Article: Early Parent-Administered Physical Therapy for Preterm Infants: A Randomized Control Trial
Authors: Tordis Ustad, PT, MSc, a, b Kari Anne I. Evensen, PT, PhD, b, c, d Suzann K. Campbell, PT, PhD, e Gay L. Girolami, PT, PhD, e Jorunn Helbostad, PT, PhD, a, f Lone Jørgensen, PT, PhD, g, h Per Ivar Kaaresen, MD, PhD, i Gunn Kristin Øberg, PT, PhDg
Journal: PEDIATRICS, Volume 138, number 2, August 2016
Discussion: Existing studies have failed to show whether early intervention to improve motor function in preterm infants has significant effects. It is known that developmental impairments increase as the gestational age decreases. Early concerning developmental issues include: impaired self-regulation, attention and behavioral state, poor postural control and quality of movements.
Maturation of the brain occurs at a rapid pace in the last trimester, making preterm infants particularly vulnerable to brain lesions. Along with the preterm period, the first year postterm is also thought to be sensitive time in brain maturation, particularly motor development. Because of the above, interventions during the immediate postterm period is thought to be beneficial to optimize motor development.
Motor skills are formed based on experience and active participation. When these two things occur, synaptic connections between the neurons involved in motor skills are refined and “re-organization” of the brain occurs. If the correct training is performed and in an enriched environment, it is likely that brain can compensate for deficits due to lesions.
The study featured in this article was the first of its kind to address the effectiveness of parent-administered physical therapy before term-equivalent age (37-42 weeks). It was a pragmatic, multicenter, randomized controlled trial comprised of 153 infants born at gestational age ≤32 weeks. The infants were randomized to either an intervention (n = 74) or a control (n = 79) group. The therapies parents were taught how to perform on their children focused on postural control, head control, and midline orientation.
The results of the study showed that the intervention group had better improvement in their short-term motor performance than the control/conventional care group. The authors point out the feasibility of parents implementing the intervention to their medically stable preterm infants in NICUs. The authors also plan to publish the long-term effects of the intervention once the infants reach 2 years’ corrected age.
1. What benefits do you see in parents taking such an active role in their child’s rehab?
2. Do you foresee any potential pitfalls in therapy being performed by parents instead of a professional?
3. Would you predict that more therapy needs to be performed on an ongoing basis to compensate for the developmental impairments in preterm infants?
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