Purpose/Hypothesis: This efficacy study was used to evaluate a Neuro-Developmental Treatment (NDT) protocol during age-appropriate, functional activities in infants 4 to 12 months of age. The NDT protocol focused on developing efficient movement and posture in response to gravity and to the body’s contact with the support surface using facilitated, actively balanced and specifically sequenced trunk movements. The hypotheses were: (1) infants receiving an NDT-based protocol will make greater gains in gross motor function than infants receiving a parent-infant playgroup (PIP) when evaluated immediately after intervention, and (2) the NDT group will maintain gains at the 3-week follow-up evaluation (FU). Subjects: Ten infants, 4 to 12 months of age with identified posture and movement dysfunction. Materials/Methods: A repeated measures, randomized block design was used. Infants scoring at or below the 5th percentile rank on the Alberta Infant Motor Scale, and demonstrating delayed head and trunk-orienting behaviors, measured by the Movement Assessment of Infants, were randomized into groups after controlling for severity of disability. After attrition, 10 of 19 participants completed the study: 5 in the experimental group; 5 in the comparison group. The NDT group received an infant NDT-based protocol of active, sequential trunk activities delivered by pediatric therapists during a post-professional 3-week training course. The PIP group received enriched play activities delivered by parents, with guidance from a Child-Life Specialist. Both groups received a block of intervention consisting of 10 hours over a 15-day-period. A reliable exminer, blind to group assignment, assessed infants before, immediately after, and 3 weeks following intervention using the Gross Motor Function Measure (GMFM). Both groups continued to receive pre-established therapeutic interventions throughout the duration of the study. Data Analysis: The differences in GMFM total percentage scores (pretest to posttest, posttest to 3-week follow-up, and pretest to 3-week follow-up) were analyzed using nonparametric, one-tailed, repeated measures analysis of variance (Friedman two-way analysis of variance by ranks) and Mann-Whitney U-test. Results: The NDT group made significantly more progress than the PIP group on the GMFM at the end of the intervention. The gros motor skills of the NDT group were maintained at 3-week follow-up. Only the NDT group demonstrated significant change in GMFM scores over time (pretest-posttest-3-week follow-up). No significant change in gross motor skills occurred in the PIP group. Conclusions: A NDT-based protocol of 10 consecutive 1-hour sessions improved motor function, and less robust motor gains were maintained at a 3-week follow-up evaluation. Clinical Relevance: Infants with posture and movement dysfunction made greater motor gains from direct service by NDT trained pediatric therapists with specialization in infant intervention than from a playgroup coordinated by a child-life specialist. A short duration, high frequency, individualized NDT-based protocol intervention may produce clinically important changes for infants at 4 to 12 months of age. The variability of application of an individualized NDT-based infant protocol can be reduced when treatment practicums are supervised within the context of a continuing education course. An evaluative outcome measure, GMFM, validated for the infant population, can be used to document change in motor skills over time.
