Infants in the Neonatal Intensive Care Unit (NICU) benefit most from occupational therapy (OT) and physical therapy (PT) when delivered at high frequencies. However, implementing these recommendations in clinical practice remains challenging. This study will investigate the impact of different therapy care delivery models on extremely preterm infants and their mothers. This pilot study uses a non-randomized comparative cohort design with historical controls. A retrospective cohort of 30 infants will represent usual care therapies (UCT). Two prospective cohorts (n = 30 each) will be enrolled following the launch of a new Small Baby Unit (SBU) at a Level IV NICU. The first prospective group will receive UCT within the SBU (SBU + UCT), while the second will receive an Immersive Therapy Model (SBU + ITM). Mothers of infants in the prospective groups will be invited to participate. The SBU introduces developmentally supportive medical and environmental protocols, with ITM adding structured, high-frequency therapy as well as parent-delivered developmental activities. As a pilot study, primary outcomes include the following: (1) feasibility of ITM implementation, measured by changes in therapy frequency and parent-administered activities and (2) comparisons of infant motor and neurobehavioral outcomes, as well as maternal stress and parenting competence. Secondarily, we will evaluate the preliminary efficacy of the SBU + ITM model on infant motor and neurobehavioral outcomes, as well as maternal stress and sense of competence. Finally, we will explore the ITM’s potential influence on two important drivers of health care costs in the NICU as compared to UCT: (1) time to infant achievement of independent oral feeds and (2) length of hospitalization. Findings may inform neonatal physical and occupational therapy practices by evaluating a novel care model aimed at improving outcomes for both infants and parents. Given its practical implementation and potential for significant impact, the ITM could represent a paradigm shift in NICU-based therapy care. ClinicalTrials.gov, NCT06927037, Registered 16 April 2025, https://clinicaltrials.gov/study/NCT06927037?intr=Immersive

BACKGROUND AND PURPOSE:This systematic review explores interventions that improve object contact and exploration skills. Given the impact of object contact and exploration on many domains of development, there is a need to optimize these interventions. METHODS:We conducted a search of the literature involving object interaction. Data were synthesized to evaluate the effectiveness of different task-specific protocols. RESULTS:Our findings suggest that structured, repetitive practice, particularly under therapeutic guidance, improves object interaction skills in both full-term and preterm infants. Notably, home-based interventions delivered consistently for at least 2 weeks, yielded largest positive effect sizes. DISCUSSION:incorporating play-based, task-oriented activities into therapy can significantly enhance object exploration and contact skills. CONCLUSION:This study highlights the importance of implementing structured, task-specific interventions in clinical settings to address motor skill deficits and support optimal developmental outcomes across populations.

Introduction Play is a way for children to develop and learn about themselves in conjunction with the world. Using play as part of pediatric physical therapy is broadly recommended. This study investigates this integration of play and seeks to answer the research question: How do pediatric physical therapists (PPT) understand and manage embedding play in pediatric physical therapy with children aged 0-3?Methods This is a qualitative study in which we connect to an enactive theoretical framework. We interviewed 14 PPTs about their use of play, including video-elicited questions while viewing recordings of their therapy sessions. Our results were developed through an abductive thematic analysis.Results The PPTs acknowledge play as a foundation of children's learning and a vital component of physical therapy. They explain that play and therapy often co-exist and intertwine, but they also experience tensions when they strive to make play therapeutic. The PPTs find it taxing to engage in play with children who present with limited interaction and play skills, and voice concern for children who struggle to engage in interactional play.Discussion Trusting play and letting play emerge through shared sense-making can resolve challenges and enable PPTs to discover new therapeutic opportunities. A child's striving and overcoming of resistance can be infused with playfulness and make play thrive. We invite PPTs to experiment with the emerging opportunities and boundaries between therapy and play during treatment sessions. Respect for the child's autonomy, attention to the child's play experience, and repairs of interactional mismatches are crucial in this process. Therapeutic guidance and mutuality in interactions can empower children to learn to play to learn new skills and experience mastery as they explore and venture beyond what they already know.

Date Presented 04/03/2025 This study demonstrates that the Somatosensory Test of Grip Force (STOG) is a reliable tool for assessing force control in young children. Tools for assessing force control in early childhood are needed to support early intervention for pediatric OT practice. Primary Author and Speaker: Madison K. Bollinger Additional Authors and Speakers: Virginia W. Chu, Jaela Watkins Contributing Authors: Elsie Baker, Mary Alice Montgomery, Stacey Dusing, James Thomas, Olivier Rolin, Jonathon Jacobs, Robert Perera

OBJECTIVE:Emotional availability (EA) describes caregiver-child emotional attunement and is critical to fostering adaptive development. Although early physical therapist interventions adopt a family centered approach, the impact of interventions on families is often not quantified. This study compares EA in dyads receiving usual care-early intervention (UC-EI) versus sitting together and reaching to play (START-Play) in addition to UC-EI. METHODS:Data were drawn from 106 children with neuromotor delay who were 7 to 16 months old at baseline (mean = 10.5 months) and from their caregiver (91% were mothers). The EA Scale, Fourth Edition, was scored from 5-min videotaped interactions collected at baseline and at 3, 6, and 12 months after baseline. Piecewise multilevel modeling controlling for baseline age and motor delay estimated short- and long-term effects between treatment groups. Additionally, within-group change over time was analyzed to understand if groups differed in direction of EA trajectories. Analyses were run aggregated across all participants and stratified by baseline severity of motor delay or caregiver reported education. RESULTS:When comparing EA between groups, there were significant positive short- and long-term effects of START-Play on adult EA (gs > 0.38), sensitivity (gs > 0.26), structuring (gs > 0.43), and nonintrusiveness (gs > 0.36). For dyads with mild or significant motor delay or whose parent reported less than a bachelor's degree at baseline, positive effects of START-Play were observed. CONCLUSION:Results support important clinical implications for the positive effect of START-Play on EA. Similar child-level treatment effects highlight that the key difference between START-Play and UC-EI may lie in the way intervention affects caregivers. START-Play may be more beneficial to dyads with higher versus lower risks to EA. IMPACT:Early physical therapist interventions can have a significant impact on parents, children, and the parent-child relationship. Measuring the effect of these interventions on the relationship is critical to optimizing the delivery of family centered care.

The development of independent sitting is associated with language development, but the learning experiences underlying this relationship are not well understood. Additionally, it is unknown how these processes play out in infants with motor impairments and delays in sitting development. We examined the real-time associations between sitting and caregiver speech input in 28 5-7-month-old infants with typical development and 22 7-16-month-old infants with cerebral palsy who were at a similar stage of early sitting development. We hypothesized that object labels would be more likely to co-occur with moments of optimal attention to the labeled object while sitting than while in other positions. Infants were video recorded in five minutes of free play with a caregiver. Coders transcribed caregivers' speech, identified instances of object labeling, and coded infants' and caregivers' attentional states during object labeling episodes. We found that caregivers labeled more objects while infants were sitting than while they were in other positions. However, object labels were not more likely to co-occur with infant attention, infant multimodal attention, or coordinated visual attention to the labeled object during sitting. Infants with cerebral palsy were exposed to fewer labels and were less likely to be attending to objects as they were labeled than infants with typical development. Our findings shed light on a possible pathway connecting sitting and language in typical and atypical development.

AIM:To evaluate the construct validity and responsiveness of the Gross Motor Function Measure-66 Item Set (GMFM-66-IS), a standardized criterion-referenced observational measure, for use with children younger than 24 months with or at high risk for cerebral palsy (CP). METHOD:Non-experimental integrative data analysis was performed on secondary data from three clinical trials involving children with or at high risk for CP (n = 79, 42 males, mean corrected age = 11.3 months [SD = 4.9]), and one observational study of typically developing children (n = 32, 14 males, mean age = 5.7 months [SD = 0.8]). The GMFM-66-IS and comparator instrument (gross motor subtest from the Bayley Scales of Infant and Toddler Development, Third Edition [Bayley-III] or Bayley Scales of Infant and Toddler Development, Fourth Edition [Bayley-4], depending on the study) were administered at baseline and 3 months later. Comparator groups were based on neurological impairment, clinical rating of gross motor change, and CP status. Correlations (r) and regression-adjusted standardized mean differences (Hedges' g) were computed. RESULTS:GMFM-66-IS and Bayley scores were correlated at baseline (r = 0.83), 3 months later (r = 0.88), and across time (r = 0.83). Children with mild impairment had higher mean GMFM-66-IS scores at baseline (g = 0.87) and 3 months later (g = 0.95). Children rated as demonstrating greater than expected gross motor change had larger mean GMFM-66-IS change scores than children demonstrating less than expected change (g = 0.62). Typically developing children had larger mean GMFM-66-IS change scores (g = 1.00). INTERPRETATION:GMFM-66-IS scores were supported by evidence of strong construct validity and moderate responsiveness.

Purpose:To assess the concurrent validity of 2 wearable sensors, GENEActiv (GA) and MonBaby (MB), for tracking tummy time in full-term and preterm infants at home.Methods:Nineteen full-term infants and 13 infants born preterm, aged 3 to 6 months, wore GA and MB sensors during caregivervideo-recorded active play at home over 3 days. Prone (tummy time) durations detected by each sensor were compared to video for validation.Results:Both GA and MB sensors demonstrated excellent (kappa = 0.86) and substantial (kappa = 0.78) second-by-second agreement with video, respectively, for tracking tummy time. For cumulative tummy time, the GA showed higher accuracy with video (GA =60 minutes, video =58 minutes, difference =2 minutes) compared to MB (MB =43 minutes, video =47 minutes, difference =4 minutes). No differences in accuracy were found between the 2 sensors.Conclusion:Wearable sensors can accurately track tummy time at home and can support adherence to movement guidelines in infants. Establishing caregiver feasibility is crucial for broader use.

This study investigated associations of gross motor delay and dyadic emotional availability (EA). Data were drawn from 99 children (Mean age = 8.79 [SD = 3.2] months, 47% Female, and 67% White) with and without motor delay and their caregivers. EA was quantified from five parent-child interactions collected over 12 months. Dyads with children with significant motor delay had significantly less growth in Total EA, Child EA, Sensitivity, Responsiveness, and Involvement compared to dyads with children with typical motor development. Children with mild motor delay differed from children with typical motor development in Involvement. Severity of motor delay was associated with risk to EA in that dyads of children with more significant motor delay had more difficulties with EA over time. Trial Registration: This trial is registered at ClinicalTrials.gov (identifier: NCT02593825).

AIMS:Conduct a systematic review and meta-analysis on the effects of motor intervention on social, communication, and cognitive skills in individuals (0-21 years) with autism spectrum disorder (ASD). METHODS:Seven databases were used to search for randomized control trials (RCT) implementing a motor intervention for children with ASD; and measured social, communication, and cognitive outcomes. Twenty-three RCTs were selected with 66 outcomes and 636 participants (range of mean age: 4.3 - 12.3 years). RESULTS:Motor interventions had a significant, positive effect on (1) all outcomes combined (i.e. social, communication, and cognitive) (SSMD: 0.41, p = .01), (2) social (SSMD: 0.46, p = .012) and (3) combined social/communication (SSMD: 0.47, p = .01) domains, but not for the motor domain (SSMD: 0.45, p = .25) or cognitive domain alone (SSMD: 0.22, p = .18). In children above age nine, a 1-year increase in age corresponded to a 0.29 decrease in SSMD (less effective). CONCLUSIONS:Motor interventions have a positive impact and should be considered when planning interventions for children with ASD.

AimsInfants with neuromotor disorders demonstrate delays in sitting skills (decreased capacity) and are less likely to maintain independent sitting during play than their peers with typical development (decreased performance). This study aimed to quantify developmental trajectories of sitting capacity and sitting performance in infants with typical development and infants with significant motor delay and to assess whether the relationship between capacity and performance differs between the groups.MethodsTypically developing infants (n = 35) and infants with significant motor delay (n = 31) were assessed longitudinally over a year following early sitting readiness. The Gross Motor Function Measure (GMFM) Sitting Dimension was used to assess sitting capacity, and a 5-min free play observation was used to assess sitting performance.ResultsBoth capacity and performance increased at a faster rate initially, with more deceleration across time, in infants with typical development compared to infants with motor delay. At lower GMFM scores, changes in GMFM sitting were associated with larger changes in independent sitting for infants with typical development, and the association between GMFM sitting and independent sitting varied more across GMFM scores for typically developing infants.ConclusionsIntervention and assessment for infants with motor delay should target both sitting capacity and sitting performance.

Motor experiences shape cognitive development in infancy, with the prone position being one such crucial motor experience in the first 6 months of life. Although the motor benefits of the prone position are well-documented, its influence on early cognitive abilities remains insufficiently explored. This study quantified the relationship between prone motor skills and motor-based problem-solving abilities in 48 full-term and preterm infants aged 3-6 months. Prone skills were assessed using the Alberta Infant Motor Scale's prone domain. The Assessment of Problem-Solving in Play was utilized to measure motor-based problem-solving by observing how motor actions were used to solve toys. Advanced prone motor skills were correlated with an increase in sophisticated exploration skills and a concurrent decline in lower order exploration skills in all infants, with correlations being stronger in preterm infants. Notably, a 1-point increase in prone skills was associated with a 1.3-point increase in total motor-based problem-solving abilities in all infants. Our findings provide preliminary evidence for the contribution of prone play to cognitive development in infants, prompting considerations for assessment and intervention strategies. Further research is needed to ascertain if the delayed acquisition of prone motor skills is indicative of poor early problem-solving abilities in preterm infants.

Importance: Parent recall is the primary method for measuring positioning practices such as tummy time in infants. Concerns regarding the accuracy of parent recall have been raised in the literature. To date, no study has examined the agreement of tummy time recall measures with gold-standard methods. Objective: To assess the agreement between parental recall versus direct observation of tummy time in infants, and to explore the impact of prematurity on this relationship. Design: Cross-sectional observational study, spanning 1 yr. Setting: Participants' homes Participants: Thirty-two infant-parent dyads (19 full-term, 13 preterm), with infants ages 3 to 6 mo and caregivers ages older than 18 yr. Outcome and Measures: Home-recorded videos of infant play across 3 days were used as a proxy for direct observation of tummy time and compared with a 12-item parent recall survey. Results: Parent recall had a significant moderate correlation (r = .54, p = .002) with direct observation in full-term infants but was not correlated (p = .23) with direct observation in preterm infants. On average, parents of preterm infants overestimated tummy time by 2.5 times per day compared with direct observation. Conclusions and Relevance: For full-term infants, parent recall measures of tummy time exhibit an acceptable level of agreement with direct observation and can be reliably used over shorter periods. Parents of preterm infants may display a bias in recalling tummy time, leading to overestimations. To accurately assess tummy time in this population, a combination of subjective and objective measures should be explored.

AIM:To establish expert consensus on key principles for therapist-supported interventions supporting infants born preterm and their families during the transition from neonatal intensive care unit (NICU) to home in the USA. METHOD:A diverse, interdisciplinary panel of experts evaluated the use of key intervention principles. A modified Delphi technique was used to seek opinions from independent and relevant interdisciplinary experts on the clarity of terminology, efficacy, and feasibility of implementing these intervention principles during the NICU-to-home transition. RESULTS:After our team consensus, one round of surveys was required to reach expert consensus. Twenty-four experts, representing a variety of disciplines, responded to the survey. Results showed strong consensus on four key therapist-supported interventions: building caregiver-child relationships; optimizing infant development; education and knowledge sharing; and enriched environments. INTERPRETATION:This research provides valuable insights into key therapist-supported interventions that may be used during the NICU-to-home transition to address the needs of high-risk infants and the well-being of their families. Findings will inform the development of streamlined and effective interventions, improving child and family outcomes during this critical transition period.

This longitudinal study related children's mastery motivation to a variety of biological, environmental, and developmental factors. The sample consisted of 40 children (24 males) with motor delays (10.93 +/- 2.56 months corrected age at baseline), tested at baseline and 3-, 6-, 12-, and 36-months post-baseline. No significant relations were observed between mastery motivation and sex (biological factor) or socioeconomic status and home affordances (environmental factors). Children with mild motor delays (biological risk) had higher mastery motivation at the age of four years compared to children with significant delays. Advanced early development of fine motor, receptive language, expressive language, means-end problem-solving, and cognitive skills was associated with higher mastery motivation at four years. Mastery motivation may be linked with children's level of physical disability as well as their prior developmental experience.

Date Presented 03/22/24 This study examines force control development in children ages 6 to 72 months, comparing children born preterm and full term. By understanding this topic more, practitioners will be better equipped to address proprioception deficits in young children. Primary Author and Speaker: Elsie Baker Additional Authors and Speakers: Virginia W. Chu, Madison K. Bollinger Contributing Authors: Nicole Botha, Megan G. Pesci, Madison Quesinberry, Marina Nguyen, Meraj Shaikh, Alyssa Tsui, Mary Alice Montgomery, Chloe Eilers, Stacey Dusing, Robert Perera, James Thomas, Olivier Rolin

In the 28th H.P. Maley Lecture, Stacey Dusing, PT, PhD, FAPTA, shares a perspective on the importance of clinician-scientists in bridging the chasm that currently exists between scholarship and clinical practice. Describing herself as a clinician-scientist, or a qualified health care professional who functions mainly as a career scientist with the other portion of time dedicated to clinical practice, Dusing highlights the potential impact of limited training for clinician-scientists in the physical therapist profession and its impact on the future of physical therapy. She challenges all physical therapists to consider the impact of Commission on Accreditation in Physical Therapy Education requirements on scholarship and the lack of requirement for clinical practice while also recognizing that training programs for clinician-scientists are quite limited. Reviewing some historical data and highlighting possible areas for growth, Dusing calls physical therapists to action in 4 areas. This paper calls all physical therapists, especially educators and administrators, to consider the role of clinician-scientist in promoting physical therapy and knowledge translation. The author challenges the profession to consider whether we are helping to train or embed clinician-scientists in our clinical workplaces to promote knowledge translation. Suggestions are made to improve research and clinical training programs to increase the number of clinician-scientists in physical therapy.

Purpose: This study investigated the psychometric properties of a 4-second interval scoring modification of the Assessment of Problem-Solving in Play (ie, Assessment of Problem-Solving in Play 4-second interval scoring [APSP-4]). Methods: A total of 95 children (3-48 months) with or at high risk for neuromotor delay were assessed with the APSP-4 and Bayley Scales of Infant and Toddler Development-III (Bayley). APSP-4 and Bayley cognitive raw scores were compared by age (construct validity) and over time (responsiveness). Twenty percent of videos were scored twice for intra- and interrater reliability. Results: The APSP-4 demonstrated excellent interrater (intraclass correlations [ICCs] >= 0.96) and intrarater (ICCs >= 0.99) reliability and performed similar to Bayley cognitive raw scores at different ages (rs > 0.5), and over time (r = 0.81). The motor delay had similar effects on APSP-4 and Bayley scores. Conclusions: Results support the validity and reliability evidence of the APSP-4 for use over time in tracking problem-solving skills in young children aged 3 to 48 months. Future research investigating clinical implementation of the APSP-4 is needed.

Background/Objectives: The Early Identification and Intervention for Infants (Ei3) Network is an interdisciplinary team dedicated to improving early detection and intervention of cerebral palsy (CP) in California. This paper describes the key (1) awareness-building and (2) capacity-building strategies utilized by the Ei3 Network in the first two years. Methods: Awareness-building methods included interactive conference discussions, resource deliverable creation, and the creation of a framework for dissemination. Capacity-building methods were hosting assessment training, gathering stakeholder feedback, and implementation training. All deliverables were created with a minimum of 3 review and revision cycles. We planned, hosted, and provided scholarships for training, including the Hammersmith Infant Neurological Examination (HINE), Prechtl’s GMA, and an implementation conference. Preliminary descriptive statistics and paired samples t-tests were performed on HINE training surveys. Results: Seven resource deliverables were created and distributed. A professional website, @steps2home.org, was launched. Online channels gained followers (146, Instagram; 198, X; 298, Mailchimp). Providers participated in various trainings: the Sykes Symposium on early detection and intervention (70), HINE (211), GMA Basic or Advanced (46), and Implementation Conference (six facilities from April 2023 to June 2024). HINE training participants reported increased ability to identify CP (p = 0.001), knowledge of (p = 0.004) early detection, ability to implement early detection guidelines (p < 0.001), and confidence in performing the HINE on the post-test (79.87%). Conclusions: The first two years of Ei3 resulted in increased awareness of the early detection guidelines through resources to help providers and families navigate complex care systems and dissemination through online and in-person strategies. We built capacity by training an increased number of providers to identify infants at risk of CP and implement the early detection guidelines. Engagement of stakeholders in focus groups, reviewing documents, and including a parent panel throughout the process increased the value of this work and should support the expansion of the network in the next year.

Date Presented 03/21/24 Emotions around the neonatal intensive care unit (NICU) experience and transition home were explored. Fear was expressed equally for NICU and home, and happiness was discussed twice as often for home experiences. Professionals need to consider parent emotions during this period. Primary Author and Speaker: Audrey Kane Contributing Authors: Christine M. Spence, Corri Stuyvenberg, Rachel Gaston, Jennifer Burnsed, Karen D. Hendricks-Muñoz, Richard D. Stevenson, Stacey Dusing