Project for Cognitive Advancement in Infants With Neuromotor Disorders

This longitudinal study will examine the ongoing interaction between the domains of cognitive
and motor development in infants with neuromotor disability, as well as compare differences
between groups of infants receiving two types of intervention.

The specific aims for this study are:

1. To measure the changes of the head, trunk and pelvis as the primary orienting segments
of the body during the achievement of sitting and the transition to crawling in infants
with neuromotor disability.

2. Describe the changes in problem-solving and cognitive abilities of infants with
neuromotor disability as they transition to stable sitting and then to crawling.

3. Using eye-tracking technology, quantify the evolution of focused attention in infants
with neuromotor disability as the motor skills of sitting and the transition to crawling
emerge.

4. Compare motor skill, visual attention and cognitive change as sitting and crawling
emerge between groups of infants with neuromotor disabilities receiving two different
interventions, and determine the effects of distinctly different paradigms: one that
focuses simply on building motor skill, and the other that builds motor and cognition
together.

This is a longitudinal study, with between group comparisons to determine the effectiveness
of the intervention, and within group comparisons to determine change over time. Measures
will occur in the home at baseline, at the end of month 1 of intervention, the end of month
2, the end of month 3, and at a 9 month follow-up visit, for a total of 5 measurement times.
Each session will take approximately 1 hour each time. Because we want to look at the child's
movement and posture, the child should be clothed in either an undergarment or a bathing suit
that allows a view of their trunk, legs and arms during the 5 measurement sessions. We will
video the child's movement and posture and play doing two standardized infant tests during
these measurement sessions. The child will sit on the floor as independently as they can and
reach for toys and move through as many developmental postures as they can (crawling, pulling
to stand, moving in and out of sitting). The parent will always be next to their child during
measurement sessions.

Children will participate in one of the parent-delivered interventions for 3-months after
being randomized to one of two groups. Both intervention groups are parent-delivered
interventions, with differing goals and differing training. Parents will be trained in one of
the following approaches:

Motor-based problem solving approach or the body weight support (BWS) approach.

In both of the above approaches, parents will receive weekly, one-hour sessions at home for
updates and training from a physical therapist to advance the program for individual infants.
Thus, there will be a total of 12 sessions with a therapist. Each program is individualized
because no two infants will have exactly the same skill set. This individualization of
programs is standard practice for early intervention. Generally, the suggestions will follow
standard developmental guidelines, with sequencing of skills presented in the order of normal
development. Both of these approaches are currently used in early intervention for young
children with developmental disabilities, but we do not know which is more effective, or if
either approach is effective.

Inclusion Criteria:

- Infants with a diagnosis of a neuromotor disorder such as cerebral palsy, or a birth
history and developmental history indicative of cerebral palsy (prematurity,
intraventricular hemorrhage, periventricular leukomalacia) will be selected for this
study. The infants will be at Gross Motor Function Classification Scale (GMFCS) levels
I, II, or III, because infants at levels IV and V would be unlikely to reach the level
of sitting independence to enter the study. Additional behavioral inclusion criteria
are: between the ages of 9 months and 3 years at the time of entry into the study; the
child should already be independent in prop sitting (sitting with arm support) for at
least 1 minute, and be able to lift one arm up in sitting (after being placed in
sitting) to reach for a toy placed directly in front of them without losing balance

Exclusion Criteria:

- blindness, dislocated hip, pending orthopedic or neurologic surgery which would
interrupt the time period of the intervention, additional diagnosis that affects the
neuromuscular system such as spina bifida. A child would not qualify for the study if
sitting skills were mature. Mature sitting is operationally defined as: the ability to
sit independently without using the arms for support for five minutes or more without
falling; reaching for toys using both hands at once without disrupting balance; moving
in and out of the sitting position independently.