D5 Improvements in motor and cognitive development following sitting together and reaching To _Play (START_Play): single subject multiple baseline study of two children S DUSING, R HARBOURNE, M LOBO, S MCCOY, J BOVAIRD Virginia Commonwealth University and Children’s Hospital of Richmond, Richmond, VA, USA; Duquesne University, Pittsburgh, PA, USA; University of Delaware, Newark, DE, USA; University of Washington, Seattle, WA, USA; University of Nebraska, Omaha, NE, USA

Background and Objective(s): American Academy of Pediatrics (AAP) recommends that “parents should incorporate supervised, awake “prone play” in their infant’s daily routine to support development and minimize the occurrence of head deformities such as positional plagiocephaly (PP)”. Prone is often reported as the least “favorite” play position of infants born preterm placing them at higher risk of developmental delays and PP. The purpose of this feasibility trial is to evaluate the potential to complete a clinical trial of high-technology intervention (HTI) that can be used by early interventionists to increase tolerance for prone and positively impact motor development. Study Design: Parallel group feasibility trial. Study Participants & Setting: Eight infants born at term with poor prone tolerance were enrolled. The average age was 4.2 7.6 months. The sample was 25 % female, 87 % white and 20 % of Hispanic origin. Materials/Methods: Infants were randomly assigned to the High-technology group (HTG) or the low-technology, Education group (EG) for a 3 week home based parent led intervention program. The HTG involved use of an instrumented rehab device, prone play activity center (PPAC) (Figure 1), for at least 30 minutes/day. The HTI combined two key elements 1) Positive reinforcement-Through activation of a toy in response to infants raising their head to an individualized threshold 2) Just Right Challenge-By challenging infants to a slight higher toy activation threshold each time they achieve a target. The EG received information on importance of prone play using the AAP brochure. Both groups were followed weekly for parent-interventionist adherence to the interventions. Data on intervention adherence was used to determine the feasibility of the intervention. Group differences in the change in Alberta Infant Motor Scale (AIMS) and Prone Tolerance (PT) were calculated using Cohen’s d effect size. Results: The study had 76% enrollment rate and 87% retention rate. With 100 % adherence to key components of the proposed interventions, the interventionist completed 95 % of total intervention sessions. Parents of infants in the HTG used PPAC for 93–120% of 15 expected sessions. Duration of PPAC used by the HTG was 19.47 8.19 minutes per day. Only 30% of the 15 expected sessions in the HTG used the PPAC for at least 30 minutes/day. However, they reported 24% more sessions than EG with at least 30 minutes of prone play per day. Effect sizes were large (2.5 for AIMS raw score and 2.2 for PT score) and in the anticipated direction. Conclusions/Significance: This study demonstrates the feasibility of the proposed HTI and its use in a clinical trial. Parents increased prone play time using the PPAC and provided valuable feedback. Large effect sizes suggest a potential for the HTI to support motor development and increase prone tolerance. Future study is needed on the efficacy of the HTI to improve prone tolerance and motor outcomes in infants at risk for developmental delays or with positional plagiocephaly.

Background and Objective(s): American Academy of Pediatrics (AAP) recommends that “parents should incorporate supervised, awake “prone play” in their infant’s daily routine to support development and minimize the occurrence of head deformities such as positional plagiocephaly (PP)”. Prone is often reported as the least “favorite” play position of infants born preterm placing them at higher risk of developmental delays and PP. The purpose of this feasibility trial is to evaluate the potential to complete a clinical trial of high-technology intervention (HTI) that can be used by early interventionists to increase tolerance for prone and positively impact motor development. Study Design: Parallel group feasibility trial. Study Participants & Setting: Eight infants born at term with poor prone tolerance were enrolled. The average age was 4.2 7.6 months. The sample was 25 % female, 87 % white and 20 % of Hispanic origin. Materials/Methods: Infants were randomly assigned to the High-technology group (HTG) or the low-technology, Education group (EG) for a 3 week home based parent led intervention program. The HTG involved use of an instrumented rehab device, prone play activity center (PPAC) (Figure 1), for at least 30 minutes/day. The HTI combined two key elements 1) Positive reinforcement-Through activation of a toy in response to infants raising their head to an individualized threshold 2) Just Right Challenge-By challenging infants to a slight higher toy activation threshold each time they achieve a target. The EG received information on importance of prone play using the AAP brochure. Both groups were followed weekly for parent-interventionist adherence to the interventions. Data on intervention adherence was used to determine the feasibility of the intervention. Group differences in the change in Alberta Infant Motor Scale (AIMS) and Prone Tolerance (PT) were calculated using Cohen’s d effect size. Results: The study had 76% enrollment rate and 87% retention rate. With 100 % adherence to key components of the proposed interventions, the interventionist completed 95 % of total intervention sessions. Parents of infants in the HTG used PPAC for 93–120% of 15 expected sessions. Duration of PPAC used by the HTG was 19.47 8.19 minutes per day. Only 30% of the 15 expected sessions in the HTG used the PPAC for at least 30 minutes/day. However, they reported 24% more sessions than EG with at least 30 minutes of prone play per day. Effect sizes were large (2.5 for AIMS raw score and 2.2 for PT score) and in the anticipated direction. Conclusions/Significance: This study demonstrates the feasibility of the proposed HTI and its use in a clinical trial. Parents increased prone play time using the PPAC and provided valuable feedback. Large effect sizes suggest a potential for the HTI to support motor development and increase prone tolerance. Future study is needed on the efficacy of the HTI to improve prone tolerance and motor outcomes in infants at risk for developmental delays or with positional plagiocephaly.

Concurrent validity of the Bayley cognitive subtest and early problem solving indicator in infants with neuromotor impairments T TRIPATHI, L HSU, N KOZIOL, G SYED, S DUSING, S CONSORTIUM Richmond, VA, USA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA; Nebraska Center for Research on Children, Youth, Families and Schools, Lincoln, NE, USA; Virginia Commonwealth University, Department of Physical Therapy, Chesterfield, VA, USA; Virginia Commonwealth University Department of Physical Therapy, Pediatrics, Psychology, and Virginia Leadership Education in Neurodevelopmental Disabilities Program, Richmond, VA, USA; University of Washington, Duquesne University, University of Delaware, University of Nebraska-Lincoln, Virginia Commonwealth, Pittsburgh, PA, USA

Concurrent validity of the Bayley cognitive subtest and early problem solving indicator in infants with neuromotor impairments T TRIPATHI, L HSU, N KOZIOL, G SYED, S DUSING, S CONSORTIUM Richmond, VA, USA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA; Nebraska Center for Research on Children, Youth, Families and Schools, Lincoln, NE, USA; Virginia Commonwealth University, Department of Physical Therapy, Chesterfield, VA, USA; Virginia Commonwealth University Department of Physical Therapy, Pediatrics, Psychology, and Virginia Leadership Education in Neurodevelopmental Disabilities Program, Richmond, VA, USA; University of Washington, Duquesne University, University of Delaware, University of Nebraska-Lincoln, Virginia Commonwealth, Pittsburgh, PA, USA

B2 Supporting mother-infant interaction in the NICU may enhance oral motor skills, weight gain, and feeding volume: a pilot study S DUSING, L BROWN, L THACKER, T TRIPATHI, K HENRICKS-MU ~ NOZ Department of Physical Therapy and Pediatrics, Virginia Commonwealth University, Richmond, VA, USA; VCU School of Nursing, Richmond, VA, USA; Virginia Commonwealth University, Departments of Family and Community Health Nursing and Biostatistics, Richmond, VA, USA; PT, Richmond, VA, USA; Children’s Hospital of Richmond at VCU, Virginia Commonwealth University School of Medicine, Richmond, VA, USA

Background/Objectives: The interaction between a child and caregivers has the potential to influence child development, particularly in the first years of life. Quantifying the impact of parent-child interaction on development and identifying intrinsic and extrinsic factors that influence the relationship will improve our ability to care for infants and children at risk for developmental delays. The purpose of this systematic review is to quantify the impact of mother-child interaction on the development of children 12 months or younger and determine intrinsic and extrinsic factors that mediate the effects of mother-child interaction on development. Study Design: Systematic review. Study Participants and Setting: This study was conducted in March 2014 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The papers were selected according to the child participants’ ages from 0 month to 12 months and assessment of mother-child interaction and child development at the same time point. Materials/Methods: A total of 2825 papers were identified and 11 selected which the data were extracted. Results: The majority of these studies found significant association between mother-child interaction and language, cognition, and social development. Only one study investigated the relationship between parent-child interaction and motor development at 4 months of age and low correlation was reported. Only a history of very low birth weight (VBLW) was found to mediate the relationship between parent-child interaction and development. However, intrinsic (mother’s age, mother depression, premature birth) and extrinsic factors (nationality, cultural aspects, parent’s education, socioeconomic status, marital relationship) impacted development directly. Conclusions/Significance: The quality of the relationship between a child and parent is an important factor influencing the child’s development during first year of life and should be assessed, particularly in infants who are at risk for developmental disabilities. The few studies that have examined mediators of parent-child interactions and development highlight the importance of medical and development risk factors including birth weight. The lack of clear behavioral cues seen in infant born at VLBW may contribute to parent’s difficulty interpreting their infant’s needs and providing developmentally supportive learning opportunities. In addition, little research has focused on the role of parent-child interaction in altering motor development, an area commonly impaired in children born VLBW. Further research is needed to determine if parent-child interactions and opportunities to utilize developmental skills during interactions with caregivers relate to later motor development. VLBW infants and young children with cerebral palsy may benefit from targeted interventions to support early parent–child interaction with the goal of improving developmental outcomes. This systematic review provides suggestions for future studies measuring parent-child interactions and developmental outcomes.

Background/Objectives: The interaction between a child and caregivers has the potential to influence child development, particularly in the first years of life. Quantifying the impact of parent-child interaction on development and identifying intrinsic and extrinsic factors that influence the relationship will improve our ability to care for infants and children at risk for developmental delays. The purpose of this systematic review is to quantify the impact of mother-child interaction on the development of children 12 months or younger and determine intrinsic and extrinsic factors that mediate the effects of mother-child interaction on development. Study Design: Systematic review. Study Participants and Setting: This study was conducted in March 2014 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The papers were selected according to the child participants’ ages from 0 month to 12 months and assessment of mother-child interaction and child development at the same time point. Materials/Methods: A total of 2825 papers were identified and 11 selected which the data were extracted. Results: The majority of these studies found significant association between mother-child interaction and language, cognition, and social development. Only one study investigated the relationship between parent-child interaction and motor development at 4 months of age and low correlation was reported. Only a history of very low birth weight (VBLW) was found to mediate the relationship between parent-child interaction and development. However, intrinsic (mother’s age, mother depression, premature birth) and extrinsic factors (nationality, cultural aspects, parent’s education, socioeconomic status, marital relationship) impacted development directly. Conclusions/Significance: The quality of the relationship between a child and parent is an important factor influencing the child’s development during first year of life and should be assessed, particularly in infants who are at risk for developmental disabilities. The few studies that have examined mediators of parent-child interactions and development highlight the importance of medical and development risk factors including birth weight. The lack of clear behavioral cues seen in infant born at VLBW may contribute to parent’s difficulty interpreting their infant’s needs and providing developmentally supportive learning opportunities. In addition, little research has focused on the role of parent-child interaction in altering motor development, an area commonly impaired in children born VLBW. Further research is needed to determine if parent-child interactions and opportunities to utilize developmental skills during interactions with caregivers relate to later motor development. VLBW infants and young children with cerebral palsy may benefit from targeted interventions to support early parent–child interaction with the goal of improving developmental outcomes. This systematic review provides suggestions for future studies measuring parent-child interactions and developmental outcomes.