Phase 1 (21Â days starting when medically stable) | Phase 2 (12Â weeks starting at the end of phase 1) |
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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 12Â 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. |