1、TRAINING MODULE FOR OCCUPATIONAL AND PHYSICAL THERAPISTS IN THE NICU,Presented by Lisa Bader, OTR/L, CEIM August, 2008,PURPOSE,To provide a systematic structure of learning for OTs and PTs who want to work in the NICU Ensure that the quality of care given by therapists in our NICU is world-class and
2、 recognized as such by other members of the NICU team Follow national AOTA and APTA guidelines for therapists working in the NICU,WHAT ARE THE GUIDELINES?,AOTA and APTA have similar articles and guidelines written regarding OT and PT services in the NICU Both emphasize the specialized knowledge requ
3、ired to practice in the NICU because of the medical fragility and developmental variability of NICU infants “Interactions and therapeutic interventions that may appear innocuous can trigger physiologic instability in an infant and can be life threatening.” (AOTA, 2006).,OUR SPECIFIC TRAINING MODULE,
4、Each specific area of 5 page outline from AOTAs guidelines was addressed For example, outline reads as follows: D. Formulate an individualized therapeutic intervention plan 1. Determine appropriate timing of infant interventions on basis of medical and physiological status, postconceptual age, and N
5、ICU routines 2. Modify sensory aspects of physical environment according to infant threshold 3. Participate with infant and caregivers in interventions that reinforce the role of the family and support the infants medical and physiological status,D. Formulate an individualized therapeutic interventi
6、on plan,1. Determine appropriate timing of infant interventions on basis of medical . . . . In general, infant evaluations and treatments are done prior to a “care time” to allow the infant to have as much sleep and undisturbed time as possible. Often, a therapist finds out what the care times are f
7、or a particular baby and then requests to see the baby 15-30 minutes prior depending on how long a session is planned. Older infants may tolerate close to 25-30 minutes where a younger premie may not even tolerate 15 minutes. Nevertheless, this is the general guidelines followed at this time. Howeve
8、r, it is important to determine the timing of assessments and interventions according to that individual infant. “Safety for the infant takes priority over convenience for the therapist in all aspects of care.” (Case-Smith, 2001, p. 652). An evaluation may have to be done in parts and no part of an
9、evaluation should be done if it is not necessary. The evaluation can be almost entirely completed through clinical observation of the infant. (Als, 1986).,D. Formulate an individualized therapeutic intervention plan,2. Modify sensory aspects of physical environment according to infant threshold Sens
10、ory stimulation is constant in the life of a baby in the NICU. Noise from machines, phones, voices; tactile input from I.V. lines, NG tubes, oxygen, CPAP; lights, position changes, nursing procedures and cares-the list can go on and on. With all of the sensory stimulation the infant must endure just
11、 to maintain his/her medical status, therapists must be aware of the infants physical environment and modify it as needed. Physical environment modification may include the use of positioning devices to decrease the effects of gravity or make an invasive tube more tolerable to the infant. Using the
12、frog for example over a babys back or torso, allows constant firm pressure for small premies or those that are easily agitated. During position changes. . .,D. Formulate an individualized therapeutic intervention plan,3. Participate with infant and caregivers in interventions that reinforce the role
13、 of the family and support the infants medical and physiological status The infants medical and physiologic status guides all interventions. The therapist may be planning a specific intervention but the baby may be telling her “not today.” As stated previously, the infants status dictates all interv
14、entions. With that said, there are many ways the NICU therapist can reinforce the role of family in the NICU. . . . .,What do other hospitals have around the country?,Literature review comes up with nothing Most practitioners agree and feel strongly about who should or should not work in the NICU Lo
15、ts of definitions about OT and PT roles in the NICU but OT/PT are almost always part of the team (examples)-YEAH! 1996 AJOT article which surveyed 174 NICU therapists showed inadequate training of NICU therapists and therapists expressed a desire for specialized training to work in this practice are
16、a,Requirements,Our goal is to have 2 OTs and 2 PTs trained to work in the NICUthis will help deal with staffing issues and have near 7 day coverage The initial requirements may be changed according to an individual therapists past work experience A therapist must have a minimal of 2 years experience
17、 as a licensed therapist before entering the NICU independently,Requirements (Cont.),40 pediatric patientsmust see for evaluation and at least 1 additional visit 8 infantseither outpatient or from pediatric floor and complete in-depth care plans on each with specific treatment techniques Write a 3 p
18、age paper on any of the following subjects with literature review and references included Family stress in the NICU Bonding/Attachment as it relates to the NICU Risks of developmental problems in premature infants and ways to identify those infants Movement and posture in premature infants Any other
19、 topic you find interesting,Requirements (Cont.),Complete tests on infant and NICU environment Interview one family about their NICU experience and write a paper about your findings Attend infant massage inservice Attend developmental care inservice Watch specific CDs/videos listed 6 month mentorshi
20、p period in NICU,Example Test Questions,Name 3 different types of brachial plexus injuries, therapy interventions for each, and prognosis. An infant was born 8 weeks premature and is now 6 months old. What is the infants corrected age? When looking at an infants physiologic status, name 5 things tha
21、t can be observed. Name 3 types of sensory input in the NICU that is disruptive to the infants neurobehavioral organization.,Test questions during mentoring period,A baby must have splints on his feet but has poor skin integrity resulting in pressure areas from the splints. What would you do? What c
22、ould your wearing schedule be? How could you prevent pressure areas? You are planning to see a baby for a treatment. Care times are at 8-11-2 and 5. The RN says, “You can see the baby anytime.” When is it appropriate to see the baby “anytime”? When would it be appropriate to discharge a baby from OT
23、/PT services before they are discharged home from the NICU?,References,American Occupational Therapy Association. (2006). Specialized knowledge and skills for occupational therapy practice in the neonatal intensive care unit. American Journal of Occupational Therapy, 60, 110 123. Als, H. (1982). Tow
24、ard a synactive theory of development: promise for the assessment of infant individuality. Infant Mental Health Journal, 3, 229-243. Case-Smith, J. (2001). Occupational therapy for children. St. Louis: Mosby.Sweeney, J. K., Heriza, C. B., Reilly, M. A., Smith, C., VanSant, A. F.(1999). Practice guidelines for the physical therapist in the neonatal intensive care unit. Pediatric Physical Therapy, 11, 3, 119-132.,
