ECSE 641 Spring 2015
(Ward, 2010)
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Neonatal Intensive Care Unit –NICUSpecial Care Nursery-SCNStaffEquipmentDevelopmental interventions
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NICU/SCNStaff
NeonatologistPediatricianNeonatal Nurse PractitionerNursesInterns and ResidentsConsulting Physicians (cardiologist,
orthopedist, neurologist, etc…)Other- Occupational, Physical, Speech
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Medical care is the primary concern in the NICU.
Equipment, lighting, and monitors are designed to optimize medical interventions.
Several reviews suggest that the NICU environment provides abnormal stimuli (timing of handling, excessive light and noise levels).
These factors have been hypothesized to contribute to the brain of the infant born preterm developing differently than the brain of the infant born at term.
NICU/SCN
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NICU/SCNEquipment
Equipment in NICU
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Developmental Interventions
“Developmental intervention encompasses specific procedures used to minimize the infant’s stress and also techniques used to promote infant organization.” Mahoney & Cohen. Effectiveness of Developmental Intervention in the Neonatal Intensive Care Unit: Implications for Neonatal Physical Therapy. Pediatric Physical Therapy. 2005
The infants “job” in the NICU is to sleep and grow (gain weight).
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Developmental Interventions in the NICU also include Family Centered Care (FCC).
Examples of core beliefs of FCC include that: the family is the constant in the infants life.
Service systems and providers will change, but the family will remain.
diversity among families is acknowledged (racial, ethnic, socioeconomic and cultural differences).
families and providers are partners in the care of the infant and families should receive complete, objective information about their child.
NICU/SCNDevelopmental Interventions
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Developmental Interventions
Evolved from Deprivation and Overstimulation theories.Deprivation Theory- Infant is deprived of
normal newborn experiences and is confined to a restricted environment.
Overstimulation Theory- Infant is bombarded with excessive stimulation (bright lights, high noise levels, constant caregiving).
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Developmental Interventions are strategies designed to reduce inappropriate stimulation increase appropriate patterns of stimulation
based on an infant’s individual responses.
Developmental Interventions
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Developmental InterventionsSigns of Infant Disorganization
Physiological SignsSkin color changes Change in breathing rate and/or heart
rate HiccoughSpitting up/gaggingSneezingYawning
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Developmental InterventionsSigns of Infant Disorganization
Motor SignsChange in muscle tone – high or low
Frantic flailing Finger splayArching Salute of armsGrimace
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Behavioral SignsWhimperingFrownFussyIrritableGaze aversionStaringEye floating- random eye movements with no
focus
Developmental InterventionsSigns of Infant Disorganization
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Development Interventions Developmental Interventions are designed to
help the infant move from a disorganized state to an organized state.
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Developmental InterventionsSigns of Organization
Physiologic SignalsSmooth, even breathing patternStable skin colorNo sign of disorganization
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Motor SignalsStable muscle toneSteady posture -no fluctuation in muscle
toneClasping hands Hands to mouthGrasping (blanket, finger)Sucking
Developmental InterventionsSigns of Organization
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Behavioral SignalsDistinct sleep patternsMaintaining quiet alert stateRelaxed facial expressionRelaxed arms and legs“Ooh” faceVisual and auditory attending
Developmental InterventionsSigns of Organization
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Developmental InterventionsSome strategies that will help infants
organize and have access to uninterrupted sleep include: Environmental strategiesPositioning strategiesHandlingCluster careSkin to skin or kangaroo care
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Developmental InterventionsEnvironmental strategies
Lighting (dimmer lights/diurnal light cycle) Diurnal lighting cycles- 24-hour, day-night cycles with
brighter lighting for a portion of the 24-hour period (usually at least 12 hours), and dimmer lighting for the remainder of the 24-hour period
Noise level Institute designated “quiet periods” when phones
are changed to a flashing light system instead of ringing, post pone care giving activities, limit conversation around isolettes, place a blanket over the isolette.
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Developmental InterventionsPositioning strategies
Prone and sidelying (avoid W-supine), promote flexion and hands to mouth
Handling StrategiesContain limbs when changing positions, move slowly
and gentlyCluster Care
Allows for extended periods of restSkin to Skin or Kangaroo Care
Fosters maternal bonding and results in improved maternal confidence in caring for her preterm infant.
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Developmental InterventionsPositioning Strategies
Supine W-positionPromotes extension
Side lyingContainmentPromotes flexionHands to mouth
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Kangaroo Care/Skin to Skin
http://www.sonstodads.com/kangaroo- care.htm
http://www.cssd.us/body.cfm?id=1116
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Individualized neuro-developmental care and family centered care have been associated with: Reduced number of apnea spells Improved oxygenationFaster weight gainImproved state organization
Referral to an early intervention program frequently occurs prior to the infants discharge from the NICU.
Developmental Interventions
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NICU/SCNUnderstanding My SignalsVideo of NICU
VCU/MCV NICU 1VCU/MCV NICU 2VCU/MCV NICU 3
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Overview to the Part C Program Under IDEA
Congress established this program in 1986 in recognition of "an urgent and substantial need" to:enhance the development of infants and toddlers
with disabilities;reduce educational costs by minimizing the need
for special education through early intervention;minimize the likelihood of institutionalization and
maximize independent living; and,enhance the capacity of families to meet their
child's needs.http://www.nectac.org/partc/partc.asp#overview04/19/23 ECSE 641
A federal grant program that assists states in operating a comprehensive statewide program of early intervention services for infants and toddlers with disabilitiesages birth through age 2 years and their families.
http://www.nectac.org/partc/partc.asp#overview
The Program for Infants and Toddlers with Disabilities (Part C of IDEA)
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The Program for Infants and Toddlers with Disabilities (Part C of IDEA)
In order for a state to participate in the program it must assure that early intervention will be available to every eligible child and its family.
http://www.nectac.org/partc/partc.asp#overview
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State governors must designate a lead agency to receive the grant and administer the program
Appoint an Interagency Coordinating Council (ICC), including parents of young children with disabilities, to advise and assist the lead agency.
Currently, all states and eligible territories are participating in the Part C program.
http://www.nectac.org/partc/partc.asp#overview
The Program for Infants and Toddlers with Disabilities (Part C of IDEA)
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The Program for Infants and Toddlers with Disabilities (Part C of IDEA)
The Lead Agency in Virginia is: The Department of Behavioral Health and Developmental Services
http://www.nectac.org/partc/partc.asp#overview
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Determining Eligibility for Services in EI
Diagnosed condition with a high probability of development delay and/or
25% or greater developmental delay in one or more developmental areas and/or
Atypical development
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Eligibility for EI Services
Additions to list of diagnosed conditions28 weeks or less gestational age28 days or more in the NICUPVL
(http://cerebralpalsy.org/about-cerebral-palsy/cause/periventricular-leukomalacia/)
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Part CVCU's Early Intervention Professional Develo
pment Center
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Additional ResourcesCampbell, S. , Palisano, R., & Orlin, M.
(2012). Physical therapy for children (4th ed.). St. Louis, Missouri: Elsevier.
Creger, P. (1995). Developmental interventions for preterm and high-risk infants: Self study modules for professionals. Tucson, Arizona: Therapy Skill Builders.
Vergara, E. & Bigsby, R. (2004). Developmental &therapeutic interventions in the NICU. Baltimore: Paul H. Brooks.
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