1. ECSE 641 Spring 2015 (Ward, 2010) 8/27/2015 ECSE 641

2. Neonatal Intensive Care Unit – NICU Special Care Nursery-SCN Staff Equipment Developmental interventions 8/27/2015 ECSE 641

3. NICU/SCN Staff Neonatologist Pediatrician Neonatal Nurse Practitioner Nurses Interns and Residents Consulting Physicians (cardiologist, orthopedist, neurologist, etc…) Other- Occupational, Physical, Speech Therapists 8/27/2015 ECSE 641

4. 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 8/27/2015 ECSE 641

5. NICU/SCN Equipment Equipment in NICU 8/27/2015 ECSE 641

6. 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). 8/27/2015 ECSE 641

7. 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/SCN Developmental Interventions 8/27/2015 ECSE 641

8. 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). 8/27/2015 ECSE 641

9. Developmental Interventions are strategies designed to reduce inappropriate stimulation increase appropriate patterns of stimulation based on an infant’s individual responses. Developmental Interventions 8/27/2015 ECSE 641

10. Developmental Interventions Signs of Infant Disorganization Physiological Signs Skin color changes Change in breathing rate and/or heart rate Hiccough Spitting up/gagging Sneezing Yawning 8/27/2015 ECSE 641

11. Developmental Interventions Signs of Infant Disorganization Motor Signs Change in muscle tone – high or low Frantic flailing Finger splay Arching Salute of arms Grimace 8/27/2015 ECSE 641

12. Behavioral Signs Whimpering Frown Fussy Irritable Gaze aversion Staring Eye floating- random eye movements with no focus Developmental Interventions Signs of Infant Disorganization 8/27/2015 ECSE 641

13. Development Interventions Developmental Interventions are designed to help the infant move from a disorganized state to an organized state. 8/27/2015 ECSE 641

14. Developmental Interventions Signs of Organization Physiologic Signals Smooth, even breathing pattern Stable skin color No sign of disorganization http://www.vort.com/products/188.html 8/27/2015 ECSE 641

15. Motor Signals Stable muscle tone Steady posture -no fluctuation in muscle tone Clasping hands Hands to mouth Grasping (blanket, finger) Sucking Developmental Interventions Signs of Organization 8/27/2015 ECSE 641

16. Behavioral Signals Distinct sleep patterns Maintaining quiet alert state Relaxed facial expression Relaxed arms and legs “Ooh” face Visual and auditory attending Developmental Interventions Signs of Organization 8/27/2015 ECSE 641

17. Developmental Interventions Some strategies that will help infants organize and have access to uninterrupted sleep include: Environmental strategies Positioning strategies Handling Cluster care Skin to skin or kangaroo care 8/27/2015 ECSE 641

18. Developmental Interventions Environmental 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. 8/27/2015 ECSE 641

19. Developmental Interventions Positioning strategies Prone and sidelying (avoid W-supine), promote flexion and hands to mouth Handling Strategies Contain limbs when changing positions, move slowly and gently Cluster Care Allows for extended periods of rest Skin to Skin or Kangaroo Care Fosters maternal bonding and results in improved maternal confidence in caring for her preterm infant. 8/27/2015 ECSE 641

20. Developmental Interventions Positioning Strategies Supine W-position Promotes extension Side lying Containment Promotes flexion Hands to mouth 8/27/2015 ECSE 641

21. Kangaroo Care/Skin to Skin http://www.sonstodads.com/kangaroo- care.htm http://www.cssd.us/body.cfm?id=1116 8/27/2015 ECSE 641

22. Individualized neuro-developmental care and family centered care have been associated with: Reduced number of apnea spells Improved oxygenation Faster weight gain Improved state organization Referral to an early intervention program frequently occurs prior to the infants discharge from the NICU. Developmental Interventions 8/27/2015 ECSE 641

23. NICU/SCN Understanding My Signals Video of NICU VCU/MCV NICU 1 VCU/MCV NICU 2 VCU/MCV NICU 3 8/27/2015 ECSE 641

24. 8/27/2015 ECSE 641

25. 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#overview 8/27/2015 ECSE 641

26. A federal grant program that assists states in operating a comprehensive statewide program of early intervention services for infants and toddlers with disabilities ages 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) 8/27/2015 ECSE 641

27. 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 8/27/2015 ECSE 641

28. 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) 8/27/2015 ECSE 641

29. 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 8/27/2015 ECSE 641

30. 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 8/27/2015 ECSE 641

31. Eligibility for EI Services Additions to list of diagnosed conditions 28 weeks or less gestational age 28 days or more in the NICU PVL (http://cerebralpalsy.org/about-cerebral- palsy/cause/periventricular-leukomalacia/) 8/27/2015 ECSE 641

32. Part C VCU's Early Intervention Professional Development Center VCU's Early Intervention Professional Development Center 8/27/2015 ECSE 641

33. Additional Resources Campbell, S., Palisano, R., & Orlin, M. (2012). Physical therapy for children (4 th 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. 8/27/2015 ECSE 641