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Project Initiate: A Clinical Feasibility Trial of Equitable Access to Early Neurodevelopmental Therapy

Jessica Trenkle1, Alison Liddle2, Lynn Boswell1

  • 1Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.

Journal of Clinical Medicine
|January 8, 2025
PubMed

Insights

Home physical therapy (PT) is feasible for infants with public insurance after NICU/CICU discharge. Early PT improved motor outcomes, highlighting the need to address early intervention (EI) access barriers for these vulnerable infants.

Area of Science:

  • Pediatrics
  • Neonatal Care
  • Physical Therapy

Background:

  • Early intervention (EI) programs are crucial for infant development, yet many eligible infants face service initiation delays or are excluded.
  • Disparities exist in EI enrollment, with infants holding public insurance showing lower participation rates.
  • Neonatal or cardiac intensive care unit (NICU/CICU) graduates, particularly those with public insurance, may benefit from timely post-discharge support.

Purpose of the Study:

  • To assess the feasibility of promptly initiating home-based physical therapy (PT) for infants with public insurance after NICU/CICU discharge.
  • To compare early motor outcomes between infants receiving home PT and those receiving standard care.
  • To identify barriers affecting early intervention (EI) access for this population.

Main Methods:

  • A pilot study involving infants discharged from a NICU/CICU with public insurance and eligible for Illinois EI services.
  • The intervention group (n=46) received weekly home-based PT until 3-4 months corrected age (CA); the control group (n=14) received standard care.
  • Infants underwent the Test of Infant Motor Performance (TIMP) at discharge and 3-4 months CA; PT and EI initiation rates were tracked.

Main Results:

  • 78% of the intervention group received at least one PT session by 3-4 months CA, demonstrating feasibility.
  • Only 13% of the entire cohort received any EI therapy, indicating a significant access gap.
  • Infants receiving 8-10 PT sessions showed a greater improvement in TIMP Z-scores (>0.5 SD).

Conclusions:

  • Prompt home-based PT is a feasible approach for urban infants with public insurance, potentially optimizing neuroplastic changes.
  • The study highlights significant barriers to early intervention (EI) access for infants with public insurance.
  • Addressing identified barriers is crucial to improve EI service delivery for at-risk infants.

Keywords:
at-risk infantearly interventionphysical therapyservice delays

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