For Therapists

Why are we doing this study?

Although early intervention is well established in all states, the service provided to infants with movement disorders varies widely from state to state, city to city, and even within the same town. These differences are not just in the amount of service received, but also in the type of intervention and the approach of teams and therapists. We truly do not know what early intervention for infants with motor delays entails, how it differs from site to site, and what is effective intervention to build school-readiness for these children. The purpose of this study is to compare the effectiveness of the START-Play intervention with business-as-usual intervention, and also to describe in detail how early intervention is provided in different parts of the U.S.

What is the START-Play intervention?

The START-Play intervention focuses on the intersection of cognition and movement. Based on the perspective of grounded cognition, this intervention is provided in the home environment with all aspects embedded in the typical features of family life and early learning. Although most early intervention occurs in the natural environment of the child, the START-Play approach focuses on two critical early motor skills, sitting and reaching, and the problem-solving that must occur to link cognitive concepts to motor exploration and experience. The specific early cognitive concepts of interest in this study, which are embedded in movement, are: object permanence, means-end understanding, object/object and object/body affordances, and joint attention to objects and actions. Therapist/caregiver and caregiver/child interaction for solving problems incrementally, depending on the skill level of the child, are also critical to the appropriate delivery of this intervention.

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What are the characteristics of the children appropriate for this study?

We want to recruit infants who:

Are between 7 and 16 months of age (adjusted for prematurity, if applicable)
Have gross motor delays
Are able to sit propping on their arms for at least 3 seconds, but are not able to get in and out of sitting by themselves
May have a neuromotor disorder which is non-progressive
Have some movement of their arms

Who is funding this study and why?

The U.S. Department of Education, Institute of Education Sciences is funding this study. The specialty area overseeing our study is the Early Intervention and Early Learning in Special Education area of the National Center for Special Education Research. They funded this study because they are interested in evaluating the efficacy of fully formed interventions for early intervention. Their mission is to expand the knowledge and understanding of infants with delays or disabilities, and create research-based evidence to support successful interventions. They are particularly interested in this study because we are focusing on children with motor problems, an area which has not been well studied in the past.

I work in early intervention; what can I hope to gain from this study?

As the study progresses, we plan to create templates for motor skills linked to the targeted cognitive concepts, with critical features that we find important in progressing an infant with motor difficulties. If you are a therapist for a child who is participating in the study, you will be helping to build knowledge about the content of early intervention in this landmark study for infants with motor disorders. If the family decides to share with the child’s team the assessment results of the child, you will have access to in-depth information that you may not otherwise have for individual children on your caseload.

If I refer a child to participate in this study, what can I expect?

The child will be assessed 5 times in the study: at the beginning, after 6 weeks, after 12 weeks, after 6 months and after 12 months. Both the family and the therapist will receive surveys to describe the amount and types of service and intervention the child receives. The assessments consist of the Bayley Scales of Infant and Toddler Development, Third Edition (cognitive, motor, and language), the Gross Motor Function Measure, the Early Problem Solving Indicator, a modified Parent Child Interaction observation, and behavioral coding of object permanence and means end behavior. The physical therapist who either performs the START-Play intervention, or the therapist in the business-as-usual (child’s usual early intervention service) group will be videotaped to describe the features and focus of each intervention; this will be done 3 times during the first 12 weeks of the child’s participation in the study. All of the videos will be coded with an identifying number for the child who is in the study, and no identification to the child, family, or therapist will be indicated on the video or in our overall records. Thus, all identities are protected, and our researchers are blinded as to the grouping of the children until all data is ready to be analyzed.

How can I be involved?

The four clinical sites are in Pittsburgh, PA; Richmond, VA; Seattle, WA; and Newark, DE. Recruitment for the project will continue until the fall of 2018, and referral to the project can be made by contacting the investigators at each site. See the main page of the website for contact information. You can also contact the investigators for further information and to request any updates on the study in your local area (see contacts).

What is the timeframe of the study?

Recruitment of children started in March, 2016. We are aiming for 140 children to participate over the next three years. The project should be completed in the summer of 2019.