Effect of a NICU to Home Physical Therapy Intervention on White Matter Trajectories, Motor Skills, and Problem-Solving Skills of Infants Born Very Preterm: A Case Series

Christiana Dodd Butera¹, Claire Rhee¹, Claire E Kelly^{2

3}, Thijs Dhollander⁴, Deanne K Thompson^{2

5}, Jessica Wisnowski⁶, Rebecca M Molinini⁷, Barbara Sargent¹, Natasha Lepore^{8

9}, Greg Vorona¹⁰, Dave Bessom¹¹, Mary S Shall⁷, Jennifer Burnsed¹², Richard D Stevenson¹³, Shaaron Brown⁷, Amy Harper¹⁴, Karen D Hendricks-Muñoz¹⁵, Stacey C Dusing^{1

7}

Affiliations

¹ Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90033, USA.
² Victorian Infant Brain Studies and Developmental Imaging, Murdoch Children's Research Institute, Parkville, VIC 3052, Australia.
³ Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC 3000, Australia.
⁴ Developmental Imaging, Murdoch Children's Research Institute, Parkville, VIC 3052, Australia.
⁵ Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia.
⁶ Departments of Radiology and Pediatrics (Neonatology), Children's Hospital Los Angeles, Los Angeles, CA 90027, USA.
⁷ Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA 23284, USA.
⁸ CIBORG Laboratory, Department of Radiology, University of Southern California, Los Angeles, CA 90089, USA.
⁹ Departments of Pediatrics and Biomedical Engineering, University of Southern California, Los Angeles, CA 90089, USA.
¹⁰ Department of Radiology, Virginia Commonwealth University, Richmond, VA 23284, USA.
¹¹ Department of Radiology, Children's Hospital of Richmond at VCU, Richmond, VA 23284, USA.
¹² Division of Neonatology, Departments of Pediatrics and Neurology, University of Virginia, Charlottesville, VA 22903, USA.
¹³ Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA 22903, USA.
¹⁴ Department of Neurology, Virginia Commonwealth University, Richmond, VA 23284, USA.
¹⁵ Department of Pediatrics, Virginia Commonwealth University School of Medicine, Children's Hospital of Richmond at VCU, Richmond, VA 23284, USA.

PMID: 36556244
PMCID: PMC9784100
DOI: 10.3390/jpm12122024

Case Reports

Effect of a NICU to Home Physical Therapy Intervention on White Matter Trajectories, Motor Skills, and Problem-Solving Skills of Infants Born Very Preterm: A Case Series

Christiana Dodd Butera et al. J Pers Med. 2022.

. 2022 Dec 7;12(12):2024.

doi: 10.3390/jpm12122024.

Authors

Affiliations

¹ Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90033, USA.
² Victorian Infant Brain Studies and Developmental Imaging, Murdoch Children's Research Institute, Parkville, VIC 3052, Australia.
³ Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC 3000, Australia.
⁴ Developmental Imaging, Murdoch Children's Research Institute, Parkville, VIC 3052, Australia.
⁵ Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia.
⁶ Departments of Radiology and Pediatrics (Neonatology), Children's Hospital Los Angeles, Los Angeles, CA 90027, USA.
⁷ Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA 23284, USA.
⁸ CIBORG Laboratory, Department of Radiology, University of Southern California, Los Angeles, CA 90089, USA.
⁹ Departments of Pediatrics and Biomedical Engineering, University of Southern California, Los Angeles, CA 90089, USA.
¹⁰ Department of Radiology, Virginia Commonwealth University, Richmond, VA 23284, USA.
¹¹ Department of Radiology, Children's Hospital of Richmond at VCU, Richmond, VA 23284, USA.
¹² Division of Neonatology, Departments of Pediatrics and Neurology, University of Virginia, Charlottesville, VA 22903, USA.
¹³ Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA 22903, USA.
¹⁴ Department of Neurology, Virginia Commonwealth University, Richmond, VA 23284, USA.
¹⁵ Department of Pediatrics, Virginia Commonwealth University School of Medicine, Children's Hospital of Richmond at VCU, Richmond, VA 23284, USA.

PMID: 36556244
PMCID: PMC9784100
DOI: 10.3390/jpm12122024

Abstract

Infants born very preterm (VPT; ≤29 weeks of gestation) are at high risk of developmental disabilities and abnormalities in neural white matter characteristics. Early physical therapy interventions such as Supporting Play Exploration and Early Development Intervention (SPEEDI2) are associated with improvements in developmental outcomes. Six VPT infants were enrolled in a randomised clinical trial of SPEEDI2 during the transition from the neonatal intensive care unit to home over four time points. Magnetic resonance imaging scans and fixel-based analysis were performed, and fibre density (FD), fibre cross-section (FC), and fibre density and cross-section values (FDC) were computed. Changes in white matter microstructure and macrostructure were positively correlated with cognitive, motor, and motor-based problem solving over time on developmental assessments. In all infants, the greatest increase in FD, FC, and FDC occurred between Visit 1 and 2 (mean chronological age: 2.68-6.22 months), suggesting that this is a potential window of time to optimally support adaptive development. Results warrant further studies with larger groups to formally compare the impact of intervention and disparity on neurodevelopmental outcomes in infants born VPT.

Keywords: corticospinal tract; early intervention; fixel-based analysis; preterm infants.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

**Figure 1**
Outcome Measures at Each Visit. Figure 1 shows individual infant scores at each visit for motor, cognitive and motor-based problem solving outcomes. Infant 6 is not included due to lack of Visit 2 data. Usual care infants are coded blue and intervention infants are coded red. Bayley-III = The Bayley Scales of Infant and Toddler Development, 3rd edition, APSP = Assessment of Problem Solving in Play. Raw scores represent the number of points earned so that an increase in raw score can be interpreted as the child completing more items. The composite scores are a comparison with the normative same, have mean of 100 and standard deviation of 15. Thus, a composite score that does not change indicates the child is learning at the same rate as the normative data, in that domain. An increase in composite scores reflects gaining skills at a faster rate than the normative sample. A decreasing composite score reflects that the child is not gaining skills at the same rate as the normative sample but must be considered along with the raw score to determine if the child is gaining new skills slowly or not at all.

**Figure 2**
FDC, FD and FC at Each Visit. Figure 2 shows individual infant metrics of FDC, FC, and FD at each visit (these are all expressed in arbitrary units). Usual care infants are coded blue and intervention infants are coded red. Infants with minimal brain injury have dashed lines, and infants with no brain injury have solid lines. BI = brain injury, FD = fibre density, FC = fibre bundle cross-section, FDC = combined fibre density and bundle cross-section, CST = corticospinal tract.

See this image and copyright information in PMC

References

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Effect of a NICU to Home Physical Therapy Intervention on White Matter Trajectories, Motor Skills, and Problem-Solving Skills of Infants Born Very Preterm: A Case Series

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Effect of a NICU to Home Physical Therapy Intervention on White Matter Trajectories, Motor Skills, and Problem-Solving Skills of Infants Born Very Preterm: A Case Series

Authors

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Abstract

Conflict of interest statement

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