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Early Intervention and Postural Adjustments During Reaching in Infants at Risk of Cerebral Palsy

van Balen, Lieke C. MSc, MD, PhD; Dijkstra, Linze-Jaap BSc; Dirks, Tineke PT; Bos, Arend F. MD, PhD; Hadders-Algra, Mijna MD, PhD

doi: 10.1097/PEP.0000000000000585

Purpose: To investigate postural effects of the family-centered program, COPing with and CAring for infants with special needs (COPCA), applied at 3 to 6 months' corrected age in infants at high risk of cerebral palsy. Previously, we reported postural differences between the infants at risk of CP in the control group of the current study and a group of infants developing typically. Now we focus on differences between 2 intervention groups.

Methods: We explored postural adjustments during reaching in seated infants at 4, 6, and 18 months using surface electromyography of arm, neck, and trunk muscles. Infants randomly received the family-centered program or another infant physical therapy. Using videotaped intervention sessions, we investigated correlations between time spent on specific physical therapeutic actions and direction specificity, recruitment order, and anticipatory activation at 18 months.

Results: Postural adjustments in both groups were similar, but development of direction specificity and anticipatory activation in COPCA infants better mimicked typical development. These 2 parameters were associated with COPCA-type physical therapeutic actions.

Conclusions: Postural control was similar after both interventions. Positive outcomes were associated with fewer intervening actions of the therapist and greater allowance of spontaneous movements.

This study investigates the postural effects of a family-centered program applied at 3-6 months corrected age in infants at high risk of cerebral palsy.

University of Groningen, University Medical Center Groningen, Department of Pediatrics, Division Developmental Neurology (Drs van Balen and Hadders-Algra, Mr Dijkstra, and Ms Dirks) and Neonatology (Dr Bos), Groningen, the Netherlands.

Correspondence: Mijna Hadders-Algra, MD, PhD, University Medical Center Groningen, Developmental Neurology, Hanzeplein 1, 9713 GZ Groningen, the Netherlands (

Grant Support: The study was supported by Stichting Fonds de Gavere, the Johanna KinderFonds, the Cornelia Stichting, Stichting de Drie Lichten, and the Post-graduate School BCN Groningen.

There was no involvement of the funders in study design, data collection, data analysis, manuscript preparation, and/or publication decisions.

Mijna Hadders-Algra, Tineke Dirks, and Arend Bos set up the study design. Lieke van Balen was in charge with a team of assistants (see Acknowledgments) of data collection and data analysis. Linze Dijkstra and Mijna Hadders-Algra were also involved in data analysis. All authors commented on the drafts. The final version was approved by all authors.

Trial registration number: ISRCTN85728836.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

Copyright © 2019 Academy of Pediatric Physical Therapy of the American Physical Therapy Association