Innovative physiotherapy aims to boost outcomes for premature babies In 2016, when Dr Barbara Lucas was on the ward at Royal North Shore Hospital’s neonatal intensive care unit (NICU), she was asked the same question by three fathers whose premature babies had all experienced severe brain bleeds.
They wanted to know what would make a difference to their babies’ development. Some of the infants, born up to three months premature, were very fragile. Babies who need care in the NICU can have a range of adverse developmental outcomes, including cerebral palsy, the most common motor disability in childhood. Barbara, a senior physiotherapist in NICU and a post- doctoral research fellow with the John Walsh Centre for Rehabilitation Research at the University of Sydney, suggested that when the babies were a little bit older – around the six-week premature mark from term age – the parents could work on five key “milestones”. They included head control, orientation of their hands towards their middle, balance activities, reciprocal kicking of their legs, and visual activities to fix their gaze on their parent’s face. They could be done three times a day for five minutes. “I couldn’t believe how quickly these babies improved,” recalls Barbara. “Surprisingly, none of these babies went on to have cerebral palsy and they were all at risk. I’m not saying we cured them, but I think we helped optimise their development.” The BeST START TRIAL » Physiotherapy for premature babies starting four to five months earlier than usual » Therapy delivered by parents » Short, frequent bursts of activity, 5-minute sessions, 3 times a day » Babies motor development assessed at 4, 12 and 24 months to determine effectiveness
The initial investigation with 13 babies led Barbara to run the Best Start Trial (BeST) in 2019, a bigger study of ultra-early parent-administered physiotherapy for 30 infants at high risk of cerebral palsy or motor delay. The parents were given exercises to promote their babies’ motor development up until they were about four months old, when the trial ended. While Barbara and her team didn’t see any significant differences in outcomes between the babies on the trial and those in the control group, their carers did. “The parents in the experimental group said they felt that the treatment was highly beneficial, and that it really improved their infant’s function,” she says. Barbara is hoping to conduct more studies down the track, particularly as the first pilot trial was interrupted by the COVID-19 pandemic. “Overall, we feel encouraged to continue working more on this project.”
Dr Barbara Lucas
30 Tomorrow’s medicine today
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