Auditory-Tactile-Visual-Vestibular (ATVV) Intervention

The auditory-tactile-visual-vestibular (ATVV) intervention is an early multisensory treatment used with preterm infants with the goal of improving infant health and development. It is a step-by-step technique consisting of providing multiple sensory stimuli to the baby. The intervention can be used as early as 31-32 weeks postmenstrual age when the baby is ready for social interactions during the NICU hospital stay. The stimuli include auditory (gentle talking), tactile (baby massage), visual (eye contact), and vestibular (rocking) components. It’s important to note that the treatment is meant to be adapted based on the infant’s responses and behavior. For example, if the baby starts crying or shows signs of stress or discomfort with a specific component of it, that part of the intervention is discontinued and the next step is initiated.

The ATVV intervention is thought to produce a transition from sleep to an alert state in babies. This is especially important for preterm infants who often struggle to achieve and sustain an alert behavioral state which is in turn essential for the transition to oral feeding and for infant growth. ATVV intervention is therefore used to improve infant feeding and promote weight gain as well as to increase sensory awareness, promote bonding/interaction between infant and parents, and decrease parental stress/anxiety.

No, there aren’t different types of ATVV intervention.  The basic steps are always the same involving a sequence of auditory, tactile, visual, and vestibular stimuli.

There is limited research on the effectiveness of the ATVV intervention for cerebral palsy. It is an early and intensive intervention which is most often used with preterm infants with or without central nervous system injury in the NICU, before a diagnosis of CP is available.

Only one recent study which included infants later diagnosed with CP was found in the literature. The reviewed study included 37 preterm infants with extreme prematurity (born at 23 to 26 weeks) or with severe brain injury. At 12 months corrected age, 55% of all infants were diagnosed with cerebral palsy (and none of the infants without brain injury developed CP).

The results showed that the ATVV intervention was not more effective than standard care in improving infant development or mother-infant interactions. However, the infants in the ATVV group were discharged home significantly earlier than infants in the control group (12 days). This finding is supported by previous research on preterm infants with or without central nervous system injury in which ATVV was found to improve infant feeding behaviors and promote infant weight gain, leading to shorter hospital stays.

It is important to note that results can vary from person to person.

The ATVV intervention will typically be provided in some hospital NICUs by trained nurses. In the reviewed study, the intervention started with 10 minutes of baby massage using light strokes followed by 5 minutes of gentle rhythmic rocking. During these 15 minutes, the person administering the intervention talked to the infant and attempted to maintain eye-to-eye contact. The intervention was then continued at home by the mothers who received training in performing all the steps prior to discharge.

The multisensory intervention is typically provided by nurses or other trained professionals in the NICU. Prior to discharge from the hospital, parents/caregivers are also trained in the steps so they can continue the treatment at home. This also helps new parents learn how to interact with their premature infants and is thought to reduce parental stress.

In the reviewed study, the intervention was administered for 15 minutes, 2x/day, 5 days/week, until discharge from the hospital. After that, the mothers of the infants took over and continued providing the intervention at home, 2x/day, until the babies were 2 months old (corrected age).

No specific side effects or risks were reported in the study. However, each baby’s needs and situation is different so we suggest that you discuss the benefits and drawbacks of starting the ATVV treatment with the healthcare provider.

The ATVV intervention has shown promise in improving feeding, growth and development of preterm infants. However, it appears to be of less benefit to the smallest infants and those with severe brain injury. In the reviewed study, infants with periventricular leukomalacia (type of brain injury affecting the white matter), in particular, had persistent developmental delays despite the intervention. More research is needed to determine the treatment’s effectiveness in infants with brain injury.

Information on this website is provided for informational purposes only and is not a substitute for professional medical advice.

One fair quality RCT (Nelson et al., 2000) investigated the effects of a multisensory intervention on infant development among preterm infants (55% were later diagnosed with CP). In this fair quality RCT, infants were randomized to receive an auditory-tactile-visual-vestibular intervention or no treatment for 2 months; both groups received routine care. . Infant development was assessed using the Bayley Scale of Infant Development (BSID: Mental Developmental Index, Psychomotor Developmental Index) at follow-up (12 months of age). No significant between-group difference was found.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that an auditory-tactile-visual-vestibular intervention is not more effective than no treatment in improving infant development in preterm infants (later diagnosed with CP).

One fair quality RCT (Nelson et al., 2000) investigated the effects of a multisensory intervention on mother-infant interaction among preterm infants (55% were later diagnosed with CP). In this fair quality RCT, infants were randomized to receive an auditory-tactile-visual-vestibular intervention or no treatment; both groups received routine care. Mother-infant interactions were assessed using the Dyadic Mutuality Code at post-treatment (2 months) and the Nursing Child Assessment Feeding Scale (NCAFS: Maternal behaviors – sensitivity to cues, response to distress, social emotion growth fostering, cognitive growth fostering; Infant behaviors – clarity of cues, infant responsivity; Summary scores – maternal behavior scale, infant behavior scale, total scaled behavior) at post-treatment (2 months) and follow-up (4 months of age). Significant between-group differences were found on 4 out of 9 measures of mother-infant interaction (NCAFS: Maternal behaviors – social emotional growth fostering, cognitive growth fostering; Infant behaviors – infant responsivity; Summary scores – maternal behavior) at post-treatment, favoring routine care vs. the multisensory intervention. A significant between-group difference in one measure (NCAFS: Maternal behaviors – social-emotional growth fostering) was maintained at follow-up, favoring routine care vs. the auditory-tactile-visual-vestibular intervention.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that an auditory-tactile-visual-vestibular intervention is not more effective than no treatment in improving mother-infant interaction among mothers of preterm infants (later diagnosed with CP).