The SPEEDI Play Based Intervention

Dusing, S. C., Tripathi, T., Marcinowski, E. C., Thacker, L. R., Brown, L. F., & Hendricks-Muñoz, K. D. (2018). Supporting play exploration and early developmental intervention versus usual care to enhance development outcomes during the transition from the neonatal intensive care unit to home: a pilot randomized controlled trial. BMC Pediatrics, 18, 46.

"The purpose of this study was to assess the initial efficacy of Supporting Play, Exploration, and Early Developmental Intervention (SPEEDI) an intervention that started in the NICU and continued for 12 weeks in the community. The goals of SPEEDI were to provide an enriched environment and increased opportunities for infant initiated movements through collaborative parent, therapist and infant interactions during the first months of life in order to enhance the infant’s development during and after the intervention period (Additional file 1).

The SPEEDI model for intervention is based on the basic premise that motor and cognitive development are tightly coupled, suggesting that delays in one domain could contribute to delays in other domains . Motor experience provides infants an opportunity to learn about objects and interaction supports development in multiple domains

 The action perception model of development is governed by the theory that motor activity contributes to the infants attempts to attend to the environment, allowing the infant to receive and interpret important information, and solve problems by linking the mind and body in a cycle that supports development [21].

Children with motor impairments or delays have limited ability to interact with and interpret the environment, restricting their opportunities to learn through action [16]. Atypical postural control and impaired reaching abilities are common in infants born preterm and infants later diagnosed with development deficits such as CP, developmental coordination disorder, and minor neurological dysfunction [22–27]. Children born preterm with motor coordination disorders or CP score lower on problem-solving tasks than those without motor disabilities at school age [14, 15]. The relationship between motor and cognitive outcomes in infants born preterm supports the need for interventions that incorporate both the motor and cognitive domains and the interaction between these domains to maximize outcomes.

Exploratory problem-solving behaviors

Problem-solving behaviors were assessed using the Early Problem Solving Indicator (EPSI) at end phase 2 and both follow up visits. The EPSI is the cognitive subtest of the Individual Growth and Development Indicators designed to measure infant and toddler play-based problem-solving from 6 to 36 months of age. While the infants in this study were initially less than 6 months of age, the final study visit was at about 6 months of age and two of the four behaviors coded as part of the EPSI are commonly observed in young infants. So this tool was deemed the best available to document early-problem solving behaviors during play. The EPSI defines problem-solving as consisting of visual exploration, object manipulation and memory [34]. Previous studies with the EPSI show adequate reliability and validity, and usefulness in documenting change over time [35, 36]. During the EPSI, the infant was video-recorded interacting with 3 standard toys: pop-up animals toy, 6 seriated plastic cups, and a pound a ball game with a hammer and 4 balls. Infants were given each toy for 2 min while the examiner supported the child in sitting (pop up and cups) and prone (pound a ball) in order to sample 2 common play positions. If needed the examiner used a standard set of prompts such as tapping on the toy at a consistent frequency to engage or re-engage the infant in the standardized toy without demonstrating the use of the toy. The lead author has been certified by the EPSI developer to train blinded examiners and coders.

The frequency of 4 behaviors (look, explore, function, solution) were coded using definitions from the EPSI protocol. These behaviors were mutually exclusive, so only one behavior is coded at any time. Look was coded when the infant was looking at the toy. Explore was coded when the infant touched, manipulated, mouthed, rubbed, shook, pushed, pulled, banged, threw, or dropped the toy. A function was coded if the infants used the toy in a manner in which it was intended but does not require that the child complete all of the functions of the toy (e.g., moved one lever to make an animal pop up or nesting any 2 cups). A solution was coded if the infant used the toy in a way that its full functionality was displayed (e.g., moved all levers and buttons, so that all animals popped up or nesting all the cups in order). Two coders who were blinded to the infant’s group assignment, recoded 20% of visits, including some from each of the 4 study visits, with an inter rater agreement of 94.0% and intra rater agreement of 97.7%. The total number of problem solving behaviors was calculated as a sum of look, explore, function, and solution for each infant at each visit to represent that infant’s problem solving abilities.