Vroege interventie bij kinderen met hoog risico op een motorische, danwel cognitieve ontwikkelingsachterstand: fysiotherapeutische interventies vergeleken

Summary INTRODUCTION: The survival rates of premature and (Very) Low Birth Weight children has increased over the last few decades. These children are at greater risk for motor-, cognitive- and behavioural disorders compared to term children. Other children with perinatal complications such as asphyxia share that risk. The importance of early intervention (EI) by means of physical therapy for these ‘high risk’ children is increasingly acknowledged. Previous research addressing EI shows promising effects, though little is known as to what aspects of EI are responsible for this beneficial effect. GOAL: The goal of this project is to identify what aspects of physical therapy in EI are associated with better motor- and cognitive development. METHOD: Participants in this project are children from the Learn-2-Move (L2M) study. Included in L2M are babies aged 1-9 months old (corrected age) at high risk for cerebral palsy (CP) (eg. with clear brain lesions, perinatal asphyxia or evident neurological dysfunction). The children are randomly allocated into two intervention groups: Traditional Infant Physiotherapy (TIP) and the novel Coping and Caring for Children with special needs (COPCA). The children are thoroughly assessed at baseline and after 3, 6 and 12 months. The assessment battery included: The Infant Motor Profile (IMP), the Alberta Scales of Infant Development (AIMS) and the Bayley Scales of Infant Development II, Dutch version (BSID-II-NL). A physical therapy session was filmed at baseline, after 6 and 12 months. For the analysis in this report data of 11 children were available at baseline 9 of the 11 children were followed for 6 months. The videos were analysed using a computer program called ‘The Observer’. With the help of a theoretically based, standardised protocol, different aspects of physical therapy can be scored in real time. The output generated is a quantification of physical therapeutical actions in terms of relative durations. The differences between developmental outcome between the two intervention groups and the correlations between aspects of physical therapy and the development were tested with non-parametric tests. RESULTS: 11 Children (6 TIP, 5 COPCA) are included so far for analysis. No significant difference has been found between the two groups with respect to the development. Positive correlations were found between coaching and the IMP-domain ‘selection’, the AIMS and the BSID and between ‘challenging the infant with large variation’ and the IMP-domain ‘performance’ and the AIMS. Negative correlations were found between ‘interfering with the infants’ actions’ and the IMP-domain ‘selection’. CONCLUSION: The current project has too few participants to draw clear conclusions. Currently no differences have been found between the two interventiongroups. Nonetheless the first data suggest that elements of COPCA are positively correlated with developmental outcome. Larger groups will be necessary to find more correlations and give more meaning to currently existing ones.