Baby Brain Optimization Project (BBOP)

The Baby Brain Optimization Project (BBOP) team focuses on the neurodevelopment of high-risk infants and rehabilitation of their long-term disabilities. Our research emphasizes the development of objective and quantitative measures of sensory and motor function in infants and children. We utilize these measures to design novel therapeutic strategies for infants and young children who suffer from neonatal neural insults.

The BBOP lab has developed a novel technique to measure response to light touch in children with disabilities. We have also established paradigms measuring cortical function in response to speech sound in preterm infants. For the past several years, we have worked with a team of scientists, engineers and therapists to conduct clinical trials of neural-based rehabilitative therapies in children and infants.

Current Research Projects

Developmental Interventions


The APPLES project (A Positive Parent-focused training for upper Limb Experience with Sensory-motor feedback) is a research study to address sensorimotor impairment in infants and young toddlers with cerebral palsy (CP). Motor development in children with CP is challenging because they do not receive accurate sensory feedback from their movements, which leads to neglect of their affected limb and difficulty learning new movements. APPLES uses Constraint-Induced Movement Therapy, in which children wear a soft mitt (C-MITT) on their more affected arm (see Figure) while participating in repetitive play activities designed to improve fine motor skills, provide sensory input, and strengthen their affected arm and hand. APPLES also incorporates Bimanual (two-handed) play activities to help children use both hands together. Activities are tailored to the child’s developmental level and areas of difficulty and are adjusted by the therapist as the child’s abilities improve. Parents are coached by experienced therapists on how to perform these daily activities at home.

Four-week intervention with: 

  1. Bimanual play
  2. Soft constraint wear 6 h/d on less-affected arm
  3. Reach training with sticky mitten on more-affected arm
  4. Graduated motor-sensory training
  5. Parent education (positive reinforcement, just-right challenge, sensory exposure in mirrored to parallel sequence, infant learning principles)

At right: This photo shows an APPLES Study participant wearing a C-MITT and crawling in a session. For parents and therapists, if you want to learn how to make your own C-MITT, please click on this link for a PDF of the design patent. It is freely available to you.


Nearly a half-million infants are born prematurely in the US (15 million worldwide). Most suffer from abnormal brain maturation resulting from how the immature brain interacts with atypical sensory experiences after birth. The MIND study (Mother’s Voice Interventions with Infants at Risk for Neurodevelopmental Disorders) uses a parent-supported multisensory intervention that uses an FDA approved pacifier-activated device to play a parents' voice in response to infant suck on a pacifier, while a therapist holds the infant and provides supportive containment. We are measuring the effects of the intervention and determining mechanisms that improve brain multisensory processing, reactions to sensory stimulation after the infant goes home, and long-term language and motor development to help optimize future intervention designs. Our goal is to implement the intervention in multiple neonatal care settings where parents cannot continuously be present at their child's bedside.

Pacifier Activated Device-Training with Mother’s Voice in Infants with Complex Congenital Heart Disease / High Risk for Cerebral Palsy

Infants with complex congenital heart disease or early brain injury often have delayed or impaired feeding skills that are associated with other neurodevelopmental problems such as worse motor and language outcomes in early childhood. Thus, acquiring efficient suck strength and patterns is necessary to promote future optimal feeding skills. Non-nutritive suck (NNS) is an early feeding milestone, and ineffective NNS can result in maladaptive oral motor skills or even oro-sensory aversions. NNS training (as opposed to simply offering a pacifier) safely improves oral feeding strength and rate in other high-risk populations even when they have suffered severe brain insults. The goal of this study is to determine whether NNS training using a standard pacifier with reinforcement with mother’s voice can improve the oral feeding outcomes of infants with congenital heart disease. Our collaborators in Japan, led by Dr. Masaki Shimizu, have recently begun enrolling patients at the Saitama Children’s Medical Center. 

View Clinical Research Studies

Neuroscience and Baby Development

Sensory Processing and Neurodevelopment in NICU Infants

Disruptions to normal brain development place critically ill and preterm infants cared for in the NICU at risk for poor developmental outcomes, with sensory systems such as hearing and touch being particularly vulnerable. Deficits in the processing of auditory information can have cumulative detrimental effects on the acquisition of language skills and learning by school age.

Our goal is to address the lack of quantitative tools to measure sensory function in NICU infants in order to allow earlier prediction of developmental outcomes and rational design of neuroprotective strategies.

Hearing, Speech and Sound

Infants are born with the ability to discriminate many different speech sounds, but this ability is lost early in life. Studies have shown that infant learning of language is improved when language exposure is presented contingent on the infant’s action. We have used a specialized interface that connects the pacifier to a device that plays an audio voice recording only when the infant actively sucks on the pacifier. Previously, we have used this device to teach preterm infants oral feeding skills without any adverse effects. More recent studies are examining discrimination between speech sounds in foreign languages. Potential impacts of these studies are the design of a new type of developmental intervention in the NICU or in daycare centers to improve differentiation of speech sounds in infancy and better later learning of language.

View Clinical Research Studies

Clinical Implementation Science

Through support from the Cerebral Palsy foundation, Dr. Maitre leads a multi-institution network for implementing international guidelines for the early detection of cerebral palsy across the US which has led to a reduction in the age at CP diagnosis. In partnership with the CPF, she has also established the Implementation of Early Detection and Intervention for Cerebral Palsy Conference that is held annually at Nationwide Children’s Hospital.

EDI Network

Early diagnosis of cerebral palsy (CP) is imperative so that intervention can begin as soon as possible to maximize neuroplasticity of the developing brain. Through collaborative efforts with the Cerebral Palsy Foundation, Dr. Maitre recently led an effort to implement recently published international guidelines for early detection of CP throughout a network of high-risk infant follow-up programs across the US with the aim of reducing the age at CP diagnosis below the age of 12 months. The study showed that large-scale implementation of international guidelines for early detection of CP in high-risk infant follow-up clinics is feasible, and that it did not adversely affect clinic operational flow. Parent perception of the initiative was largely favorable, and the team was able to learn about additional parental needs for support and education. Efforts continue to build upon this initiative and expand the network.

For publications demonstrating successful implementation science from this team, visit:

Maitre NL, Burton VJ, Duncan AF, Duncan AF, Iyer S, Ostrander B, Winter S, Ayala L, Burkhardt S, Gerner G, Getachew R, Jiang K, Perez CM, Moore-Clingenpeel M, Lam R, Lewandowski DJ, Byrne R. Network Implementation of Guideline for Early Detection Decreases Age at Cerebral Palsy Diagnosis. Pediatrics. 2020 May;145(5):e20192126. doi:10.1542/peds.2019-2126

Byrne R, Noritz G, Maitre NL; NCH Early Developmental Group. Implementation of Early Diagnosis and Intervention Guidelines for Cerebral Palsy in a High-Risk
Infant Follow-Up Clinic. Pediatr Neurol. 2017 Nov;76:66-71. doi: 10.1016/j.pediatrneurol.2017.08.002

Maitre NL, Chorna O, Romeo DM, Guzzetta A. Implementation of the Hammersmith Infant Neurological Examination in a High-Risk Infant Follow-Up Program. Pediatr 
Neurol. 2016 Dec;65:31-38. doi: 10.1016/j.pediatrneurol.2016.09.010

View Clinical Research Studies

Life After The NICU | Meet Dr. Nathalie Maitre, Neonatologist