Does Timing Matter? Supporting Play, Exploration, and Early Developmental Intervention

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 during delivery at 2 time point; the transition from
the NICU to home (around the infant's due date) and at 3-4 months of adjusted age (after the
infants due date). Ninety infants will be randomly assigned to a Usual Care group,
SPEEDI_Early, or SPEEDI_Later group. Group differences will be assessed in developmental
outcomes on the motor and cognitive scales of the Bayley Scales for Infant and Toddler
Development as well as the Early Problem Solving Indicator and Gross Motor Function Measure
at the end of each intervention period, 12 and 24 months of age.