The Effects of an Early Physical Therapy Intervention for Very Preterm, Very Low Birth Weight Infants: A Randomized Controlled Clinical Trial

Purpose: A randomized controlled clinical trial was used to investigate effects of physical therapy (PT) intervention on motor outcome of infants born very preterm with very low birth weight (VLBW). Methods: Seventy-two infants born very preterm with VLBW were randomly assigned to a nontreatment (NT) (n = 38) or treatment (T) (n = 34) group. The T group received developmental PT from birth until four months corrected age (CA) weekdays during the infant’s neonatal stay and on a needs- and problem-orientated basis thereafter. The NT group received no intervention. Both groups were assessed at four months CA using the Alberta Infant Motor Scale (AIMS) as was a control group of 14 infants born full term. Parental compliance was measured using a parent questionnaire. Results: PT intervention had no significant effect on the T group’s motor performance. However, no T group subjects had abnormal motor development at four months CA when compared to the NT group (16%) and the control group (14%) (p = 0.09). The T group subjects with high levels of parental compliance had better scores on the AIMS than those with lower parental compliance (p = 0.05). Conclusion: PT intervention does not significantly affect motor performance of infants born very preterm with VLBW at four months CA. Parental compliance and intervention frequency may have influenced the outcome. Preliminary evidence suggests that neonatal and early PT may reduce the incidence of motor delay among infants born very preterm with VLBW. Follow-up of this group is recommended to ascertain the long-term benefits of this type of early PT.

[1]  Joan L Lacey Mapa,et al.  Assessment of preterm infants in the intensive‐care unit to predict cerebral palsy and motor outcome at 6 years , 1998 .

[2]  R. Cooke,et al.  Motor, cognitive, and behavioural disorders in children born very preterm. , 2003, Developmental medicine and child neurology.

[3]  J. Oldham,et al.  Patient Recruitment in Clinical Trials: A Review of Literature , 2001 .

[4]  J. Darrah,et al.  Construction and validation of the Alberta Infant Motor Scale (AIMS). , 1992, Canadian journal of public health = Revue canadienne de sante publique.

[5]  J. Cole,et al.  Effect of a developmental program on motor performance in infants born preterm. , 2001, The Australian journal of physiotherapy.

[6]  A. Orgill,et al.  Collaborative study of very-low-birth-weight infants. Correlation of handicap with risk factors. , 1983, American journal of diseases of children.

[7]  R. Lilford,et al.  BENEFITS OF IN-VITRO FERTILISATION , 1989, The Lancet.

[8]  Marsha P. Johnson.  Statistical Methods for Health Care Research , 1996 .

[9]  J. Preisser,et al.  Trends in Mortality and Cerebral Palsy in a Geographically Based Cohort of Very Low Birth Weight Neonates Born Between 1982 to 1994 , 1998, Pediatrics.

[10]  M. Allen,et al.  The high-risk infant. , 1993, Pediatric clinics of North America.

[11]  F. Murphy.  The High-risk Infant: Some New Views on Early Assessment , 1991 .

[12]  D. Henderson-smart,et al.  A LONGITUDINAL STUDY OF EARLY LEG POSTURES OF PRETERM INFANTS , 1990, Developmental medicine and child neurology.

[13]  B. Hopkins,et al.  Muscle power, sitting unsupported and trunk rotation in pre-term infants. , 1995, Early human development.

[14]  Neil Marlow,et al.  Patterns of motor disability in very preterm children. , 2002, Mental retardation and developmental disabilities research reviews.

[15]  J. Darrah,et al.  GROSS AND FINE MOTOR DEVELOPMENT OF PRETERM INFANTS AT EIGHT AND 12 MONTHS OF AGE , 1989, Developmental medicine and child neurology.

[16]  Gail D. Wegner.  Statistical Methods for Health Care Research , 1995 .

[17]  J. Samsom,et al.  The influence of postural control on motility and hand function in a group of 'high risk' preterm infants at 1 year of age. , 2000, Early human development.

[18]  M. Watt,et al.  Assessment of gross motor skills of at‐risk infants: predictive validity of the Alberta Infant Motor Scale , 1998, Developmental medicine and child neurology.

[19]  Mijna Hadders-Algra,et al.  The Neuronal Group Selection Theory : a framework to explain variation in normal motor development , 2000 .

[20]  S. Campbell,et al.  Efficacy of a Neuro‐Developmental Treatment Program to Improve Motor Control in Infants Born Prematurely , 1994 .

[21]  Y. Futagi,et al.  Neurodevelopmental outcomes of infants with birth weights of less than 1000 g: comparison between periods before and after the introduction of surfactant , 1999, Brain and Development.

[22]  M. Msall,et al.  Functional outcomes in self-care, mobility, communication, and learning in extremely low-birth weight infants. , 2000, Clinics in perinatology.

[23]  Improvement of outcome for infants of birth weight under 1000 g. The Victorian Infant Collaborative Study Group. , 1991, Archives of disease in childhood.

[24]  C. Simons,et al.  MOTOR DEVELOPMENT, INFANTILE REACTIONS AND POSTURAL RESPONSES OF PRETERM, AT‐RISK INFANTS , 1994, Developmental medicine and child neurology.

[25]  Delay Are Listed.  Treatment of cerebral palsy and motor delay. , 1983, Archives of disease in childhood.

[26]  T. Markestad,et al.  Early motor development of premature infants with birthweight less than 2000 grams , 2000, Acta paediatrica.

[27]  W. Fetter,et al.  Muscle power development during the first year of life predicts neuromotor behaviour at 7 years in preterm born high-risk infants. , 2002, Early human development.

[28]  L. von Wendt,et al.  Neurodevelopment until the adjusted age of 2 years in extremely low birth weight infants after early intervention--a case-control study. , 1998, Pediatric rehabilitation.

[29]  Heidelise Als,et al.  Toward a synactive theory of development: Promise for the assessment and support of infant individuality , 1982 .

[30]  B. Galland,et al.  Participation in research: Informed consent, motivation and influence , 2001, Journal of paediatrics and child health.

[31]  C. Drillien.  Abnormal Neurologic Signs in the First Year of Life in Low‐birthweight Infants: Possible Prognostic Significance , 1972, Developmental medicine and child neurology.

[32]  M. Mirza,et al.  Attitudes towards clinical research amongst participants and nonparticipants , 2002, Journal of internal medicine.

[33]  J. Golding,et al.  Does the Supine Sleeping Position Have Any Adverse Effects on the Child? II. Development in the First 18 Months , 1998, Pediatrics.

[34]  R. Feldman,et al.  Intervention programs for premature infants. How and do they affect development? , 1998, Clinics in perinatology.

[35]  B Hagberg,et al.  Cerebral palsy in preterm infants: a population‐based case‐control study of antenatal and intrapartal risk factors , 2002, Acta paediatrica.

[36]  S. Ling,et al.  Infant walker use, injuries, and motor development. , 1997, Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention.

[37]  B. Hopkins,et al.  Development of the relationship between active and passive muscle power in preterms after term age. , 1992, Neuropediatrics.

[38]  J. Hutton,et al.  A randomized controlled trial of early physiotherapy for high‐risk infants , 1996, Acta paediatrica.

[39]  L. Ray.  Evidence and outcomes: agendas, presuppositions and power. , 1999, Journal of advanced nursing.

[40]  H. Prechtl,et al.  The behavioural states of the newborn infant (a review). , 1974, Brain research.

[41]  D. Henderson-smart,et al.  The early development of head control in preterm infants. , 1985, Early human development.

[42]  Y. Plantinga,et al.  Hand function in low‐risk preterm infants: its relation to muscle power regulation , 1997, Developmental medicine and child neurology.

[43]  K. Ratliffe.  Clinical pediatric physical therapy : a guide for the physical therapy team , 1997 .

[44]  P. Cooper,et al.  EFFECT OF EARLY NEURODEVELOPMENTAL THERAPY IN NORMAL AND AT-RISK SURVIVORS OF NEONATAL INTENSIVE CARE , 1985, The Lancet.

[45]  B. Hopkins,et al.  Motor asymmetries in preterm infants at 18 weeks corrected age and outcomes at 1 year. , 1997, Early human development.

[46]  R. Palisano.  USE OF CHRONOLOGICAL AND ADJUSTED AGES TO COMPARE MOTOR DEVELOPMENT OF HEALTHY PRETERM AND FULLTERM INFANTS , 1986, Developmental medicine and child neurology.

[47]  R. Moon,et al.  Effects of Sleep Position on Infant Motor Development , 1998, Pediatrics.

[48]  C. Heriza,et al.  Effects of NICU intervention on preterm infants: Part 1—Implications for neonatal practice , 1990 .

[49]  M. Georgieff,et al.  Abnormal shoulder girdle muscle tone in premature infants during their first 18 months of life. , 1986, Pediatrics.

[50]  C. Simons,et al.  Assessment of Motor Development in Very Low Birth Weight Infants , 2000, Journal of Perinatology.

[51]  C. Sanderson,et al.  The outcomes of neonatal intensive care , 1995, BMJ.

[52]  Joyce Salls,et al.  The relationship of infant sleep and play positioning to motor milestone achievement. , 2002, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[53]  B. Mazer,et al.  Early physical therapy effects on the high-risk infant: a randomized controlled trial. , 1986, Pediatrics.

[54]  Carole Hurran,et al.  Motor Assessment of the Developing Infant , 1995 .

[55]  B. Hopkins,et al.  Mental and motor development in preterm infants: the issue of corrected age. , 1993, Early human development.

[56]  G. Escobar,et al.  Outcome among surviving very low birthweight infants: a meta-analysis. , 1991, Archives of disease in childhood.

[57]  J. Darrah,et al.  Impact of gestational age on preterm motor development at 4 months chronological and adjusted ages. , 1989, Child: care, health and development.

[58]  Jill Anderson,et al.  Developmental Therapy in the Neonatal Intensive Care Unit , 1984 .

[59]  J. M. Dickson.  A model for the physical therapist in the intensive care nursery. , 1981, Physical therapy.

[60]  M. Stokes,et al.  Reliability of assessment tools in rehabilitation: an illustration of appropriate statistical analyses , 1998, Clinical rehabilitation.

[61]  C. Drillien,et al.  Low‐birthweight Children at Early School‐age: A Longitudinal Study , 1980, Developmental medicine and child neurology.

[62]  R. Burton,et al.  Effects of baby walkers on motor and mental development in human infants. , 1999, Journal of developmental and behavioral pediatrics : JDBP.

[63]  L. Groot,et al.  Transient dystonias revisited: a comparative study of preterm and term children at 2[fraction one-half] years of age , 2002 .

[64]  Mijna Hadders-Algra,et al.  Early Brain Damage and the Development of Motor Behavior in Children: Clues for Therapeutic Intervention? , 2001, Neural plasticity.

[65]  T. Markestad,et al.  Transient dystonia in non‐handicapped low‐birthweight infants and later neurodevelopment , 1996, Acta paediatrica.

[66]  D. Gorga.  Occupational therapy treatment practices with infants in early intervention. , 1989, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.