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Table 1 SPEEDI Intervention Description

From: 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

Phase 1 (21 days starting when medically stable)

Phase 2 (12 weeks starting at the end of phase 1)

In NICU

Primarily at home, but started in NICU if not ready for discharge on day 21 post baseline.

5 intervention sessions provided by the parent and therapist jointly and in response to the infant’s behavioral cues based on the synactive theory of development [31, 32].

Parents were encouraged to provided activities daily, with a goal of at least 20 min per day of activities 5 days per week, provided by the parent

33 Videos of positive and negative interaction available to parents throughout the phase 1 intervention as examples (Additional file 2)

An activity booklet (Additional file 3), with pictures, simple text, and a log for parent to record daily activities and questions was used to encourage parents to provide motor and cognitive opportunities daily in a variety of play positions, environments, and with objects [13].

Coaching on behavioral states, self-calming, environmental modification, and choosing times for feeding and play based interactions using dolls or video clips if the infant was not alert or fatigued

Parent encourage to provide the “just right challenge” advancing from stage 1 to stage 2 activities as they observed their infant improving or discuss with therapist at each visit

Provide experience with variable and self-directed movements and social interaction without physiological or behavioral stress. Introduced phase 2 activities by end of phase1

Physical Therapist participated in 5 parent-infant activity session over 12 weeks and helped with advancing from stage 1 to stage 2 activities as the infant was ready.

Guided participation used in identifying cues to stop, alter, or delay interactions during caregiving, feeding, play activities

Parent was encouraged to develop a daily routine for encouraging developmental play.

  1. Over arching theme: Encouraging parents to provide the “just right challenge” by pacing intervention and the experiences provided based on the infant’s behavioral state, signs of stress including autonomic, motor, or attention changes and demonstrated readiness for increasing duration or difficulty of developmental play skills
  2. Key principles: Encourage self-initiated movement, variability, object interaction, and social interaction. Do not impose movement on the infant. Observe and respond to the infant’s behavioral cues. (Additional file 1)
  3. Key Strategies to support motor development during interactions: provide graded postural support, observe spontaneous movement in response to your support, vary postural support to encourage different opportunities and sensory input, vary positioned with the minimal support to encourage variable movements