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Topics in Peds > Topics in Neonatal Physical Therapy > Flashcards

Topics in Neonatal Physical Therapy Flashcards

1
Q

5 Roles of Physical Therapy in the NICU

A
  1. Screening of NICU census and determining needs based on established referral criteria (NICU rounds)
  2. Provide ongoing management and support to family during and after hospitalization to promote ongoing neuromotor development
  3. Perform safe, evidenced based assessments
  4. Deliver hands on therapeutic interventions and develop plan of care
  5. Ensure appropriate referrals are in place prior to discharge
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2
Q

Physical therapy in the NICU qualifications

A
  • Specialized training: advanced expertise in subspecialty due to the fragile nature of the premature infants
  • Need access to CPGs
  • Neonatology fellowships available
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3
Q

In order to work in the NICU, you must hold advanced knowledge in:

A
  • Typical and atypical development of a premature infant including motor and sensory development and infant behavior
  • NICU Theoretical frameworks
  • Developmental outcomes of a variety of neonatal diagnoses
  • Effective Communication and safe and effective handling skills
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4
Q

Level 1 NICU

A
  • Unit provides basic neonatal care
  • Minimal requirement for any facility that provides maternity care
  • PTs rarely involved
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5
Q

Level 2 NICU

A

Special Care Nursery (SCN). Basic care plus moderately ill
infants, >32 weeks GA, >1,500 grams, no mechanical ventilation

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6
Q

Level 3 NICU

A

Sub-speciality unit for extremely premature, ECMO and surgical interventions if needed. <28 weeks GA and <1,000 grams

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7
Q

Level 4 NICU

A

Specialty unit capable of all levels plus more complex

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8
Q

Key players in NICU

A
  • Neonatologist
  • Residents/Fellows
  • Nurse practitioners
  • Dietician/Nutritionist
  • Pharmacists
  • PT/OT
  • Respiratory Therapist
  • SLP
  • Audiologist
  • Social Workers
  • Case Managers
  • Child Life Specialist
  • Music Therapists
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9
Q

Environmental Noise in the NICU

A
  • keep things quiet! Noise can impact sleep patterns, effect
    physiological stability and development
  • Minimize telephones, conversations, monitor alarms
  • Monitoring noise levels aides in sleep organization which is CRITICAL in neural development and organization
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10
Q

What is the core focus in the Dynamic Systems Theoretical Framework?

A

Neonate and development of postural control

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11
Q

Explain the Dynamic Systems Theoretical Framework

A
  • NICU environment influences postural
    control and MS systems > motor outcome
  • A single change in one system impacts the other systems (enhancing or limiting)
  • Consider all the aspects of physiological, anatomical and environmental influences
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12
Q

Who developed Synactive Model of Infant Behavior?

A

Heidelise Als

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13
Q

What does Synactive Model of Infant Behavior focus on?

A
  • Focus on importance of ongoing observations while infant at rest and before<>after hands on care (CLUSTER)
  • Physiological systems must be organized and stable FIRST before handling
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14
Q

Synactive Model of Infant Behavior Assessments

A
  • APIB: Assessment of Preterm Behavior
  • NIDCAP: Newborn Individualized Care and Development Program
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15
Q

Synactive Model of Infant Behavior Pyramid

A

Physiological stability –> motor organization –> behavioral state organization –> attention/interaction –> self- regulation

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16
Q

What is the Theory of Neuronal Group Selection based on?

A

Biological and behavioral observations

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17
Q

Explain the Theory of Neuronal Group Selection

A
  • Brain operates as selective system: Brain impacted by input from body and environment
  • Neural Plasticity: adapting and taking in new information leading to new behaviors. The brain encodes experiences (positive and negative)
  • To induce a change in behavior, need continued performance and practice
  • With ongoing practice, neural circuitry altered
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18
Q

Overview of the Theoretical Frameworks

A
  • PT must understand their role in facilitating brain growth
  • Cluster Care and teach family to read infant’s cues
  • Brain development is dependent on many factors including genetics, environmental experiences and sensory and motor interventions on preterm brains
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19
Q

Average BW

A

2500 g to 4200 g

20
Q

Low Birth Weight

A

< 2,400 grams

21
Q

VLBW

A

< 1,500 grams

22
Q

ELBW

A

< 1,000 grams

23
Q

Grade 1 Intraventricular Hemorrhage

A

Bleed limited to the germinal matrix

24
Q

Grade 2 Intraventricular Hemorrhage

A

Bleed in ventricles; however, ventricles unchanged

25
Q

Grade 3 Intraventricular Hemorrhage

A

Bleed causing ventricular dilation

26
Q

Grade 4 Intraventricular Hemorrhage

A

Bleed in ventricles and near other areas

27
Q

Periventricular Leukomalacia (PVL)

A
  • Most common ischemic injury
  • Poor blood flow to immature and weak arterial vessels
  • Cystic changes: the white matter “necrosis” close to
    lateral ventricles
  • High risk for diagnoses of CP
28
Q

Hypoxic Ischemic Encephalopathy (HIE)

A
  • Prevalence of Perinatal Asphyxia: 3-5 per 1,000 live births
  • Impairs O2 delivery to infant
  • Standard of Care: Whole body cooling
29
Q

What is the most common intestinal disease

A

Necrotizing Enterocolitis (NEC)

30
Q

Necrotizing Enterocolitis (NEC)

A
  • Most common intestinal disease: 10% in extreme prematurity
  • Medical vs Surgical (medical: treat with medicine to slow tissue death down before being removed)
  • Causes include prematurity, asphyxia, CHD, viruses
31
Q

Clinical Presentation of Respiratory Distress Syndrome

A

tachypnea, poor feeding, grunting, cyanosis, intercostal
retractions

32
Q

Pathophysiology of Respiratory Distress Syndrome

A
  • Pathophysiology: lack of surfactant in lungs (elasticity)
  • Fewer and larger alveoli so less gas exchange
33
Q

Bronchopulmonary Disease

A
  • Need of supplemental O2 > 28 days after birth; form of
    chronic lung disease
  • Increased risk: < 30 weeks GA
  • Increased risk: < 1,500 grams
  • Large alveoli = less gas exchange
34
Q

Retinopathy of Prematurity

A
  • Blood vessel in eyes swell and overgrow
  • More common in those receiving O2
  • Risk factors: <1,250 grams and < 31 weeks GA
  • Medicine vs laser surgery (New med Avastin)
35
Q

Newborn Orthopedic Complications - Newborn Fractures

A
  • Majority of newborn fractures are clavicle and humeral by nature
  • Healing time is quick
  • PTs in NICU typically not involved
36
Q

Newborn Orthopedic Complications - Metatarsus Adductus

A
  • Medial displacement of the metatarsals on cuneiforms
  • Most cases are self limited (15% need PT)
  • Interventions includes: ROM, strengthening, splinting/casting
    ** Peace Sign Test
37
Q

Newborn Orthopedic Complications - Vertical Talus

A
  • Talus and navicular bones sit on top of calcaneus
  • “Rocker bottom” appearance
  • Casting > Surgery (reverse Ponseti)
    ** if bones don’t move between max DF and max PF x-ray, that is positive
38
Q

Newborn Orthopedic Complications - Congenital Clubfoot

A
  • Components: midfoot cavus, forefoot adductus, hindfoot equinus
  • Fibrotic musculature and misshape bones
  • Ponseti Serial Casting (have to wait until baby is full term)
39
Q

Standardized Assessment with highest predictive validity

A

General Movement Assessment (GMA)

40
Q

Standardized assessment with highest evaluative validity

A

Test of Infant Motor Performance (TIMP)

41
Q

Test of Infant Motor Performance

A

42 Items
13 Observed movements
29 Elicited movements

42
Q

General Movement Assessment

A
  • Looking for the presence of fidgety movements
  • Time frame: between 9-20 weeks but best between 12-16 weeks
  • Predictive of CP with > 90% sensitivity
43
Q

General PT Assessment in NICU

A
  • Observation * Muscle Tone * Reflexes
  • Active ROM * Strength/ MMT * Head Shape * Tolerance for movement and handling
44
Q

See Headship Examples

A
45
Q

Goals of Positioning

A
  • Encourage physiologic flexion
  • Encourage midline
  • Hand to mouth behavior
  • Avoid head preferences
  • Bracing of LEs or Body
  • Improve respiratory system
  • Optimize development by supporting infant’s state
46
Q

Goals of Infant Massage

A
  • Decreases level of stress
  • Improves weight gain
  • Immunological effects
  • Decreases feeding intolerance
  • Helps Digestive system
  • Improves bone metabolism
  • Facilitates mother/baby bonding
47
Q

Goals of Parent Education

A
  • Teach therapeutic handling
  • Discuss goals, plan of care, and follow-up needs
  • Recognize baby stress cues
  • Discuss strengths of infant
  • Impacts home environment can make on infant
  • Typical development with respect to prematurity

Topics in Peds (15 decks)

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