Multisensory Stimulation and Priming (MuSSAP) in 4-10 Months Old Infants with a Unilateral Brain Lesion: A Pilot Randomised Clinical Trial

Abstract

Aim. To explore the effect of an Early Intensive-Upper Limb intervention (EI-UL) compared to EI-UL with integrated Multisensory Stimulation And Priming (MuSSAP) training on improving manual ability in infants with a unilateral brain lesion. Method. A pilot randomised clinical trial with pre- and postintervention and follow-up measurements (T0, T1, and T2) was conducted. Sixteen infants with a unilateral brain lesion (corrected age is 4-10 months) received home-based intervention with video coaching. Eight infants received EI-UL and eight infants received EI-UL with integrated MuSSAP training. Primary outcome was the Hand Assessment for Infants (HAI) score. Additionally, effects were explored on initiation of goal-directed movements in both groups and on attention in the EI-UL with integrated MuSSAP training group. Results. No significant group differences in HAI scores were found. Overall, HAI ‘Affected hand score’ increased between T0 and T1 ( $p=0.001$ , $\text{Cohen}\text{’}\text{s}\text{d}=1.04$ ) and between T0 and T2 ( $p<0.001$ , $\text{Cohen}\text{’}\text{s}\text{d}=1.28$ ); and the HAI ‘Both Hands Measure’ increased between T0 and T1 ( $p<0.001$ , $\text{Cohen}\text{’}\text{s}\text{d}=1.72$ ) and between T0 and T2 ( $p<0.001$ , $\text{Cohen}\text{’}\text{s}\text{d}=1.81$ ). At the start of the intervention, six infants (three in both groups) did not demonstrate initiation of goal-directed contralesional upper limb movements. During the intervention one infant receiving EI-UL and all three infants receiving EI-UL with integrated MuSSAP training started to initiate goal-directed movements. Conclusion. The results suggest manual ability of infants with unilateral brain lesion improved with both interventions. We hypothesize that the integrated MuSSAP training may facilitate attention and initiation of contralesional upper limb goal-directed movements. This trial is registered with NCT05533476).