Congratulations to Regina (Reggie) Harbourne and her colleagues for receiving the most prestigious award of the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM)—for the second time!—for their NCSER-funded research on the efficacy of the START-Play intervention. The Gayle G. Arnold Award is presented annually to the authors of the best scientific manuscript in the field. Dr. Harbourne and her colleagues received the award in 2019 for their first publication on the initial motor and cognitive outcomes of this study. They recently accepted this award again at the 2022 annual meeting for a follow-up publication on the impacts of the intervention on the important cognitive construct of object permanence.
Sitting Together and Reaching to Play (START-Play) is an intervention designed to target sitting, reaching, and motor-based problem solving in infants with motor delays or disabilities. Physical therapists work in the child’s home with the family on providing intensive, individualized activities to promote these motor skills, building toward goal-directed movements, problem-solving, and learning basic cause-effect relationships based in early motor skills. In this study, the research team conducted a randomized controlled trial with 112 infants aged 7 to 16 months. Those receiving START-Play and those in the control group all continued to receive their usual early intervention services. Children were assessed at various timepoints during the 12-week intervention as well as follow-up visits up to examine maintenance of outcomes.
In their first award-winning manuscript, START-Play Physical Therapy Intervention Impacts Motor and Cognitive Outcomes in Infants With Neuromotor Disorders: A Multisite Randomized Clinical Trial, the authors report on the primary impacts of the intervention. They found that for those infants with more significant motor delay, those who received START-Play had greater improvements in cognition, fine motor skills, and problem-solving (at the 3-month follow up), and greater improvements were maintained for fine motor skills and for reaching at the 12-month follow up when compared to the infants receiving usual care. In addition to the Arnold Award, this manuscript won another prestigious research award from the American Physical Therapy Association, the Chattanooga Award, which recognizes authors who publish work in the association’s journal, Physical Therapy Journal.
The most recent Arnold award was for the research team’s new secondary outcomes manuscript, Early vs. Late Reaching Mastery’s Effect on Object Permanence in Infants with Motor Delays Receiving START-Play and Usual Care Early Intervention. Object permanence is the cognitive construct that allows us to maintain a continual mental representation of an object, an important working memory skill for infants to develop. This manuscript reports that, overall, infants who mastered the motor skill of reaching early showed greater development of object permanence understanding than infants who mastered reaching later. Children who reached early and also received the START-Play intervention continued to improve their object permanence understanding to a greater degree than children receiving usual care. This study extended our understanding of how object permanence relates to developing motor skills, described in the authors’ previous publication, which revealed that object permanence skills improved as sitting skills improved. Together, these two papers show how developing the motor skills of sitting and reaching are important to building cognitive skills and understanding objects in the world.
After accepting the award, Dr. Harbourne answered some questions from NCSER about her team’s research on START-Play.
What was the motivation behind your work on developing and testing the efficacy of START-Play?
Early intervention services for children with motor delays or dysfunction are often siloed into disciplines by functional areas. For example, educators address cognitive skills and physical therapists address only motor skills. But our study supported the idea that early learning that combines movement with problem solving can advance cognitive skills, problem-solving, and fine motor skills, all areas important to eventual success in school.
What do your results tell us about how the intervention is working and its implications for implementation?
Because we found that adding problem-solving and cognitive challenges to our motor intervention did not slow progress in motor skills, we believe that integrating motor and cognitive challenges may be better for overall development than separating these areas during service delivery. We also had a strong fidelity of intervention program, assuring that the key ingredients of the intervention were adhered to, and that it was clearly different from usual care. However, one implication is that early interventionists need further training to deliver this type of service to families of children with significant motor delays.
Please tell us about your current and ongoing work on START-Play. How are you moving forward with these positive results?
We are currently examining the data from our long-term follow-up study that we conducted with supplemental funding through NCSER. We are also working on a study, funded through NIH, to look at a dose-matched comparison of START-Play intervention with a formalized version of usual care called MORE-PT for infants with cerebral palsy. In addition, we have developed an online continuing education course that translates our findings from the original START-Play study and will help therapists to implement the key ingredients of START-Play in early intervention. We are excited to work on implementation and hope to gain further understanding of the implementation process as we move forward.
Regina (Reggie) Harbourne is the director of the infant development lab and associate professor of physical therapy in the Rangos School of Health Sciences, Duquesne University. This blog was produced by Amy Sussman, the program officer for NCSER’s Early Intervention and Early Learning program.
 Manuscripts are submitted for review for this award before they are published. Although AACPDM has first option to publish the wining manuscripts, the paper is not yet published or available publicly.