Related Experiment Video
Updated: Jun 13, 2025
Enhancing the Development and Growth of Infant Cerebral Palsy Rats Using Selective Spinal Manipulations
Published on: February 2, 2024
The Small Step Early Intervention Program for Infants at High Risk of Cerebral Palsy: A Single-Subject Research
Ann-Kristin G Elvrum1,2,3, Silja Berg Kårstad4,5, Gry Hansen6
1Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491 Trondheim, Norway.
Insights
The Small Step early intervention program showed positive effects on motor development in infants at high risk of cerebral palsy (CP). Infants with higher initial neurological scores (Hammersmith Infant Neurological Examination) experienced greater improvements.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Early intervention is crucial for infants at high risk of cerebral palsy (CP).
- Limited evidence exists for the efficacy of specific early intervention programs.
- The Small Step program is a family-centered, interprofessional approach.
Purpose of the Study:
- To evaluate the impact of the Small Step early intervention program on motor development in high-risk infants.
- To assess the relationship between initial participant characteristics and intervention response.
Main Methods:
- A single-subject research design was used.
- Hammersmith Infant Neurological Examination (HINE) and Alberta Infant Motor Scale (AIMS) assessed initial severity.
- Peabody Developmental Motor Scales-2 (PDMS2) and Gross Motor Function Measure-66 (GMFM-66) tracked motor development.
Main Results:
- Infants with higher initial HINE scores (>25) demonstrated better motor development outcomes.
- Four infants with moderate HINE scores showed greater-than-expected GMFM-66 improvements.
- Three infants with the highest initial scores were not diagnosed with CP at two years.
Conclusions:
- The Small Step program positively influenced motor development in infants at high risk of CP.
- Initial neurological status, specifically HINE scores, predicted intervention response.
- The program's specific training components' efficacy could not be definitively confirmed.
Abstract:
Background/Objectives: Early interventions for infants at high risk of cerebral palsy (CP) are recommended, but limited evidence exists. Our objective was, therefore, to evaluate the effects of the family-centered and interprofessional Small Step early intervention program on motor development in infants at high risk of CP (ClinicalTrials.gov: NCT03264339). Methods: A single-subject research design was employed to investigate participant characteristics (motor dysfunction severity measured using the Hammersmith Infant Neurological Examination (HINE) and Alberta Infant Motor Scale (AIMS) at three months of corrected age (3mCA) related to intervention response. The repeated measures Peabody Developmental Motor Scales-2 fine and gross motor composite (PDMS2-FMC and -GMC) and Hand Assessment for Infants (HAI) were analyzed visually by cumulative line graphs, while the Gross Motor Function Measure-66 (GMFM-66) was plotted against reference percentiles for various Gross Motor Function Classification System (GMFCS) levels. Results: All infants (n = 12) received the Small Step program, and eight completed all five training steps. At two years of corrected age (2yCA), nine children were diagnosed with CP. The children with the lowest HINE < 25 and/or AIMS ≤ 6 at 3mCA (n = 4) showed minor improvements during the program and were classified at GMFCS V 2yCA. Children with HINE = 25-40 (n = 5) improved their fine motor skills during the program, and four children had larger GMFM-66 improvements than expected according to the reference curves but that did not always happen during the mobility training steps. Three children with HINE = 41-50 and AIMS > 7 showed the largest improvements and were not diagnosed with CP 2yCA. Conclusions: Our results indicate that the Small Step program contributed to the children's motor development, with better results for those with an initial higher HINE (>25). The specificity of training could not be confirmed.
