GAME (Goals-Activity-Motor Enrichment) Program
Evidence reviewed as of before 01-01-2021
Author(s): Ogourtsova, T. (PhD OT); Steven, E. (MSc App OT); Iliopoulos, G. (MSc App OT); & Majnemer, A. (PhD, OT, FCAHS)
Introduction
GAME (Goal-Activity-Motor-Enrichment) program was developed in Australia to provide early intervention to premature infants at high risk of cerebral palsy (CP), targeting their motor skills, as well as parental perception and satisfaction of motor performance. The GAME program is an intervention based on the principles of motor learning, family-centered care, parent coaching, and environmental enrichment. Environmental enrichment includes assistance in setting up play environments to promote child self-generated movements, exploration and task success. The specific interventions are customized based on parental goals, the child’s motor ability and home environment (including toys and equipment). Interventions are provided in the child’s home every 2 weeks until the child turns 1 year old. Home programs with suggested activities are provided based on identified goals.
Resources
Parent & Family Information
GAME targets motor skills in infants at high risk of CP. The intervention consists of three components: (1) goal-oriented intensive motor training, (2) parent education, and (3) strategies to enrich the child’s motor learning environment. The intervention is done at home by a therapist and a home program is given.
GAME is used to target infant motor development, motor function, cognitive development, as well as parental perception of motor performance and satisfaction.
No, but each intervention is based on client specific goals.
The effectiveness of the GAME program for infants at high risk of CP was examined in one high quality research study.
Compared to standard care, GAME was shown to improve:
- Infant motor development
- Infant motor function
- Infant cognitive function
- Parental perception of infant motor performance
- Parental satisfaction with goals
It was not shown to improve:
- Enrichment of environment
- Parental mood and affect
- Therapist will provide home visits every 2 weeks.
- Families collaborate with the therapists to determine a set of realistic goals for their child’s development
- The goals are targeted during therapy sessions and are built into a home program
- Parents are encouraged to use their knowledge of their child’s play preferences to elicit self-generated motor activity.
- Parents are to give minimal manual guidance (physical help) and only when needed, then they are to stop giving the physical help as soon as the child has the idea of how to do the movement (ensuring self-generated motor activity).
- The motor challenge is increased by altering the task or environment to encourage problem solving
Typically, a physiotherapist or occupational therapist. If the goal identified is more related to communication, a speech therapist might be involved.
- 1 home session every 2 weeks until 12 months of age.
- Duration of each home session not specified
- Home program is provided
No side effects or risks were reported in the study on GAME. However, if you have concerns, we suggest that you discuss this with the treating therapist.
The study reviewed examined the impact of GAME on a population of infants at high risk of CP, but the type of CP and level of severity were not indicated.
Information on this website is provided for informational purposes only and is not a substitute for professional medical advice.
One high quality RCT (Morgan et al., 2016) investigated the effects of the GAME (Goals Activity Motor Enrichment) program (focus: family centered care with parent coaching + active motor learning + environmental enrichment) on home enrichment among infants at very high risk for CP. In this high quality RCT, infants were randomized to receive the GAME program or standard care. Home enrichment was assessed using the Affordance in the Home Environment for Motor Development – infant scale at post-treatment (12 months). No significant between-group difference was found.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that the GAME program (focus: family centered care with parent coaching + active motor learning + environmental enrichment) is as effective as the comparison intervention (standard care) in improving home enrichment for infants at very high risk of CP.
One high quality RCT (Morgan et al., 2016) investigated the effects of the GAME (Goals Activity Motor Enrichment) program (focus: family centered care with parent coaching + active motor learning + environmental enrichment) on cognitive function among infants at very high risk for CP. In this high quality RCT, infants were randomized to receive the GAME program or standard care. Infant cognitive function was assessed using the Bayley Scales of Infant and Toddler Development – III (BSIT: Cognition) at post-treatment (12 months). A significant between-group difference was found, favoring GAME vs. standard care.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that the GAME program (focus: family centered care with parent coaching + active motor learning + environmental enrichment) is more effective than a comparison intervention (standard care) in improving cognitive function in infants at very high risk of CP.
One high quality RCT (Morgan et al., 2016) investigated the effects of the GAME (Goals Activity Motor Enrichment) program (focus: family centered care with parent coaching + active motor learning + environmental enrichment) on motor learning among infants at very high risk for CP. In this high quality RCT, infants were randomized to receive the GAME program or standard care. Infant motor development and function were assessed using the Peabody Developmental Motor Scales –II (PEDI-II: Raw scores; Total motor quotient) and the Gross Motor Function Measure-66 at post-treatment (12 months). Significant between-group differences were found post-treatment on both measures, favoring GAME vs. standard care.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that the GAME program (focus: family centered care with parent coaching + active motor learning + environmental enrichment) is more effective than a comparison intervention (standard care) in improving motor development and function in infants at very high risk of CP.
One high quality RCT (Morgan et al., 2016) investigated the effects of the GAME (Goals Activity Motor Enrichment) program (focus: family centered care with parent coaching + active motor learning + environmental enrichment) on mood and affect among parents of infants at very high risk for CP. In this high quality RCT, infants were randomized to receive the GAME program or standard care. Mood and affect was assessed using the Depression Anxiety and Stress Scale -21 (DASS-21: Total score; Depression; Stress; Anxiety) during treatment (16 weeks) and post- treatment (12 months). No significant between-group differences were found.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that the GAME program (focus: family centered care with parent coaching + active motor learning + environmental enrichment) is as effective as the comparison intervention (standard care) in improving mood and affect in parents of infants at very high risk of CP.
One high quality RCT (Morgan et al., 2016) investigated the effects of the GAME (Goals Activity Motor Enrichment) program (focus: family centered care with parent coaching + active motor learning + environmental enrichment) on parent perception of infant motor performance among parents of infants at very high risk for CP. In this high quality RCT, infants were randomized to receive the GAME program or standard care. Parent perception of infant motor performance was assessed using the Canadian Occupational Performance Measure – Performance during treatment (16 weeks) and at post-treatment (12 months). Significant between-group differences were found during treatment (16 weeks), favoring GAME vs. standard care.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that the GAME program (focus: family centered care with parent coaching + active motor learning + environmental enrichment) is as effective as the comparison intervention (standard care) in improving parent perception of infant motor performance for infants at very high risk of CP.
One high quality RCT (Morgan et al., 2016) investigated the effects of the GAME (Goals Activity Motor Enrichment) program (focus: family centered care with parent coaching + active motor learning + environmental enrichment) on parent satisfaction with infant motor performance among parents of infants at very high risk for CP. In this high quality RCT, infants were randomized to receive the GAME program or standard care. Parent satisfaction with infant motor performance was assessed using the Canadian Occupational Performance Measure –Satisfaction during treatment (16 weeks) and at post-treatment (12 months). A significant between-group difference was found at post-treatment, favoring GAME vs. standard care.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that the GAME program (focus: family centered care with parent coaching + active motor learning + environmental enrichment) is more effective than a comparison intervention (standard care) in improving parent satisfaction with infant motor performance for infants at very high risk of CP.
References
Morgan, C., Novak, I., Dale, R. C., Guzzetta, A., & Badawi, N. (2016). Single blind randomised controlled trial of GAME (Goals – Activity – Motor Enrichment) in infants at high risk of cerebral palsy. Research in developmental disabilities, 55, 256–267. https://doi.org/10.1016/j.ridd.2016.04.005
Definitions
A group of lifelong disorders affecting a person’s movement, coordination, and muscle tone and which are the result of damage to the brain before, during, or shortly after birth.
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