Efficacy of Motor and Cognitive Intervention for Infants Born Very Preterm

早产儿(妊娠28周的≤)患发育障碍的风险很高 包括脑瘫、协调障碍、注意力缺陷和学习障碍。减损 包括减少姿势控制、运动可变性、视觉运动技能和运动学习。 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 极早产儿很少在出生后的头几个月接受循证治疗干预 科学和动物干预研究表明效果最好。注册服务的障碍延迟 服务的启动和交付模式很少支持有针对性的预防性干预或增强 从新生儿重症监护病房(NICU)到家庭过渡过程中的父母参与度。 NICU中支持姿势控制和运动学习的有针对性的干预导致了 长期马达收益。加强父母读懂婴儿暗示的能力的干预措施 参与机会改善母亲的心理健康以及婴儿的社会和认知结果 短期的。这项随机临床试验的目的是评估一种干预措施的疗效 结合基于证据的运动干预和父母参与来增强父母的能力 提供日常运动和认知机会，从而改善运动和认知结果。 支持实演探索和开发干预(SPEEDI)使用引导参与来 使父母能够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堂课，学习原理 提高参与度，为互动做好准备，并提供早期运动和认知学习机会。 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 理疗师支持。父母有权决定婴儿目前的能力和进步 在整个12周的时间里，这些活动都是“恰到好处的挑战”，很可能会在干预之后继续下去。 SPEEDI的疗效将通过三个目标进行评估：将SPEEDI的疗效与常规护理进行比较 2)在两个时间点分娩期间；从NICU到家的过渡(大约在婴儿的预产期)和 从调整年龄3-4个月(婴儿预产期之后)开始3)婴儿后来被诊断为 脑性瘫痪和未被诊断为脑性瘫痪的人。90名婴儿将被随机分配到一个 普通护理组、SPEEDI_EARLY或SPEEDI_LATE组。小组差异将在#年进行评估 贝利婴幼儿运动和认知量表的发育结果 发展、早期问题解决指标和每个结束时的粗大运动功能测量 干预期为12个月龄和24个月龄。此外，我们还将探索一种可能的行动机制， 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.