Exploratory problem-solving behaviors were assessed via The Early Problem-Solving Indicator (EPSI). The EPSI is designed to measure play-based problem-solving from 6 to 36 months of age and includes aspects of visual exploration, object manipulation, and memory.
Secondary Outcomes were measures of neuromotor control and development and included the Test of Infant Motor Performance (TIMP) and Bayley Scales of Infant Development, 3rd edition (BSID-III). The TIMP was administered at baseline, end of each phase of intervention, and the first follow-up visit. The BSID-III was administered at the final follow-up visit and 3 months post-intervention and was used to quantify longer-term outcomes.
Results
These results suggest that interventions encouraging and equipping parents to implement environmental enrichment and daily routine of planned movement opportunities, such as SPEEDI, has the capability to improve development, during and post-intervention. The SPEEDI and Usual Care groups both demonstrated an increase in the duration of contact with the toy during reaching trials. Infants subjected to the SPEEDI intervention exhibited a greater frequency of exploratory problem-solving behavior compared to those in the usual care group. The larger effect sizes on the BSID-III was evidence of the infants in the SPEEDI group having higher cognitive scores at 3 and 9 months post-intervention. Higher motor outcome scores in the SPEEDI group, compared to the usual care, were evident in effect sizes of the TIMP and BSID-III.
Strengths – the multiple outcome measures utilized strengthened the conclusion in this study. The frequent reassessments, follow-up and post-intervention assessments strengthened the findings that SPEEDI improves development, even after recorded interventions ceased. This is evident that the education given to parents is pertinent in the continued development of pre-term and/or brain-injured infants.
Weaknesses – The limited number of participants greatly decreased the efficacy determined in this study. The number of participants further declined due to medical complications and time commitment required. The low participant number forced the investigators/authors to report effect size of secondary outcomes rather than statistical significance values in order to properly display the results to the reader. The number of participants also decreases the generalizability over multiple diagnoses and the valid applicability to common disorders seen with pre-term infants, such as Cerebral Palsy.
Conclusion – Overall, these results indicate that SPEEDI can be a beneficial intervention in advancing the development of motor and problem-solving skills in infants whom are pre-term and/or have experienced a brain-injury. These findings suggest that the usual care protocols may not be sufficient for maximal development in these infants and that parent education can significantly increase the level of development achieved during and post-intervention.
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