Objective: Our objective was to evaluate the efficacy of the Sitting Together and Reaching to Play (START-Play) intervention in young infants with neuromotor disorders. Method: This randomized controlled trial compared usual care early intervention (UC-EI) with START-Play plus UC-EI. Analyses included 112 infants with motor delay (55 UC-EI, 57 START-Play) recruited at 7 to 16 months of age across 5 sites. START-Play included twice-weekly home visits with the infant and caregiver for 12 weeks provided by physical therapists trained in the START-Play intervention; UC-EI was not disrupted. Outcome measures were the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley); the Gross Motor Function Measure; reaching frequency; and the Assessment of Problem Solving in Play (APSP). Comparisons for the full group as well as separate comparisons for infants with mild motor delay and infants with significant motor delay were conducted. Piecewise linear mixed modeling estimated short- and long-term effects. Results: For infants with significant motor delay, positive effects of START-Play were observed at 3 months for Bayley cognition, Bayley fine motor, and APSP and at 12 months for Bayley fine motor and reaching frequency outcomes. For infants with mild motor delay, positive effects of START-Play for the Bayley receptive communication outcome were found. For the UC-EI group, the only difference between groups was a positive effect for the APSP outcome, observed at 3 months. Conclusion: START-Play may advance reaching, problem solving, cognitive, and fine motor skills for young infants with significant motor delay over UC-EI in the short term. START-Play in addition to UC-EI may not improve motor/cognitive outcomes for infants with milder motor delays over and above usual care. Impact: Concepts of embodied cognition, applied to early intervention in the START-Play intervention, may serve to advance cognition and motor skills in young infants with significant motor delays over usual care early intervention. Lay Summary: If you have a young infant with significant delays in motor skills, your physical therapist can work with you to develop play opportunities to enhance your child’s problem solving, such as that used in the START-Play intervention, in addition to usual care to help your child advance cognitive and motor skills.

Embodied cognition interests physical therapists because efforts to advance motor skills in young infants can affect learning. However, we do not know if simply advancing motor skill is enough to support advances in cognition. The objective was to examine the effect of 2 interventions on the developing motor skill of sitting and problem solving and to describe the feasibility of using eye-tracking technology to explore visual and motor interaction. This was a longitudinal, randomized comparison of interventions. Twenty infants with developmental delay and/or cerebral palsy, ranging in age from 8 to 34 months (mean [SD] = 15 [6.9] months), participated in an intervention emphasizing motor-based problem solving, and an intervention focused on advancing motor skill through assistance for attaining optimal movement patterns. Outcome measures were the Gross Motor Function Measure sitting subsection and the Early Problem Solving for Infants test. Active touch and looks were measured with eye-tracking technology. Participants in both groups made significant motor gains from baseline, with no difference between intervention groups on Gross Motor Function Measure change scores. Participants in the problem-solving group showed significant gains in Early Problem Solving for Infants scores over the participants in the optimal movement patterns group. Overall, participants increased active touch of toys and increased concurrent looking with active touching. This exploratory study was small, with variation in participants’ skills. The sampled behaviors for analysis were a small portion of the overall function of the participant. An intervention using motor-based problem solving could improve infants’ problem-solving skill. The use of eye-tracking could help to understand embodied cognition as infants develop, but the challenges of embedding the method in natural settings require further work. Listen to the author interview athttps://academic.oup.com/ptj/pages/podcasts

Background: There is limited research examining the efficacy of early physical therapy on infants with neuromotor dysfunction. In addition, most early motor interventions have not been directly linked to learning, despite the clear association between motor activity and cognition during infancy. Objective: The aim of this project is to evaluate the efficacy of Sitting Together And Reaching To Play (START-Play), an intervention designed to target sitting, reaching, and motor-based problem solving to advance global development in infants with motor delays or neuromotor dysfunction. Design: This study is a longitudinal multisite randomized controlled trial. Infants in the START-Play group are compared to infants receiving usual care in early intervention (EI). Setting: The research takes place in homes in Pennsylvania, Delaware, Washington, and Virginia. Participants: There will be 140 infants with neuromotor dysfunction participating, beginning between 7 to 16 months of age. Infants will have motor delays and emerging sitting skill. Intervention: START-Play provides individualized twice-weekly home intervention for 12 weeks with families to enhance cognition through sitting, reaching, and problem-solving activities for infants. Ten interventionists provide the intervention, with each child assigned 1 therapist. Measurements: The primary outcome measure is the Bayley III Scales of Infant Development. Secondary measures include change in the Early Problem Solving Indicator, change in the Gross Motor Function Measure, and change in the type and duration of toy contacts during reaching. Additional measures include sitting posture control and parent-child interaction. Limitations: Limitations include variability in usual EI care and the lack of blinding for interventionists and families. Conclusions: This study describes usual care in EI across 4 US regions and compares outcomes of the START-Play intervention to usual care.