The Effect of START-Play Intervention on Reaching-Related Exploratory Behaviors in Children with Neuromotor Delays: A Secondary Analysis of a Randomized Controlled Trial

Abstract

Aims

Children with neuromotor delays are at risk for reaching and object exploration impairments, which may negatively affect their cognitive development and daily activity performance. This study evaluated the effectiveness of the Sitting Together And Reaching To Play (START-Play) intervention on reaching-related exploratory behaviors in children with neuromotor delays.

Methods

In this randomized controlled clinical trial, 112 children (Mean = 10.80, SD = 2.59 months old at baseline) with motor delays were randomly assigned to receive START-Play intervention or usual care-early intervention. Performance for ten reaching-related exploratory behaviors was assessed at baseline and 1.5, 3, 6, 12 months post-baseline. Piecewise linear mixed-effects modeling was used to evaluate short- and long-term effects of the intervention.

Results

Benefits of START-Play were observed for children with significant motor delays, but not for those with mild delays. START-Play was especially beneficial for children with significant motor delays who demonstrated early mastery in the reaching assessment (i.e., object contact ≥65% of the time within 3 months after baseline); these children showed greater improvements in manual, visual, and multimodal exploration, as well as intensity of exploration across time.

Conclusions

START-Play advanced the performance of reaching-related exploratory behaviors in children with significant motor delays.

Keywords:

• Children
• early intervention
• motor delay
• reaching
• START-Play intervention

Acknowledgements

We would like to express our gratitude to participating families for their time, patience, and commitment during this longitudinal study. In addition, we would like to acknowledge the multiple research assistants who helped with the collection and coding of the data.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data from this study are available on request.

Notes

1 Previous research showed that contact 65–100% of the time is the ceiling range of performance for children experienced in reaching (Babik et al., 2022).

2 Considering the Gross Motor Function Classification System level, Manual Ability Classification System level, the distribution of motor impairment, and the level of active movement assessed by experienced therapists (Harbourne et al., 2018).

Additional information

Funding

This research was supported by the Institute for Education Sciences [grant R324A150103].

Notes on contributors

Iryna Babik

Iryna Babik is an Assistant Professor at the Department of Psychological Science at Boise State University, Boise, ID, USA.

Andrea B. Cunha

Andrea B. Cunha is an Assistant Professor at the University of Nebraska Medical Center’s Munroe-Meyer Institute, Omaha, NE, USA.

Dongho Choi

Dongho Choi is a graduate student at Nebraska Center for Research on Children, Youth, Families and Schools at the University of Nebraska-Lincoln, Lincoln, NE, USA.

Natalie A. Koziol

Natalie A. Koziol is a Research Assistant Professor at Nebraska Center for Research on Children, Youth, Families and Schools at the University of Nebraska-Lincoln, Lincoln, NE, USA.

Regina T. Harbourne

Regina T. Harbourne is an Associate Professor in the Department of Physical Therapy at Duquesne University, Pittsburgh, PA, USA.

Stacey C. Dusing

Stacey C. Dusing is the Sykes Family Chair of Pediatric Physical Therapy, Health, and Development in the Department of Biokinesiology and Physical Therapy at the University of Southern California, Los Angeles, CA, USA.

Sarah W. McCoy

Sarah W. McCoy is a physical therapist and UW Professor Emeritus in the Department of Rehabilitation Medicine at the University of Washington, Seattle, WA, USA.

James A. Bovaird

James A. Bovaird is an Associate Professor in the Department of Educational Psychology at the University of Nebraska-Lincoln, Lincoln, NE, USA.

Sandra L. Willett

Sandra L. Willett serves as the Director of Physical Therapy Department and Pediatric Physical Therapy Residency Program at the University of Nebraska Medical Center’s Munroe-Meyer Institute, Omaha, NE, USA.

Michele A. Lobo

Michele A. Lobo is an Associate Professor in the Department of Physical Therapy, Biomechanics and Movement Science Program, at the University of Delaware, Newark, DE, USA.