Project Activities
Structured Abstract
Setting
Sample
Research design and methods
Control condition
Key measures
Data analytic strategy
Key outcomes
People and institutions involved
IES program contact(s)
Products and publications
ERIC Citations: Find available citations in ERIC for this award here.
Publicly Available Data: The final dataset and corresponding documentation will be deposited in the University of Nebraska-Lincoln Data Repository (https://dataregistry.unl.edu). Researchers interested in accessing the data will be required to complete a Data Use Agreement Form.
WWC Review: https://ies.ed.gov/ncee/wwc/Study/90301
Project Website: http://start-play.unl.edu/
Project Video: (created through IES) https://www.youtube.com/watch?v=ZrIo0zXgkdQ
Additional online resources and information:
Study video for recruitment: https://www.youtube.com/watch?v=mP7-Eo-EBe4&t=27s
Object permanence video: https://www.youtube.com/watch?v=dAaMAoomjWg&t=39s
Fidelity video: https://www.youtube.com/watch?v=UEat5MVwZFM
Select Publications
Journal articles
An, M., Nord, J., Koziol, N. A., Dusing, S. C., Kane, A. E., Lobo, M. A., … & Harbourne, R. T. (2021). Developing a fidelity measure of early intervention programs for children with neuromotor disorders. Developmental Medicine & Child Neurology, 63(1), 97-103.
Cunha, A. B., Babik, I., Koziol, N. A., Hsu, L. Y., Nord, J., Harbourne, R. T., ... & Lobo, M. A. (2021). A novel means-end problem-solving assessment tool for early intervention: Evaluation of validity, reliability, and sensitivity. Pediatric Physical Therapy, 33(1), 2-9.
Cunha, A. B., Babik, I., Harbourne, R., Cochran, N. J., Stankus, J., Szucs, K., & Lobo, M. A. (2020). Assessing the validity and reliability of a new video goniometer app for measuring joint angles in adults and children. Archives of Physical Medicine and Rehabilitation, 101(2), 275-282.
Harbourne, R. T., Dusing, S. C., Lobo, M. A., McCoy, S. W., Koziol, N. A., Hsu, L. Y., ... & Sheridan, S. M. (2021). START-Play physical therapy intervention impacts motor and cognitive outcomes in infants with neuromotor disorders: A multisite randomized clinical trial. Physical Therapy, 101(2), 1-11.
Harbourne, R. T., Dusing, S. C., Lobo, M. A., Westcott-McCoy, S., Bovaird, J., Sheridan, S., ... & Babik, I. (2018). Sitting Together and Reaching to Play (START-play): protocol for a multisite randomized controlled efficacy trial on intervention for infants with neuromotor disorders. Physical therapy, 98(6), 494-502.
Jensen-Willett, S., Cunha, A., Lobo, M. A., Harbourne, R., Dusing, S. C., McCoy, S. W., ... & Bovaird, J. A. (2022). The effect of early-life seizures on cognitive and motor development: A case series. Pediatric Physical Therapy, 34(3), 425-431
Koziol, N. A., Butera, C. D., Kretch, K. S., Harbourne, R. T., Lobo, M. A., McCoy, S. W., ... & Dusing, S. C. (2022). Effect of the START-Play physical therapy intervention on cognitive skills depends on caregiver-provided learning ppportunities. Physical & Occupational Therapy In Pediatrics, 1-16.
Molinini, R. M., Koziol, N. A., Marcinowski, E. C.; Hsu, L., Tripathi, T., Harbourne, R. T., McCoy, S. W., Lobo, M. A., Bovaird, J. A., Dusing, S. C. (2021). Early motor skills predict the developmental trajectory of problem solving in young children with motor delays. Developmental Psychobiology, 63, 1-12.
Molinini, R. M., Koziol, N. A., Tripathi, T., Harbourne, R. T., McCoy, S. W., Lobo, M. A., ... & Dusing, S. C. (2020). Measuring early problem-solving in young children with motor delays: A validation study. Physical & Occupational Therapy In Pediatrics, 33, 1-19.
Stuyvenberg, Corri L.; Brown, Shaaron E.; Inamdar, Ketaki; Evans, Megan; Hsu, Lin-ya; Rolin, Olivier; Harbourne, Regina T.; Westcott McCoy, Sarah; Lobo, Michele A.; Koziol, Natalie A.; Dusing, Stacey C. , (2021) Targeted physical therapy combined with spasticity management changes motor development trajectory for a 2-year-old with cerebral palsy. Journal of Personalized Medicine, 11(3), Article 163.
Project website:
Supplemental information
Long-Term Follow-Up Award: 3 Years (FY 2020–FY 2022), $929,509
To examine longer-term impacts of START-Play, the research team received $929,509 in additional funding to collect follow-up data 24 and 36 months after the baseline assessment.
Pre-registration Site: This study was registered at ClinicalTrials.gov (Identifier: NCT02593825)
- For the full sample (both mild and significant motor delay together), there were significant short-term effects (0-3 months) in favor of the START-Play group for sitting skills and fine motor skills.
- For infants with significant motor delay, the positive effects of START-Play were observed at 3 months for Bayley cognition, Bayley fine motor, and problem-solving skills as measured by the Assessment of Problem Solving in Play.
- For infants with mild delays there were significantly positive effects for the START-Play group in receptive communication, but significant negative effects on problem solving.
- For what was initially to be the longer-term outcomes (up to 12 months), across all children, there was a significant positive effect of START-Play on Bayley fine motor scores.
- For infants with significant motor delay, significantly positive longer-term effects (up to 12 months) for the START-Play group were found for fine motor and reaching frequency outcomes, as measured by the Bayley.
- For infants with mild motor delay, no significant difference was found between the START-Play and usual care groups in motor or cognitive outcomes.
- Motor-based problem-solving mediated the longer-term impact of START-Play on cognition for infants with significant motor delay. START-Play initiated positive short-term changes (baseline to 3 months post baseline) in problem-solving, which accelerated longer-term changes (3 to 12 month post baseline) in cognition. Sitting, reaching, and fine motor skills did not mediate the intervention effect.
- Baseline caregiver-provided learning opportunities (parent-child interaction) moderated the 3- and 12-month effects of START-Play on cognition. Cognitive gains due to START-Play were more pronounced for children whose caregivers provided more learning opportunities.
- Analysis of the longer-term outcomes (24 to 36 months), using the supplemental funding, did not support the maintance of positive outcomes for any of the primary outcomes including gross motor skills, fine motor skills, cognitive skills, language skills, or problem solving, nor were there group differences in parent-child interactions. However, note that much of this period of time took place in the early stages of the pandemic shutdown.
- An analysis on the subset of children who participated up to the final 36-month follow-up assessment suggested that early bimanual object manipulation and corresponding visuomanual coordination may serve as important precursors for developing exuctive functioning skills in children with motor delays. These early sensorimotor behaviors may facilitate the development of attention to a task, goal-directedness, and problem solving, thus providing the foundation for more complex executive function skills. Identification of sensorimotor precursors to emerging EF skills may support the design of early interventions to improve EF outcomes in at-risk populations.
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