title: Single blind randomised controlled trial of GAME (Goals - Activity - Motor Enrichment) in infants at high risk of cerebral palsy.
abstract: BACKGROUND
  Cerebral palsy (CP) is caused by a lesion in the developing infant brain. Recent neuroplasticity literature suggests that intensive, task-specific intervention ought to commence early, during the critical period of neural development.
  
  
  OBJECTIVE
  To determine whether "GAME" (Goals - Activity - Motor Enrichment), a motor learning, environmental enrichment intervention, is effective for improving motor skills in infants at high risk of CP.
  
  
  METHODS
  Single blind randomised controlled trial of GAME versus standard care. Primary outcome was motor skills on the Peabody Developmental Motor Scales-2 (PDMS-2). Secondary outcomes included Canadian Occupational Performance Measure (COPM), Bayley Scales of Infant and Toddler Development (BSID-III) and Gross Motor Function Measure-66 (GMFM-66). Outcome assessors were masked to group allocation and data analyzed with multiple regression.
  
  
  RESULTS
  All n=30 infants enrolled received the assigned intervention until 16 weeks post enrolment. At 12 months of age, n=26 completed assessments. Significant between group differences were found in raw scores on the PDMS-2 in favour of GAME (B=20.71, 95%CI 1.66-39.76, p=0. 03) and at 12 months on the total motor quotient (B=8.29, 95%CI 0.13-16.45,p =0.05). Significant between group differences favored GAME participants at 12 months on the cognitive scale of the BSID-III and satisfaction scores on the COPM.
  
  
  CONCLUSIONS
  GAME intervention resulted in advanced motor and cognitive outcomes when compared with standard care.
authors.affiliation: Cerebral Palsy Alliance Research Institute, The University of Sydney, PO Box 6427, Frenchs Forest, NSW 2086, Australia. Electronic address: cmorgan@cerebralpalsy.org.au.
authors.forename: Catherine
authors.initials: C
authors.lastname: Morgan
authors.affiliation: Cerebral Palsy Alliance Research Institute, The University of Sydney, PO Box 6427, Frenchs Forest, NSW 2086, Australia. Electronic address: inovak@cerebralpalsy.org.au.
authors.forename: Iona
authors.initials: I
authors.lastname: Novak
authors.affiliation: Department of Neurology, Children's Hospital at Westmead, University of Sydney, Australia, Locked Bag 4001, Westmead, NSW 2145, Australia. Electronic address: russell.dale@health.nsw.gov.au.
authors.forename: Russell C
authors.initials: RC
authors.lastname: Dale
authors.affiliation: Stella Maris Infant Lab for Early Intervention, Dept of Developmental Neuroscience, Stella Maris Scientific Institute, University of Pisa, Italy. Electronic address: a.guzzetta@inpe.unipi.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Guzzetta
authors.affiliation: Cerebral Palsy Alliance Research Institute, The University of Sydney, PO Box 6427, Frenchs Forest, NSW 2086, Australia; Grace Centre for Newborn Care, Children's Hospital at Westmead, University of Sydney, Australia. Electronic address: nadia.badawi@health.nsw.gov.au.
authors.forename: Nadia
authors.initials: N
authors.lastname: Badawi
mesh_terms: D001007:Anxiety / Q000523:psychology; D002547:Cerebral Palsy / Q000453:epidemiology / Q000534:rehabilitation*; D003071:Cognition; D003863:Depression / Q000523:psychology; D061345:Early Medical Intervention / Q000379:methods*; D004777:Environment; D005260:Female; D006040:Goals; D006801:Humans; D007223:Infant; D007858:Learning; D008297:Male; D009048:Motor Skills; D009473:Neuronal Plasticity; D010290:Parents / Q000193:education* / Q000523:psychology; D018802:Patient-Centered Care; D012306:Risk; D016037:Single-Blind Method; D013315:Stress, Psychological / Q000523:psychology
keywords: Cerebral palsy; Early intervention; Environmental enrichment; Motor learning