Table 2.
Environmental enrichment intervention and other treatments in the included trials
| Author, year | Details of EE intervention | Other treatments | Duration | ||
|---|---|---|---|---|---|
| Program and Enrichment used | Providers | Sites | |||
| Nelson (2001) [30] |
Program: multisensory intervention Sensory enrichment: auditory stimuli via a female human voice, tactile stimuli administered as light stroking, visual stimuli involving eye-to-eye contact, and vestibular stimulation consisting of rhythmic rocking. Social enrichment: educating parents on parent-infant interaction was conducted. |
Healthcare workers | Hospital (special care nursery) | Standard care: a special care nursery environment was designed to reduce environmental stress (reduce sound and light) and promote sleep cycle and motor development (stress reduction program) | until 2 mon of CA |
| Ohgi (2004) [31] |
Program: NBAS-based intervention combined with developmental support Motor and cognitive enrichment: based on the infant’s capabilities and developmental needs, parents were taught how to care for the baby. Social enrichment: optimize caregiving interactions by enhancing the mothers’ adjustment to their infants’ behavior. |
Caregivers | Hospital (NICU) | Standard care: general guidance was imparted to parents, and upon discharge, developmental services were provided to all infants and parents as per their individual needs. | until 6 mon of CA |
| Blauw-Hospers (2011) [32] |
Program: COPCA Motor and cognitive enrichment: caregivers identified infants’ signals and responded appropriately to their actual needs while promoting self-generated motor behaviors, variations, and trial-and-error experiences through play Social enrichment: educating parents on parent-infant interaction was conducted |
Caregivers and Healthcare workers | Home | Standard care: traditional infant physical therapy based on neurodevelopmental treatment was employed | 3–6 mon of CA |
| Morgan (2015) [33] |
Program: GAME Motor and cognitive enrichment: motor task practice and set up motor enriched play environments; instructed parents to recognize and understand infants’ motor behaviors, and subsequently provided them with opportunities for motor development |
Caregivers and Healthcare workers | Home | Standard care: the content of child guidance encompassed physical instruction, along with advice given to parents regarding posture and manipulation; the selection of therapeutic approaches was determined by the therapist and could include NDT, motor learning, developmental skills approaches, or a combination of methodologies | 12w |
| Morgan (2016) [34] |
Program: GAME Motor and cognitive enrichment: motor task practice and set up motor enriched play environments; instructed parents to recognize and understand infants’ motor behaviors, and subsequently provided them with opportunities for motor development |
Caregivers and Healthcare workers | Home | Standard care: intervention methods included NDT, sensory integration training, etc. | 16w |
| Dusing (2018) [35] |
Program: SPEEDI Motor and cognitive enrichment: parents provided daily opportunities designed to support the infants’ emerging motor control and exploratory behaviors Social enrichment: educating parents on parent-infant interaction was conducted |
Caregivers |
Phase 1: Hospital (NICU) Phase 2: Home |
NA | 15w |
| Holmström (2019) [36] |
Program: Small Step Motor enrichment: learn new gross motor activities Cognitive enrichment: object exploration triggered different hand actions |
Caregivers | Home | Standard care: based on family-centered intervention and functional training | 35w |
| Harbourne (2019) [37] |
Program: Motor-Based Problem-Solving Intervention Motor and cognitive enrichment: set up the environment to facilitate small increments of movement, which infants could utilize to solve movement problems. |
Healthcare workers | Home | Optimal Pattern Approach: helped babies initiate movement within normal or optimal movement patterns and directly blocked movement patterns that could lead to errors or misalignment | 12w |
| Hielkema (2020a) [38] |
Program: COPCA Motor and cognitive enrichment: caregivers identified infants’ signals and responded appropriately to their actual needs, while promoting self-generated motor behaviors, variations, and trial-and-error experiences through play Social enrichment: educating parents on parent-infant interaction was conducted |
Healthcare workers | Home | PT: based on NDT principles | 12 mon |
| Hielkema (2020b) [39] |
Program: COPCA Motor and cognitive enrichment: caregivers identified infants’ signals and responded appropriately to their actual needs, while promoting self-generated motor behaviors, variations, and trial-and-error experiences through play Social enrichment: educating parents on parent-infant interaction was conducted |
Healthcare workers | Home | PT: based on NDT principles | 12 mon |
| Harbourne (2021) [40] |
Program: START-play Motor and cognitive enrichment: Embed motor learning and problem-solving skills into games |
Caregivers and Healthcare workers | Home | Usual care: most of the infants in the control group received only natural environment Part C services, some of them received only outpatient therapy, and some received both types of services | 3 mon |
| Ziegler (2021) [41] |
Program: COPCA Motor and cognitive enrichment: caregivers identified infants’ signals and responded appropriately to their actual needs, while promoting self-generated motor behaviors, variations, and trial-and-error experiences through play Social enrichment: educating parents on parent-infant interaction was conducted |
Healthcare workers | Home | Standard care: Standard care was heterogeneous and eclectic, using parent training, and often included components of neurodevelopmental treatment with hands-on techniques | 6 mon |
| Cemali (2022) [42] |
Program: Sensory integration training Motor, cognitive and sensory enrichment: provided sensory opportunities, posed just right challenges, avoided negative experiences, cooperated in activity choices, helped with self-organization, supported with the optimum stimuli, created a play context, maximized the child’s success, ensured physical safety, arranged the child’s play environment, and provided an alliance during treatment |
Healthcare workers | Hospital (therapy rooms) | PT: based on what the infant can and cannot do in the AIMS | 8w |
| Alberge (2023) [43] |
Program: Early post-hospital psychomotor therapy Motor and cognitive enrichment: infants are encouraged to engage and maintain attention, visuospatial environmental exploration, physical exploration, and interactive behaviors |
Healthcare workers | Home | N/A | 8 mon |
EE environmental enrichment, NBAS Neonatal Behavioral Assessment scale, COPCA COPing with and CAring for infants with special needs, GAME Goals-Activity-Motor-Enrichment, SPEEDI Supporting Play Exploration and Early Development Intervention, START Play Sitting Together and Reaching to Play, NICU Neonatal Intensive Care Unit, PT physiotherapy, NDT Neuro-Developmental Treatment, N/A not applicable, AIMS Alberta Infant Motor Scale, mon months, CA corrected age, w weeks