A comparison of treatment protocols for infants with motor delay

Master Thesis


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University of Cape Town

Purpose: Early intervention (EI) strategies are reported to have positive results on decreasing the extent of motor delay in children. However, most studies regarding treatment of infants with motor delay as a result of psychosocial/environmental factors have taken place in developed countries where resource constraints are not as severe as in the South African context. The aim was thus to determine which intervention protocol (standard vs. intense group orientated therapy) was the most feasible and efficacious for infants with motor delay, primarily due to psychosocial/environmental factors. Methodology: A cross sectional, descriptive, correlational research approach was used to identify infants with motor delay using the Bayley Infant Neurodevelopmental Screener III (BINS) at three Well Baby clinics. After a baseline assessment, infants who met the criteria to participate entered an experimental study consisting of a single blinded randomized control trial. The final sample included 24 infants aged 3 to 12 months. Participants were randomly divided into two groups and a repeated measures design was followed to conduct this study. The Bayley Scales of Infant Development II (BSID II) was used to evaluate motor progress over a three month intervention period. The standard group received treatment once a month for three months compared to a weekly treatment session attended by dyads in the intense group. Care-giver compliance along with their level of satisfaction was investigated using self-structured questionnaires. Results: Twenty four participants were recruited with a mean age of 5.69 months (SD= 2.36; range 3-10.4). Both monthly and weekly treatment groups showed significant motor developmental progress over the intervention period. The overall difference between the groups was not significant (p=.78) and by the final assessment, during the intervention period, both groups displayed similar psychomotor developmental indices (monthly: mean= 87.92, SD= 10.87, range 73-109; weekly: mean= 94.18, SD= 7.63, range 85-109). However there was a medium to large effect size ( d = 0.65) in favour of the weekly treatment group and they also showed better initial developmental progress after 1 month compared to the gradual trend of progress illustrated by the monthly group. After treatment sessions were withheld for six weeks, an assessment of motor performance showed the monthly group retained their skills better than the weekly group. This difference had a medium effect size of d = 0.58 in favour of the monthly group. Care-givers generally showed a high level of satisfaction with no significant differences between groups (p= .64). Similarly, no statistically significant difference was found between the groups in terms of compliance to the home programme. Conclusion: Both the intense and standard group orientated treatment protocols had significantly positive results after treatment. The intense group showed rapid initial progress compared to the monthly group. However, the monthly group better retained their skills after treatment was discontinued. Therefore, in a South African, low socio-economic context, the monthly protocol might be more practical and cost effective.