Infant Stimulation and Physical Therapy
An Early Intervention for Children with Spastic Diplegia

Frederick B. Palmer, MD, Bruce K. Shapiro, MD, & Marilee C. Allen, MD

Program Summary
The Infant Stimulation and Physical Therapy program was developed to address both cognitive and motor developmental areas for children with mild to severe spastic diplegia, a form of cerebral palsy. This program is an early intervention program that lasts a full year and incorporates both an infant stimulation curriculum for the first six months, followed by neurodevelopmental physical therapy for the remaining six months.

The Infant Stimulation and Physical Therapy program is both center and home-based. Parents (or primary caregivers) meet bi-weekly for one-hour sessions at a clinic for twelve months where they receive training in the daily home implementation of the program. During the first six months of the program, parents or primary caregivers meet with a child development therapist and receive infant stimulation training structured around checklists and specific behavioral objectives. During the second six months of the program, parents or primary caregivers meet with a physical therapist and receive physical therapy training that are also structured around checklists and specific behavioral objectives.
 

Target Population
Risk factors during pregnancy or birth
Physical impairment or disadvantage
At risk for developmental delay or disorder
 

Infant and/or Child Developmental Outcomes
Cognition
Motor skills
 

Program Core Components
Early childhood education
Health and development monitoring
Parent education and support
Parent involvement/enriched care giving
Physical therapy

Curriculum Used
Activities/games for child functioning
Enriched care giving/parent involvement
Parent education and support
Neurodevelopmental physical therapy

Delivery
Center-based
Home-based
Medical setting (clinic)

Direct Participants
Child
Child and parent together 

Child's Age at Program Start
13 to 24 months

Duration
4 to 12 months

 

Evaluation Summary
At the six-month assessment, infants in the test group demonstrated statistically significant improvements in key developmental outcomes compared to infants in the contrast group. Infants who received the Infant Stimulation curriculum had improved motor outcome (Bayley motor quotient: 58.1 versus 49.1), improved cognitive outcome (Bayley mental quotient: 75.5 versus 65.6), and were more likely to walk (percent walking 10 steps: 35% versus 12%) compared to infants in the contrast group who only received neurodevelopmental therapy.

At 12-months evaluation, the test group (infant stimulation & physical therapy) continued to show improved motor outcome (Bayley motor quotient: 63.3 versus 47.9) and were more likely to be walking independently: 73% versus 36%, compared to infants in the contrast group who received only neurodevelopmental therapy. However, there was no longer any statistically significant difference between the test group and contrast group with regard to cognitive outcomes. Social development (Vineland scores) did not differ at either 6 or 12-month time points.

Furthermore, twenty psychosocial variables were analyzed as secondary assessments at 12 months post-therapy utilizing the HOME, Roth-Mother Child Relationship Evaluation and Carey Infant Temperament Questionnaire. The results of these secondary outcomes showed only one statistically significant difference among the variables analyzed. Mothers with infants in the contrast group (neurodevelopmental therapy only) showed a greater improvement in emotional and verbal responsiveness and this change was noted in the HOME sub scores (mean score change in contrast group= 1.2, test group= 0.3). However, the degree of change was small. No baseline differences were seen in any of the outcome variables.

Staffing Requirement/Training
The Infant Stimulation curriculum requires a child development specialist trained to deliver the infant stimulation portion. A certified physical therapist trained in neurodevelopmental physical therapy, delivers the second portion of the program, physical therapy. Parents, or other primary caregivers, are trained in both curricula for the daily home implementation of the program. In the original program implementation, an independent social worker, along with the child development specialist and physical therapist, conducted periodic home visits.


The Program Package includes:

  • Infant Stimulation and Physical Therapy Program Summary. Provides a general overview of the program and how the program has demonstrated positive impacts on child developmental outcomes.
  • Infant Stimulation and Physical Therapy Facilitator's Manual. Provides information on how to implement the program.
  • Infant Stimulation Program Materials. This booklet contains the following materials: Table of Contents (0 ??? 12 Months, 12 ??? 24 Months, & 24 ??? 36 Months); Developmental Checklists (0 ??? 12 Months, 12 ??? 24 Months, & 24 ??? 36 Months); Infant Stimulation Progress Record and Assessment Instrument (0 ??? 12 Months, 12 ??? 24 Months, & 24 ??? 36 Months); Infant Stimulation Parent Comment Form.
  • The Creative Curriculum® LearningGames®. A set of three books used to implement the LearningGames® as part of the home visitation and child development center components of IHDP: Birth ??? 12 Months; 12 ??? 24 Months; 24 ??? 36 Months.
  • Abecedarian: The Ideas, the Approach, and the Findings. This book provides additional resources for implementing the home visitation and child development center components of IHDP.
  • Physical Therapy Program Materials. This booklet contains the following materials: Physical Therapy Initial Evaluation and Summary; Quality of Movement Evaluation and Criteria; Physical Therapy Miscellaneous Forms; Physical Therapy Parent Comment Form.
  • Evaluation Measures. This packet contains samples of five assessment measures used in the original evaluation of the program including: Bayley Scales of Infant Development; Vineland Social Maturity Scale; Home Observation Measurement of the Environment; Mother-Child Relationship Evaluation; Carey Infant Temperament Questionnaire.
  • Early Intervention Evidence-Based Practice Resource Guide. This USB drive features an interactive, easy-to-use tool that consists of practical tips and resources designed to assist professionals and organizations to select, adopt, and implement early intervention evidence-based practices to successfully promote child development and well-being.
  • Telephone technical support on implementation for 1 year
  • .


Infant Stimulation and Physical Therapy Program Package
   
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Infant Stimulation and Physical Therapy Program Summary
   
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Infant Stimulation and Physical Therapy Program
   
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