The impact of severity of motor delay, timing of task mastery, and START-play intervention on the development of means-end problem solving in young children.

BACKGROUND: Children with motor delays are at increased risk for delayed means-end problem-solving (MEPS) performance. OBJECTIVES: To evaluate children with motor delays: 1) the impact of motor delay severity and MEPS mastery timing on developmental trajectories of MEPS; and 2) the effectiveness of Sitting Together And Reaching To Play (START-Play) intervention for improving MEPS. METHODS: This represents a secondary analysis from a multi-site randomized controlled trial, with blinded assessors and prospective registration. Children with mild or significant motor delays (n = 112, mean age=10.80, SD=2.59 months at baseline) were randomly assigned to START-Play or usual care early intervention (UC-EI) and assessed at five visits across one year using the Means-End Problem-Solving Assessment Tool that included three 30-second MEPS trials per visit. Task mastery occurred at the first visit the child achieved the highest level of performance in at least two of the three trials. Multilevel analyses evaluated trajectories of MEPS outcomes dependent upon the timing of MEPS mastery, motor delay severity, and intervention group. RESULTS: At baseline, children with mild motor delays demonstrated better MEPS than children with significant delays, but this difference was only observed for children who achieved mastery late. Children with significant delays demonstrated greater improvements in MEPS in the post-intervention phase compared to children with mild delays. No MEPS differences were found between START-Play and UC-EI. CONCLUSION: Motor delay severity and timing of task mastery impacted MEPS trajectories, whereas START-Play intervention did not impact MEPS for children with motor delays. CLINICAL TRIALS REGISTRY IDENTIFIER: NCT02593825 (https://clinicaltrials.gov/ct2/show/NCT02593825).

Effect of Short-Term Training on Reaching Behavior in Infants: A Randomized Controlled Clinical Trial.

The purpose of this study was to test the effect of short-term training on reaching behavior in infants at the onset of reaching. The study was a single-blind, parallel group design, randomized controlled clinical trial. Thirty healthy infants were randomly assigned to a social control group (n = 15) or a reaching training group (n = 15). Infants began the study up to 3 days after the onset of reaching and were assessed three times across 2 days: pretraining (before training), posttraining 1 (after 1 session of training), and posttraining 2 (after 3 sessions of training). The reaching training group received 3 sessions of training by a physical therapist while the control group received a similar amount of time sitting in the therapist's lap. The data were analyzed using repeated-measures analyses of variance, and independent-samples tests with Bonferroni adjustments. Short-term training resulted in increased frequency of object contacts, shorter and smoother reaches, and improved hand positioning. The few short training sessions likely provided opportunities for infants to explore and learn to select movements from their existing movement repertoire. These results demonstrate that adaptive changes in infants' novel behaviors can emerge rapidly, and highlight the need for increased understanding of how to most effectively time early interventions.