The study

The VIP-project (Dutch: Vroegtijdige Interventie Project) studied the effect of early physical therapy in high risk infants. Infants were considered to be high risk if they showed definitely abnormal general movements (see General Movements) around 3 months corrected age.

What we previously did

Forty six infants were included in the VIP project. They randomly received between the corrected ages of 3 and 6 months early intervention either according to the novel program COPCA or traditional infant physical therapy (TIP).

The infants development was monitored with an extensive assessment battery, at baseline, during the intervention, immediately after the intervention and again at the ages of 18 months and 8 years.

The results showed that developmental outcome in both intervention groups was more or less similar. Nevertheless a small advantage in cognitive development was present in COPCA infants of mothers with relatively little education.

We had anticipated that we would find no or minimal differences between the groups, as we expected that physical therapists in both groups would perform in part similar actions. We investigated this by means of video-recordings of physical therapy sessions. Indeed, we found that the physical therapy actions in both groups were partially comparable. On the other hand, also substantial differences between the groups were present.

We also found that the physical therapy actions (what the therapist actually did during a session) was associated with the child's developmental outcome at 18 months. Physical therapy actions characteristic for COPCA were associated with better functional outcome, whereas traditional physical therapy actions were associated with worse outcome at 18 months; traditional communication (training, instruction) was associated with less adequate mobility at 8 years.

We also assessed whether families applied knowledge acquired during intervention in daily life. To this end we analyzed the position in which the infant was bathed. The results showed that families who had received COPCA bathed their 6-month-old infant more often in sitting position than the other families did, implying that the COPCA families challenged the infant's motor behaviour during bathing. Being bathed in sitting position at 6 months was associated with a better developmental outcome at 18 months. This means that the data suggest that COPCA principles get integrated into daily life, which in turn is associated with a better developmental outcome.


Mijna Hadders-Algra
, MD, PhD
Developmental Neurology

Arend F Bos, MD, PhD
Neonatology, UMCG

Tineke Dirks, PT
Developmental Neurology

Elisa G. Hamer, MD, PhD

Lieke van Balen, MD

Key publications

  • Blauw-Hospers CH, Hadders-Algra M. A systematic review on the effects of early intervention on motor development. Dev Med Child Neurol 2005; 47: 421-32.
  • Blauw-Hospers CH, Dirks T, Hulshof LJ, Hadders-Algra M. Development of a quantitative tool to assess the content of physical therapy for infants. Pediatr Phys Ther 2010; 22: 189-97.
  • Dirks T, Blauw-Hospers C, Hulshof H, Hadders-Algra M. Differences between the family-centered ‘COPCA’ program  and traditional infant physical therapy based on NeuroDevelopmental Treatment principles. Phys Ther 2011; 91: 1303-22.
  • Blauw-Hospers CH, Dirks T, Hulshof LJ, Bos AF, Hadders-Algra M. Pediatric physical therapy in infancy: from nightmare to dream? A two arm randomized trial. Phys Ther 2011, 91: 1323-38.
  • Hielkema T, Blauw-Hospers CH, Dirks T, Drijver-Messelink M, Bos AF, Hadders-Algra M. Does physiotherapeutical intervention affect motor outcome in high risk infants? An approach combining a randomized controlled trial and process evaluation. Dev Med Child Neurol, 2011; 53: e8-e15.
  • Hadders-Algra M. Challenges and limitations in early intervention. Dev Med Child Neurol 2011; 53 (suppl 4): 52-5.
  • Dirks T, Hadders-Algra M. The role of the family in intervention of infants at high risk for cerebral palsy - a systematic analysis. Dev Med Child Neurol 2011; 53 (suppl 4): 62-7.
  • Dirks T, Hielkema T, Hamer EG, Reinders-Messelink HA, Hadders-Algra M. Infant positioning in daily life may mediate associations between physical therapy and child development - video-analysis of an early intervention RCT. Res Dev Disabil 2016; 53-54: 147-57.
  • Hamer EG, Dirks T, Bos AR, Hielkema T, Hooijsma SJ, Reinders-Messelink HA, Toonen RF, Hadders-Algra M. Effect of early intervention on functional outcome at school age: follow-up and process evaluation of a randomized controlled trial in infants at risk. Early Hum Dev 2017; 106-107: 67-74.
  • Van Balen L, Dijkstra LJ, Dirks T, Bos AF, Hadders-Algra M. Early intervention and the development of postural adjustments during reaching in infants at risk of cerebral palsy. Pediatr Phys Ther. 2019; 31: 175-83.


Johanna Kinderfonds

Stichting Fonds de Gavere

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