***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: 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 . AIMS 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 AND PROCEDURES Single blind r and omised controlled trial of GAME versus st and ard 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 . OUTCOMES AND RESULTS All n=30 infants enrolled received the assigned intervention until 16 weeks post enrolment . At 12 months of age , n=26 completed assessment s. 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 . CONCLUSION GAME intervention result ed in advanced motor and cognitive outcomes when compared with st and ard care Background Infants with unilateral brain lesions are at high risk of developing unilateral cerebral palsy ( CP ) . Given the great plasticity of the young brain , possible interventions for infants at risk of unilateral CP deserve exploration . Constraint-induced movement therapy ( CIMT ) is known to be effective for older children with unilateral CP but is not systematic ally used for infants . The development of CIMT for infants ( baby-CIMT ) is described here , as is the methodology of an RCT comparing the effects on manual ability development of baby-CIMT versus baby-massage . The main hypothesis is that infants receiving baby-CIMT will develop manual ability in the involved h and faster than will infants receiving baby-massage in the first year of life . Method and design The study will be a r and omised , controlled , prospect i ve parallel-group trial . Invited infants will be to be r and omised to either the baby-CIMT or the baby-massage group if they : 1 ) are at risk of developing unilateral CP due to a known neonatal event affecting the brain or 2 ) have been referred to Astrid Lindgren Children ’s Hospital due to asymmetric h and function . The inclusion criteria are age 3–8 months and established asymmetric h and use . Infants in both groups will receive two 6-weeks training periods separated by a 6-week pause , for 12 weeks in total of treatment . The primary outcome measure will be the new H and Assessment for Infants ( HAI ) for evaluating manual ability . In addition , the Parenting Sense of Competence scale and Alberta Infant Motor Scale will be used . Clinical neuroimaging will be utilized to characterise the brain lesion type . To compare outcomes between treatment groups generalised linear models will be used . Discussion The model of early intensive intervention for h and function , baby-CIMT evaluated by the H and Assessment for Infants ( HAI ) will have the potential to significantly increase our underst and ing of how early intervention of upper limb function in infants at risk of developing unilateral CP can be performed and measured . Trial registration Physical therapists recommend neurodevelopmental therapy for cerebral palsy , but its effectiveness has not been fully established . A r and omized controlled trial was undertaken to compare the effects over 6 months , of weekly ( intensive ) and monthly ( basic ) neurodevelopmental therapy on the motor development of young children with suspected cerebral palsy . Subjects were no older than 18 months when referred for physical therapy because of a motor delay . All those meeting specified criteria were assessed on seven motor development tests : reflex activity , postural reactions , gross motor ability , fine motor skills , mental functioning , dominance of abnormal movement patterns and ability to participate in activities of daily living . The average proportional change in aggregate motor development for the 17 infants on the weekly ( intensive ) regimen was substantially better than that for the 12 on the monthly ( basic ) regimen , after adjusting for the child 's age , whether the child was born at term or not , and mother 's education . A statistical test led to an equivalent of a Student 's t= 3.49 , which with 24 df was associated with P= 0.0019 ( two-sided ) Background The average age for the diagnosis of cerebral palsy ( CP ) is 19 months . Recent neuroplasticity literature suggests that intensive , task-specific intervention ought to commence as early as possible and in an enriched environment , during the critical period of neural development . Active motor interventions are effective in some population s , however the effects of active motor interventions on the motor outcomes of infants with CP have not been research ed thoroughly , but pilot work is promising . The aim of this study was to determine the short- term effects of “ GAME ” ; a new and novel goal -oriented activity-based , environmental enrichment therapy programme on the motor development of infants at high risk of CP and test study procedures for a r and omized controlled trial ( RCT ) . Methods Pragmatic 2-group pilot RCT to assess motor outcomes , goal attainment , parent well-being and home environment quality , after 12-weeks of GAME intervention versus st and ard care . GAME included : creation of movement environments to elicit motor behaviours ; parent training in motor learning and task analysis ; frequent practice of motor tasks using a programme that was individualised to the child , was varied and focused on self-initiated movement . Data were analyzed using multiple regression . Results Thirteen infants were consented , r and omised , treated and completed the study . At study conclusion , the GAME group ( n = 6 ) demonstrated an advantage in Total Motor Quotient of 8.05 points on the Peabody Developmental Motor Scale-2 ( PDMS-2 ) compared to the st and ard care group ( n = 7 ) ( p < .001 ) . No significant differences existed between groups on any other measure . Conclusions GAME appears to offer a promising and feasible new motor intervention for CP , with favourable short-term motor outcomes . A pressing need exists for an adequately powered RCT with long-term end points , to determine if GAME may advance these children ’s motor trajectory BACKGROUND CareToy is an intelligent system , inspired by baby gyms , aim ed to provide an intensive , individualized , home-based and family-centred early intervention ( EI ) program . AIMS A pilot study was carried out to explore the feasibility of CareToy intervention in preterm infants , aged 3 - 9 months of corrected age . METHODS Twenty low-risk preterm infants , without brain lesion or other clinical complications ( 14 allocated to CareToy intervention and 6 to St and ard Care ) were recruited . The Infant Motor Profile ( IMP ) was predefined as the primary outcome measure and Alberta Infant Motor Scale and Teller Acuity Cards as secondary measures . Moreover , 202 pre-programmed training scenarios were developed and instructions for the management of CareToy intervention were defined as general guidelines . OUTCOMES AND RESULTS All infants received 4 weeks of their allocated intervention and were evaluated with the selected tests before and immediately after the 4 weeks . The mean difference changes in IMP total score and Teller Acuity Cards over the intervention period were higher in the CareToy group than in the St and ard Care group . CONCLUSIONS AND IMPLICATION S CareToy seems a feasible device for providing EI . An adequately powered r and omized clinical trial is warranted A r and omized clinical trail ( RCT ) employed a 12-month individualized cognitive/sensorimotor stimulation program to look at the efficacy of the intervention on 62 infants with suspected brain injury . The control group infants received the State-funded follow-up program provided by the Los Angeles ( LA ) Regional Centers while the intervention group received intensive stimulation using the Curriculum and Monitoring System ( CAMS ) taught by public health nurses ( PHNs ) . The developmental assessment s and outcome measures were performed at 6 , 12 and 18 months corrected age and included the Bayley motor and mental development , the Home , mother-infant interaction ( Nursing Child Assessment Feeding Scale ( NCAFS ) and Nursing Child Assessment Teaching Scale ( NCATS ) ) , parental stress and social support . At 18 months , 43 infants remained in the study . The results indicate that the intervention had minimal positive effects on the Bayley mental and motor development scores of infants in the intervention group . Likewise , the intervention did not contribute to less stress or better mother-infant interaction at 12 or 18 months although there were significant differences in the NCAFS scores favoring the intervention group at 6 months . There was a significant trend , however , for the control group to have a significant decrease over time on the Bayley mental scores . Although the sample was not large and attrition was at 31 % , this study provides further support to the minimal effects of stimulation and home intervention for infants with brain injury and who may have more significant factors contributing to their developmental outcome A developmental cascade defines a longitudinal relation in which one psychological characteristic uniquely affects another psychological characteristic later in time , separately from other intrapersonal and extrapersonal factors . Here , we report results of a large-scale ( N = 374 ) , normative , prospect i ve , 14-year longitudinal , multivariate , multi source , controlled study of a developmental cascade from infant motor-exploratory competence at 5 months to adolescent academic achievement at 14 years , through conceptually related and age-appropriate measures of psychometric intelligence at 4 and 10 years and academic achievement at 10 years . This developmental cascade applied equally to girls and boys and was independent of children ’s  behavioral adjustment and social competence ; mothers ’ supportive caregiving , verbal intelligence , education , and parenting knowledge ; and the material home environment .  Infants who were more motorically mature and who explored more actively at 5 months of age achieved higher academic levels as 14-year-olds Introduction Infants with asymmetric brain lesions are at high risk of developing  congenital hemiplegia .  Action – observation training ( AOT ) has been shown to effectively improve upper limb motor function in adults with chronic stroke .  AOT is based on action observation , whereby new motor skills can be learnt by observing motor actions . This process is facilitated by the Mirror Neuron System , which matches observed and performed motor actions . This study aims to determine the efficacy of AOT in : ( 1 ) influencing the early development of reaching and grasping of typically developing infants and ( 2 ) improving the upper limb activity of infants with asymmetric brain lesions . Methods and analysis This study design comprises two parallel r and omised sham-controlled trials ( RCTs ) in : ( 1 ) typically developing infants ( cohort I ) and ( 2 ) infants with asymmetric brain lesions ( eg , arterial stroke , venous infa rct ion , intraventricular haemorrhage or periventricular leukomalacia ; cohort II ) . Cohort II will be identified through a neonatal ultrasound or neonatal MRI . A sham control will be used for both RCTs , taking into consideration that it would be unethical to give no intervention to an at-risk population . Based on a two-tailed t test of two independent means , with a significance ( α ) level of 0.05 , 80 % power , predicted effect size of 0.8 and a 90 % retention rate , we require 20 participants in each group ( total sample of 40 ) for cohort I. The sample size for cohort II was based on the assumption that the effect size of the proposed training would be similar to that found by Heathcock et al in preterm born infants ( n=26 ) with a mean effect size of 2.4 . Given the high effect size , the calculation returned a sample of only four participants per group , on a two-tailed t test , with a significance ( α ) level of 0.05 and 80 % power . As cohort II will consist of two subgroups of lesion type ( ie , arterial stroke and venous infa rct ion ) , we have quadrupled the sample to include 16 participants in each group ( total sample of 32 ) . Infants will be r and omised to receive either AOT or st and ard Toy Observation Training ( TOT ) . Both interventions will be of 4 weeks ’ duration , from the infant 's 9th–13th post-term week of age . Three sessions of 5 min each will be performed each day for 6 days/week ( total of 6 h over 28 days ) . Parents of the AOT group will repeatedly show the infant a grasping action on a set of three toys , presented in r and om order . Parents of the TOT group will show the infant the same set of three toys , in r and om order , without demonstrating the grasping action . At 14 , 16 and 18 weeks , the quantity and quality of reaching and grasping will be measured using the Grasping and Reaching Assessment of Brisbane ; symmetry of reaching and grasping will be measured using the H and  Assessment of Infants ( HAI ) and  pressure of grasping  for each h and with a customised pressure sensor . At 6 months ’ corrected age , the primary outcome measures will be the HAI and Bayley Scales of Infant and Toddler Development ( third edition ; BSID III ) , to measure cognitive and motor development . At 8 months , HAI and EEG will be used to measure brain activity and cortical coherence . 
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Yet , two suggestions emerged : ( 1 ) dosing may be critical for effectiveness ; ( 2 ) multifaceted intervention may offer best opportunities for child and family .