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29 Cards in this Set
- Front
- Back
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Primary Goal of OT in the NICU: |
optimize the infant’s potential for development |
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Treatment Strategies24-28 weeks |
Reduce or eliminate stress, suggestions to nurses on positioning and handling |
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Treatment Strategies 28-32 weeks |
Promote autonomic regulation and homeostasis, positioning for midline orientation – hand to mouth |
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Treatment Strategies 32-37 weeks |
Promote state organization, provide input to baby going from one state the next i.e.wake to cry to sleep. Minimize postural disorganization. Provide flexion in midline (swaddling and bendybumpers). |
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a premature infant is more sensitive to sensoryinput or stimulation than full term infants. Thus plan to implement intervention for the following times |
Baby is stable and well rested. Not fatigued by medical procedures. More organized and in a state of alertness. In a supportive, calm and nurturing environment. |
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Environment: Assess the __________ with respect to the ___________ and _____________ the baby is exposed to before touching the baby |
environment, sensory input and stimulation |
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Macro environment |
the entire physical layout of the room – the layout of the NICU or the baby’s room; consider noise level, lighting etc. |
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Micro environment |
infants crib or isolette – proximity to nurses station, doors, windows, other lighting sources, positioning equipment available, visual environment |
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Brazelton |
who created frame of ref |
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Infant State andInteractive Behaviors framework |
Brazelton et al. (1982) developed a conceptual framework toassess behavior in premature infants, It is divided into five developmental subsystems |
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Infant Signs that allow for engagement |
attentional or interactional signs and self -regulatory behaviors |
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Infant signs of stress that may cause disengagement |
autonomic signs, motor signs and state signs |
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Attentional orInteractional Signs |
Smiling, mouthing, cooing, relaxed face, “OOH face,” relaxed limbs, minimal motor movement, smooth movements, alertness |
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Self-Regulatory Behaviors |
Visual looking, sucking, hand to face or mouth, grasping, fisting, hand clasp, foot clasp, leg bracing, postural change, pushing or bracing againstcrib, flexing in all extremitiesand trunk, shifting to lower states(light sleep or drowsy) |
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Autonomic Signs ofStress |
Color changes, changes in vital signs (HR,RR, BP, O2), vomiting, gagging, hiccups, diarrhea, sneezing, yawning, burping |
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Motor Signs of Stress |
Hypotoniaf, flailing mvts, tunk arching, hyperextension of extremities, frantic, disorganizedmovements, squirming movements, posturing (salute, sitting inair, airplane) finger splaying, tongue thrusting |
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State Signs of Stress |
Gaze aversion, glassy eyes, staring, irritability, panicked look, twitching, grimacing, deep sleep, diffuse sleep states, lack of alertness |
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The goal is the ____________ and ________________. |
help an infant become more self-regulated, willing to engage in interaction |
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Intervention is focused on ___________________ and ______________________ in the baby |
avoiding stress related events, promoting self-regulatory behaviors and engagement |
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General treatment considerations |
Contain baby to reduce extra motor activity – swaddling or props in crib, determine what sensory inputs lead to stress vs engagement, fragile infants cannot usually tolerate input through multiple systems so it is best to use just touch calm voice |
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Evidence supports that baby’s who learn to self-regulate |
have shorter NICU stays, increased weight gain, lower incidence of medical complications, and improved developmental outcomes. |
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PhysiologicalCost |
stress behaviors are associated with increased heart rate, respiratory rate, oxygen consumption, calorie expenditure and they COST the baby energy |
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The response to sensory input should be determined in thefollowing developmental sequence |
tactile, proprioceptive, vestibular, auditory and then visual |
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Evaluation of response to sensory input includes |
orientation, reactivity and habituation visual |
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Orientation |
ability to locate source of stimuli – head turn, gaze, movement toward source |
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Reactivity |
how the baby reacts – cry, grimace, blink or ignore it? |
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Habituation |
ability to stop reacting to a sustaining stimulus i.e. bell ringing etc. |
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how often should you observe for signs of stress |
within five or ten minutes after the activity |
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Tactile SystemOrientation |
use light stroking, deep touch, massage or cuddling against body |
