Effects of a Physical Therapy Intervention on Motor Delay in Infants Admitted to a Neonatal Intensive Care Unit

The Bayley-4 is an individually administered instrument that assesses the developmental functioning of infants and young children, aged between 16 days and 42 months, by observing the child's interaction with stimuli designed to engage them. It assesses five domains: Motor, Cognitive, Language, Social-emotional, and Adaptive behavior. The primary outcome will be the Bayley-4 motor score at 12-months corrected age. The standard scores range from 45-155 for the motor domain. Higher scores indicate better outcomes.

Wireless, lightweight sensors that record continuous, real-time movement information will be applied to the infant's limbs, head, and upper torso at standardized locations either before, during, or after motor assessments. Up to 10 sensors will be applied. The infant's movements will be recorded in various postures, as appropriate to the age/abilities of the infant, such as: supine, prone, pull-to-sit/sitting, standing, and ventral suspension.

This 36-item module measures parent self-reported functioning in physical (6 items), emotional (5 items), social (4 items), and cognitive (5 items) domains, communication (3 items), and worry (5 items), as well as two scales measuring parent-reported family functioning: daily activities (3 items) and family relationships (5 items). Items are reverse-scored and linearly transformed to a 0-100 scale, such that the minimum score is 0 and the maximum score is 100. A higher score indicates better quality of life.

The cognitive section is part of a larger assessment that also covers language and motor skills. It is commonly used to determine developmental delays in children aged between 16 days and 42 months. The standard scores range from 45-155 for the motor domain. Higher scores indicate better outcomes.

The PEDI-CAT measures abilities in three functional domains: daily activities, mobility, and social/cognitive. The PEDI-CAT can be used in participants from birth to 20 years of age. It is used to identify functional delay and to determine effects of an intervention. The PEDI-CAT mobility domain, which will be administered in this study, comprises items in several content areas, including basic movement, standing and walking, steps and inclines, and running and playing. The survey is completed by the caregiver. The PEDI-CAT scores range from 20-80. A higher score indicates better functional ability.

WIDEA-FS assesses a child's adaptive skills in everyday contexts and it is completed by the caregiver. It evaluates four domains, including: mobility (9 items), communication (13 items), social cognition (11 items), and self-care (17 items). The total score for each domain ranges from 50-200 points. A higher score indicates better skills in that domain.

The HINE comprises 26-items, spanning five domains: cranial nerve function, posture, quality and quantity of movements, muscle tone, and reflexes and reactions. Each item is given a score between 0 and 3 based on a rubric, with a minimum possible score of 0 and a maximum score of 78. A higher score indicates better neurological performance.

The AIMS is a norm referenced, standardized, gross motor assessment. Infants are observed in four positions: prone, sitting, supine, and standing. For each subscale, items are scored as "observed" or "not observed". Scores from each subscale are added to achieve the total AIMS score. The minimum total score is 0 and the maximum is 58. A higher score indicates more advanced neurological development

The NSMDA measures neurodevelopment between 1-month and 6-years of age. It is composed of five domains: neurological, postural, sensory, fine motor, and gross motor. This assessment has both item scores and functional grades. A item score is obtained for each domain and the overall score is calculated by summing up all items. Depending on the assessment time point, the maximum item scores may range from 185-259. A higher item score is a better outcome.

Each applicable domain is assigned a functional grade score ranging from 1-5. A higher functional grade score indicates reduced function.

The GMA is used to identify absent or abnormal general movements, which may place infants at higher risk of developing neurologic conditions. For the assessment, the infant, ideally in a calm alert state, is placed in a supine position and video-recorded from above.

For pre-term and term age infants, we will assess both the global and the optimality score, where possible. The optimality score ranges from 0-38. Greater optimality scores indicate better neurologic integrity. The global score is a qualitative description of observed movement repertoire (normal, poor, cramped-synchronized, or chaotic) and variability (variable, monotonous or broken, synchronized, or disorganized).

For infants aged 3-5 months, optimality score range from 5-28. Greater optimality scores indicate better neurologic integrity. The motor optimality list consists of fidgety movements, repertoire of co-existent other movements, quality of other movements, posture, and movement character.

The TIMP is a 42-item assessment of postural and selective motor control of functional performance in infants between 34 weeks gestational age and 4 months corrected age. Items are either observed (13) or elicited (29). Item scores are summed. The minimum possible raw score is 0 and the maximum is 142. A higher raw score indicates better performance. Infants receive an age standard rating, based on performance, of average, low average, below average, or far below average. z-score calculations may also be utilized.

The Bayley-4 is an individually administered instrument that assesses the developmental functioning of infants and young children ages 16 days to 42 months by observing the child's interaction with stimuli designed to engage them. It assesses five domains: Cognitive, language motor, social-emotional, and adaptive behavior. The standard scores range from 45-155 for the cognitive domain. Higher scores indicate better outcomes.