Sam's Notes (Week 4) Flashcards
What is the NICU, and who does it serve?
- The NICU is an intensive care unit for newborns with medical needs, serving both full-term (37 - 42 weeks) and preterm infants (< 37 weeks).
- Preterm = infants are at high risk medically and developmentally.
What are some common comorbidities in babies who survive NICU care?
- Cerebral palsy (CP)
- sensory impairments
- intellectual learning challenges
- social/emotional challenges
Describe Level 1 and Level 2 NICUs.
- Level 1 provides postnatal care and stabilization for infants born 35-37 weeks.
- Level 2 provides care for infants recovering after intensive care and offers CPAP or mechanical ventilation for < 24 hours.
- care for infants >/= 32 weeks gestation or >/= 1500g who do not need subspecialty care
Describe Level 3 and Level 4 NICUs.
Level 3: NICU offers sustained life support and comprehensive care for critically ill infants.
- < 1500g (3.3lbs) or < 32 weeks
Level 4 includes complex surgeries and advanced neonatal care.
What are some causes of prematurity?
Amniotic infection, maternal drug/alcohol use, increased maternal age, poor prenatal care, multiple gestations, preeclampsia, and genetic conditions.
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What is the APGAR score and what does it assess?
The APGAR score is a newborn screening tool assessing
- appearance
- pulse
- grimace
- activity
- respiration
It is administered at 1, 5, and 10 minutes after birth.
What equipment is commonly used in the NICU for temperature regulation?
Radiant warmers and isolettes (incubators) are used for infants to regulate body temperature.
Describe gavage tubes used in the NICU.
- Gavage tubes, such as OG and NG tubes, are used to feed infants directly into the stomach.
- Transpyloric tubes are used for infants with GER or aspiration risks.
What is ECMO and when is it used?
ECMO stands for extracorporeal membrane oxygenation, a heart and lung bypass machine used in cases of severe respiratory or cardiac failure.
When does the vestibular nuclei fully develop?
fully developed by 20 weeks gestation
Describe the auditory development in infants.
- By 28 weeks gestation, infants can hear at 40 dB.
- NICU noise should not exceed 45 dB to avoid disruptions in growth and cochlear damage.
What are some environmental strategies for pain reduction in the NICU?
Dim lighting, reducing noise, swaddling, kangaroo care, and non-nutritive sucking.
What are the Hammersmith and TIMP assessments used for in the NICU?
These assessments evaluate neuromotor development and motor performance in preterm infants to identify any neurological impairments.
What is trauma-informed care in the NICU?
It involves understanding that families may be in crisis and aims to provide support that is sensitive to both the infant’s and family’s emotional needs.
What are the signs of infant stress in the NICU?
Pale or flushed skin, glassy eyes, gasping for air, grimacing, fussiness, irregular breathing, and fluctuating muscle tone.
What are the key roles of a physical therapist in the NICU?
Facilitating neurodevelopmental progress, providing positioning support, and educating families on infant care and therapeutic interventions.
What is Bronchopulmonary Dysplasia (BPD) and its interventions?
- BPD is a chronic lung disease from underdeveloped lungs in preterm infants.
- Interventions include reducing environmental stimulation and supporting respiration.
What orthopedic issues are common in the NICU?
- brachial plexus injury
- congenital hip dysplasia
- metatarsus adductus
- talipes equinovarus (clubfoot)
What are common PT interventions for infants with orthopedic issues in the NICU?
ROM exercises, taping, splinting, and education on proper positioning to prevent contractures and promote motor development.
Describe Moro and ATNR reflexes and their role in development.
- Moro reflex helps with fight-or-flight reactions
- ATNR assists with developing muscle tone and eye-hand coordination
What are retained reflexes and their potential impacts?
Retained reflexes may indicate developmental issues, such as motion sickness, poor balance, or delayed rolling if not integrated by the typical age.
What are some consequences of an unintegrated ATNR?
Poor midline development, difficulty with handwriting, and delayed rolling and crawling, which may lead to skeletal deformities.
What is the Spinal Galant reflex, and what issues arise if it is not integrated?
- The Spinal Galant reflex helps with movement in the womb and during birth.
- If unintegrated, it can cause bed wetting, poor concentration, and scoliosis.
Describe the Babinski reflex and its developmental significance.
- The Babinski reflex prepares feet for walking and influences lower extremity muscle tone.
- Lack of integration may cause issues like flat feet or difficulty walking.
What are the two phases of the gait cycle?
Swing (foot in the air) and stance (foot contact with the ground).
What are the basic tasks of walking?
Weight acceptance, single limb support, and limb advancement.
What are the subphases of gait during stance?
Initial contact, loading response, midstance, terminal stance, and preswing.
What are the subphases of gait during swing?
Initial swing, midswing, and terminal swing.
What factors contribute to the development of typical walking?
- stability in stance
- foot clearance in swing
- prepositioning of the foot
- adequate step length
- energy conservation
What are the prerequisites for independent walking?
Adequate motor control, CNS maturation, sufficient ROM and strength, intact sensation, and muscle activation for pelvic stabilization.
What are some characteristics of immature walking (ages 2.5 and younger)?
Decreased postural stability, decreased single leg stand time, slower walking speed, and a wide base of support.
Describe biomechanical factors influencing gait development.
ROM, muscle strength, bone structure, and body composition, which all impact muscle activity and joint kinematics.
What is a central pattern generator (CPG), and how does it relate to walking?
CPG circuits exist in the spinal cord and brainstem and organize the activation of muscles for locomotion.
At what age does a mature gait pattern develop?
By age 7, with improvements in single stance duration, walking velocity, and step length.
How do toddlers (9-15 months) typically walk?
Toddlers walk with small steps, increased cadence, wide base of support, and decreased postural stability.
What happens to gait characteristics between 18-24 months?
Genu varus resolves, heel strike becomes consistent, and dynamic balance and strength improve.
What gait characteristics are observed in 3-3.5-year-olds?
Narrowed BOS, tibiofemoral valgus, and a more mature heel-toe pattern.
What are typical gait characteristics for a 6-7-year-old?
- neutral tibiofemoral angle
- coordinated visual and vestibular systems
- mature gait pattern
What are the five determinants of mature walking?
Single stance duration, walking velocity, cadence, step length, and the ratio of pelvic span to ankle spread.
How does body composition affect developmental gait in infants?
High fat content in infancy affects balance and muscle strength, which influences walking.
What factors limit independent walking in toddlers?
Lack of extensor strength to support body weight during single limb stance and poor dynamic balance.
How does motor control influence walking in early development?
Visual, proprioceptive, and vestibular systems must work together to bring the center of mass back to a stable position.
How do visual and vestibular systems mature during gait development?
These systems mature between ages 10-12, enhancing postural control and motor activity.
What is the significance of calcaneal eversion in toddlers?
Calcaneal eversion is present during early walking and resolves as balance and coordination improve.
How do toddlers learn to navigate uneven surfaces?
They develop dynamic balance and strength, which lowers the center of mass and improves movement over obstacles.
What is the importance of quad and gluteal muscle activation in gait?
These muscles provide stability in stance and are crucial for tasks like navigating stairs.
What changes occur in gait between 3-7 years of age?
- improvements in postural control
- decreased calcaneal eversion
- better coordination of the lower extremities
What are the benefits of video-assisted gait analysis in pediatrics?
It allows for multiple observations, frontal and sagittal views, and the ability to review gait mechanics in detail.
How does muscle activation change with independent walking?
- Co-contraction of antagonist muscles decreases.
- There is more selective activation of muscle groups during stance and swing phases.
