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Lifespan > The High Risk Infant - PT Management > Flashcards

The High Risk Infant - PT Management Flashcards

1
Q

what are the 3 main frameworks that guide PT

A

ICF
family-centered care
theories of development

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2
Q

what are the 2 theories of development

A

dynamic systems

synactive model of neonatal behavioral organization

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3
Q

dynamic systems vs synactive model of neonatal behavioral organization

A

dynamic:
- interacting subsystems -> functional behavior
- NICU: bio, sociocultural, tasks of infant

synactive model:
- subsystem interaction & interdependence

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4
Q

what adds a layer of complexity to the dynamic systems theory of development

A

NICU

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5
Q

what is the synactive model of development

A

5 subsystems organized as hierarchal but interconnected, reacting and influencing one another

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6
Q

what are the 5 subsystems/tiers of the synactive model of neonatal behavioral organization

A
  1. physiological stability
    - starting point
  2. motor organization
    - low level, tone, reflexes
  3. behavioral state organization
    - alertness
  4. attention/interaction
    - attend for short periods of time
  5. self-regulation
    - around different tasks while maintaining physiological homeostasis
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7
Q

how do the tiers of the synactive model work and how does this differ b/w FT and high risk newborns

A

need tier below to progress above

FT healthy newborns can maintain homeostasis at varying levels while high risk infants might not be able to

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8
Q

what is neurobehavioral organization state control (6)

A

quiet sleep
active sleep
drowsy
quiet alert
active alert
crying

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9
Q

how does state control differ b/w FT and PT babies

A

FT - can attain all states and transition smoothly b/w level of alertness functionally
- how babies can stay asleep in noisy settings after interaction (adaptive to recovery)

PT babies might not be able to regulate/transition as smoothly

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10
Q

at what state is the newborn most attentive to interact w environment

A

quiet alert state

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11
Q

why is there a difference b/w FT and PT babies in their regulation and transition b/w states of control

A

PT might not have level of behavioral state control d/t level of brain maturity (no cellular differentiated or myelination)
- no gyri or sulci (or very shallow) at 24wks

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12
Q

what does the synactive theory and neurobehavioral maturation state

A

infants tell you what they need all the time
- have ability to regulate their own functioning and the behavior f their caregivers which ensures input and feedback they need for development

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13
Q

what are signals in the neurobehavioral maturation

A

self-regulatory behaviors
- signs of approach
- signs of stress

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14
Q

what happens if you don’t respect signs of stress that the infant is presenting with

A

babies will go back to earlier levels on synactive model and will jeopardize physiologic and autonomic state

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15
Q

what are signals that the baby is “happy and ready”

A

soft, alert
face, arms, legs relaxed
look at objects and people

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16
Q

what are signals that the baby is “not happy and need a change”

A

physiologic status change
- pass gas, vomit
- sneeze, yawn, hiccup

salute
spreads fingers apart
frowns
grimace or grunt
arch back/neck and push away
looks away

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17
Q

what are the signals that the baby is coping or self-regulating

A

*sucking
hand to mouth/face
grasp/holding on
leg bracing
- push against surface for proprioceptive input
tucking/swaddling
*hand/foot clasp
- prevents them from waving around
*light sleep
*snuggle into corners of bed

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18
Q

what is developmentally appropriate care (3)

A

application of synactive model
acknowledge medical fragility of neonate
observe & respect neurobehavioral cues to guide PT actions
- exam, intervene, family ed

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19
Q

if you go to see an infant and they are stressed, what do you do

A

don’t come back later
part of intervention is to help when they are stressed to foster neuroplastic change

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20
Q

how do PT actions in developmentally appropriate care change depending on if the infant is presenting w signs of approach or stress

A

approach
- proceed but observe for tolerance / expense

stress
- intervene to facilitate coping behaviors

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21
Q

what is the main thing you observe in PT exam of an infant

A

behavioral states

22
Q

what do you do as part of your exam before you even touch the pt

A

hx: chart review
medical status/stability

23
Q

what are 3 parts of your chart review when getting the infant’s hx for your exam

A

med dx
med interventions
meds

24
Q

what are 3 parts of checking their medical status/stability for your PT exam

A

recognize current med status
observe changes in physio status
cluster care

25
Q

how do you cluster care in your PT exam of a high risk infant

A

coordinate w NICU team so can have clusters of periods of time that infant is being cared for which allows for periods of rest (so can gain weight, grow, develop)

ex: ask the nurse if they want you to come before or after they are doing something
- if come after, it is our job to calm the baby down again

26
Q

what do PT goals look like for a high risk infant

A

have nothing to do w developmental milestones
- trying to help them to tolerate stress

ex: infant will tolerate up to 10min of stim without _______ stress change / HR changes

27
Q

what are components to observe in the behavioral stats during your exam and how do you utilize this info

A

neonate behaviors as safety guide
not ability to transition b/w states

use to determine best time for interaction

28
Q

what component do we consider when doing a systems review in our PT exam

A

expectations for gestational age (GA)

29
Q

what are components of the clinical exam

A

mvmt patterns
- including quality & quantity
- reflexes, tone

30
Q

what are 4 common tests and measures to use in the high risk infant population

A

pain assessment
assessment of PT infant behavior (APIB)
test of infant motor performance (TIMP)
alberta infant motor scales
(AIMS)

31
Q

what is a common way to assess pain in the high risk infant population

A

FLACC
- face
- legs
- activity
- cry
- consolability

(doc before, during, and after procedure/exam/intervention)

32
Q

who is appropriate for the APIB

A

medically stable PT or high risk FT
from birth - 1mo after due date

33
Q

what does the APIB look at

A

subsystems of functioning (neurobehavioral maturation)

34
Q

who is the TIMP appropriate for

A

34wks post GA and 4mo post term (44-46wks)

35
Q

what does the TIMP look at

A

posture and mvmt for function
- observed & elicited

36
Q

who is the AIMS appropriate for

A

birth - 18mo

37
Q

what does the AIMS look at

A

observation of motor skills in supine, prone, sitting, and supine

38
Q

how do you determine a premature infant’s corrected age

A

(actual/chronological age) - (# of wks premature)

39
Q

why is it important to adjust the age of premature infants

A

provides more accurate sense of developmental course
- accounts for infant’s system being underdeveloped when born prematurely

40
Q

at what age do we stop correcting the infant’s age and why

A

2-2.5yrs
- usually have caught up and any deficits seen aren’t because they were born early

if we continue to correct will miss opportunity to provide intervention if continue to “cut them slack” for what they can achieve at this point

41
Q

what are the 3 prioritized desired outcomes of PT intervention in the high risk infant and which is the most important? after achieving those 3 outcomes, what is the next goal of interventions

A
  1. regulation**
    - behavior and mvmt
    - can they recover/attend w/o jeopardizing VS
  2. interaction abilities
  3. attachment

motor skill acquisition

42
Q

what are 4 strategies with PT interventions

A

modification - environment
modulation - sensory
positioning - multisystem needs
promoting efficient mvmt

43
Q

what are environment modifications that can be made during non-cluster care times

A

dimming lights (safely) to allow infant to sleep

44
Q

what about the environment should the PT consider in their interventions

A

make modifications to support developmental needs
- NICU much louder, brighter, and more people than in womb or even at home

45
Q

what should you be looking at before starting any intervention

A

observe infant at rest & w nursing care
- physiologic homeostasis maintained?
- startle w every touch?
- smooth mvmt or jerky/tremulous?

46
Q

what is an important timing consideration when planning when you do your intervention for the infant and why

A

not immediately after feeding
- priorities are for wt gain and growth

don’t want to jeopardize calories during a stress reaction

47
Q

what are the 2 main types of PT interventions seen

A
  1. positioning & sensory strategies to improve neurobehavioral regulation
  2. facilitation of early head control, etc.
48
Q

what are 4 examples of PT interventions for positioning and sensory strategies to improve neurobehavioral regulation

A

hands together, flexion
inc somatosensation
- pressure at feet in isolette
- swaddling
non-nutritive sucking
skin to skin care

49
Q

why is skin-to-skin care a successful strategy to improve neurobehavioral regulation

A

entrapment phenomenon
- HR slows down to match person holding them, temp control (comes down)

50
Q

what is the key to implementing PT interventions in this patient population

A

only do what they can handle and evaluate the expense

51
Q

what do we typically want positioning to facilitate in the patient

A

mimic physiological flexion

Lifespan (20 decks)

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