Article

Systematic reviews have suggested that early intervention by means of
specific motor training programs and general developmental programs in which
parents learn how to promote infant development may be the most promising ways to
promote infant motor and cognitive development of infants with or at high risk
for developmental motor disorders. OBJECTIVE: The purpose of this study was to
investigate the effects of a recently developed pediatric physical therapy
intervention program ("Coping With and Caring for Infants With Special Needs"
[COPCA]) on the development of infants at high risk for developmental disorders
using a combined approach of a 2-arm randomized trial and process evaluation.
SETTING: The study was conducted at the University Medical Center Groningen in
the Netherlands. PARTICIPANTS AND INTERVENTION: Forty-six infants at high risk
for developmental disorders were randomly assigned to receive COPCA (a
family-centered program) (n=21) or traditional infant physical therapy (TIP)
(n=25) between 3 to 6 months corrected age (CA). Developmental outcome was
assessed by blinded assessors at 3, 6, and 18 months CA with a neurological
examination, the Alberta Infant Motor Scales, the Pediatric Evaluation of
Disability Inventory, and the Mental Developmental Index (MDI) of the Bayley
Scales of Infant Development. Contents of the intervention were analyzed by a
quantitative video analysis of therapy sessions. Quantified physical therapy
actions were correlated to evaluate associations between intervention and
developmental outcome components. RESULTS: The trial revealed that developmental
outcome in both groups was largely identical. Process evaluation showed that
typical COPCA actions-(1) family involvement and educational actions, (2)
application of a wide variation in challenging the infant to produce motor
behavior by himself or herself and allowing the infant to continue this activity,
and (3) stimulation of motor behavior at the limit of the infant's
capabilities-had positive correlations with developmental outcome at 18 months
CA. The use of handling techniques was negatively associated with the Pediatric
Evaluation of Disability Inventory outcome at 18 months CA. LIMITATIONS: Major
limitations were the limited size of the groups studied and the differences
between the groups in frequency and duration of physical therapy sessions.
CONCLUSION: Extending the randomized trial with process evaluation was needed to
obtain insight into associations between the components of intervention and
developmental outcome. Specific therapist behaviors of parent coaching are
associated with improved developmental outcome measures. Further studies are
needed to examine whether these associations are caused by therapist behavior or
whether therapist behavior is modified by children's motor skills.
Enfant

Langue : ANGLAIS