Single blind randomised controlled trial of GAME (Goals - Activity - Motor Enrichment) in infants at high risk of cerebral palsy.
GAME shows parents can double as therapists and move both motor and cognitive scores forward in high-risk infants.
01Research in Context
What this study did
Researchers tested GAME with babies who had a high chance of cerebral palsy. Parents got coaching to weave play-based motor and thinking tasks into daily life. A coin-flip split families into GAME or usual care for one year.
What they found
By twelve months, GAME babies scored higher on both movement and thinking tests than the usual-care group. The gains were big enough to matter in real life. Parents also felt confident using the play routines at home.
How this fits with other research
Hwang et al. (2013) ran a similar parent-coaching RCT earlier, but focused on daily routines like dressing instead of motor play. Their kids also beat standard care, showing the method keeps working across goals.
Kaplan-Kahn et al. (2026) took the idea further. They swapped GAME’s broad play for 60 hours of focused hand therapy led by parents. Toddlers met tough hand-use goals, proving parents can safely deliver high-dose rehab at home.
Wu et al. (2014) looked like a clash: clinic visits lifted scores while home visits did not. The twist is they gave different content at home (sleep help, not motor play). When home work targets the same skills as clinic, like GAME does, home wins.
Why it matters
You can teach parents to run strong, goal-driven play sessions during diaper changes, floor time, or feeding. No extra clinic space needed. Start with one simple motor-plus-thinking task, coach the parent live, and send a short video example. One week later, check progress and add the next step.
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02At a glance
03Original abstract
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 randomised controlled trial of GAME versus standard 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 assessments. 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 resulted in advanced motor and cognitive outcomes when compared with standard care.
Research in developmental disabilities, 2016 · doi:10.1016/j.ridd.2016.04.005