Efficacy of Motor and Cognitive Intervention for Infants Born Very Preterm

极早产儿（≤28周妊娠期）具有发育障碍的高风险 包括脑瘫、协调障碍、注意力缺陷和学习障碍。减值 包括姿势控制、运动变异性、视觉运动技能和运动学习能力的降低是常见的 在生命的最初几个月，并与后来的发育障碍有关。然而，婴儿出生 极早产儿在出生后的头几个月很少接受基于证据的治疗干预， 科学和动物干预研究表明其功效最大。阻碍服务延迟登记的障碍 服务和提供模式的开始很少支持有针对性的预防性干预， 从新生儿重症监护室（NICU）到家庭过渡期间的父母参与。 有针对性的干预支持姿势控制和运动学习在新生儿重症监护室已导致短期 术语运动增益。干预措施，提高父母的能力，阅读他们的婴儿的线索，并提供 参与机会改善了母亲的心理健康和婴儿的社会和认知结果， 短期内这项随机临床试验的目的是评估干预的有效性， 结合基于证据的运动干预和家长参与，以提高家长的能力， 提供日常运动和认知机会，从而改善运动和认知结果。 支持游戏探索和发展干预（SPEEDI）使用指导参与， 授权父母阅读婴儿的行为线索，确定理想的互动时间，并丰富 环境和学习机会。家长在3周内参加5次会议，同时学习原则 参与，准备互动，并提供早期运动和认知学习的机会。 父母每天提供20分钟的运动和认知游戏，为期12周，每两周一次 物理治疗师支持父母有权决定婴儿目前的能力和进步 在整个12周内进行“恰到好处的挑战”活动，可能在干预后继续进行。 SPEEDI的疗效将在3个目标中进行评估：比较SPEEDI 1）与常规治疗的疗效 2)分娩期间2个时间点;从NICU到家中的过渡（婴儿预产期前后）， 从调整后年龄的3-4个月开始（婴儿预产期后）3）对于后来被诊断为 脑瘫和那些没有被诊断为脑瘫。90名婴儿将被随机分配到一个 监护组、SPEEDI_Early或SPEEDI_Late组。组间差异将在 贝利婴幼儿量表运动和认知量表的发育结果 发展，早期解决问题的指标，并在每个结束时的粗大运动功能测量 干预期，12和24月龄。此外，我们还将探索一种可能的作用机制， 父母的参与，以及这种干预对以后康复服务需求的影响。

Infants born very preterm (≤28 weeks of gestation) are at high risk of having developmental disabilities including cerebral palsy, coordination impairments, attention deficit and learning disabilities. Impairment including reduced postural control, movement variability, visual motor skills, and motor learning are common during the first months of life and are associated with later developmental disabilities. However, infant born very preterm rarely receive evidence based therapeutic intervention in the first months of life when basic science and animal intervention studies suggest the greatest efficacy. Barriers to enrollment in services delay the onset of services and delivery models rarely support targeted preventative intervention or enhanced parent engagement during in the transition from the neonatal intensive care unit (NICU) to home. Targeted intervention supporting postural control and motor learning in the NICU have resulted in short term motor gains. Interventions that enhance parent's ability to read their infant's cues and provide engagement opportunities improve maternal mental health and infant social and cognitive outcomes in the short-term. The purpose of this randomized clinical trial is to evaluate the efficacy of an intervention that combines evidence based motor intervention and parent engagement to enhance the parent's ability to provide daily motor and cognitive opportunities resulting in improved motor and cognitive outcomes. Supporting Play Exploration and Development Intervention (SPEEDI) uses guided participation to empower parents in reading infant's behavioral cues, identifying ideal times for interaction, and enriching the environment and learning opportunities. Parents participate in 5 session in 3 weeks while learning principles of engagement, readiness for interaction, and to provide early motor and cognitive learning opportunities. Parents provide 20 minutes of motor and cognitive play based enrichment daily for 12 weeks with bi-weekly physical therapist support. The parent is empowered to determine the infant's current abilities and advance the activities to the “Just Right Challenge” throughout the 12 weeks, likely continuing after the intervention. The efficacy of SPEEDI will be assessed in 3 aims: To compare the efficacy of SPEEDI 1) to usual care 2) during delivery at 2 time point; the transition from the NICU to home (around the infant's due date) and beginning at 3-4 months of adjusted age (after the infants due date) 3) for infant who are later diagnosed with Cerebral Palsy and those not Diagnosed with Cerebral Palsy. Ninety infants will be randomly assigned to a Usual Care group, SPEEDI_Early, or SPEEDI_Late group. Group differences will be assessed in developmental outcomes on the motor and cognitive scales of the Bayley Scales for Infant and Toddler Development, Early Problem Solving Indicator, and Gross Motor Function Measure at the end of each intervention period, 12 and 24 months of age. In addition, we will explore a possible mechanism of action, parent's engagement, and the impact of this intervention on the need for later rehabilitation services.