Cerebral Palsy (CP) is the most common motor disability in children born preterm. CP can cause profound disability, lifelong need for extensive care and result in significant economic burden. Ideally infants at risk for CP should be identified while still in the neonatal intensive care unit (NICU), at a stage of rapid brain development where intervention may have an impact on synaptic pruning and brain rewiring. The general movement assessment (GMA) tool has been shown to reliably identify infants at high risk for CP and can be implemented shortly after birth making it an ideal screening tool for preterm infants. This tool provides a unique opportunity to greatly decrease the age of CP diagnosis, an essential step for the implementation of earlier, potentially course-modifying interventions. Previous studies indicate that intervention focusing on environmental enrichment, emotional connection between mother and infant can positively impact the neurodevelopmental outcomes of infants born preterm. However, whether this type of interventions can improve the motor outcomes of infants at risk for CP remains unknown. To address this gap in knowledge, we have developed a NICU-based multimodal rehabilitation program (NEO rehab) to support neuromuscular development in preterm infants at high risk for CP (as determined by the GMA). This multimodal program, is composed of 6 evidence-based interventions (vocal soothing, scent exchange, comforting touch, kangaroo care, infant massage and physical therapy) administered in a GA appropriate fashion by a parent. We hypothesize that this innovative NEO rehab program will positively impact short-term motor outcomes in preterm infants at risk for CP. At risk infants (?32 week?s gestation and/or ?1500 grams birthweight) will be eligible for a pilot randomized controlled trial (RCT) comparing the effects of the NEO rehab program versus usual care on short term motor outcomes (general movements (GMs), cranial nerves, posture, movements, tone, and reflexes). The effects of the NEO rehab program the primary outcome will be measured using the GMA, the Test of Infant Motor Performance (TIMP) and the Hammersmith Infant Neurological Examination (HINE) instruments at NICU discharge and at 3 months corrected GA. In addition, the acceptability, feasibility and fidelity of the Neo Rehab program will be determined by performing direct observation, weekly interviews and activity log reviews. This study addresses one of the priorities of the National Center for Medical Rehabilitation Research to explore ?multimodal rehabilitation approaches that promote plasticity and sensorimotor function?. Results from this study will provide the preliminary evidence necessary to design and implement a large, multi-center RCT to test the efficacy of NICU-based rehabilitation programs to improve the motor outcomes of infants born preterm.
Cerebral Palsy (CP) is a movement disorder that appears in early childhood. CP is caused by abnormal development or injury to the brain. Identification of infants at the highest risk for CP is a critical step in the development of targeted interventions with the potential to decrease the severity of CP. The main goal of this research project is to evaluate an innovative NICU rehabilitation program that will include 6- components, multimodal, gestational appropriate interventions (vocal soothing, scent exchange, comforting touch, kangaroo care, infant massage and physical therapy) administered by a parent.
