The Neonatal & Paediatric Occupational Therapist

Neonatal Occupational Therapists  (OT) play an important role in the development of premature and fragile infants many of whom have an increased risk of experiencing developmental difficulties.  The presentation of some developmental difficulties can be very subtle in nature and can be easily overlooked by the untrained eye, only becoming more evident when there are increased demands on the child e.g. starting school. Occupational therapy treatment for neonatal intensive care focuses on developmental treatment for premature babies and newborns and on providing guidance for their parents.

The purpose of occupational therapy intervention is to reduce the stressful conditions that the premature or newborn baby is exposed to as a result of the physiological immaturity of their various bodily systems, including the nervous system. The therapeutic intervention and parental guidance enables the identification of environmental conditions that bring about imbalance or stress for the baby. In this way, the occupational therapist provides important tools needed to respond to the infant’s needs and to make the baby more comfortable. By this intervention, occupational therapist’s help encourage the baby’s physiological stability, serenity, vitality and the ability to interact with his/her physical and human environment.

Occupational therapists who practice neonatal therapeutic intervention have a comprehensive knowledge of the medical situations and unique developmental conditions that characterize the infant population.

Occupational Therapy graphic featuring blocks in various colours with key words in different fonts associated with Occupational Therapy

The unique, professional areas of knowledge required for the treatment of premature or newborn babies are:

  • Knowledge and experience in pediatric and neonatal occupational therapy.
  • Knowledge and therapeutic tools needed for evaluation and treatment.
  • Knowledge and tools that are essential for identifying life-threatening conditions and for providing the appropriate immediate response. Knowledge and the ability to cope with the sensitive and complex situation that parents find themselves facing.
  • Knowledge about organizing the environment and supporting the parents’ ability to function under continuous stressful conditions.

 

Areas of intervention and methods of treatment

  • Occupational therapy intervention includes direct intervention in treating the premature or newborn infant, and the provision of advice and guidance to the parents and to the NICU staff.

 

Treatment methods include:

  • Adapting and modifying the stimuli that the premature or newborn baby is exposed to, and providing the appropriate stimuli and guidance needed to encourage the development of sensory modulation and equilibrate the sleep wake cycles;
  • Treatment in the areas of eating and feeding, and in this context, to encourage sucking, swallowing and eating skills;
  • Maintaining adaptive positions that support the child and encourage development, including: methods of handling; adapting assistive devices such as splints, in cases of trauma or improper positioning of the limbs.
  • Guiding parents to be actively involved in the day-to-day treatment of their premature or newborn baby, such as: The use of tactile, proprioceptive and vestibular stimuli; strengthening the infant’s oral musculature and the functions needed for feeding.
  • Assisting and instructing parents on methods through which they can continue to function at home and in the NICU simultaneously.

 

Treatment approaches

Occupational therapy approaches, such as sensory integration (SI) and the neurodevelopmental treatment approach (NDT), must be adapted to the medical condition of the premature or newborn infant, his/her physiological homeostasis and the baby’s unique developmental and familial needs.

The occupational therapist also integrates the principles of Newborn Individualized Developmental Care Assessment Program (NIDCAP) within their treatment approaches. According to this approach, one must perform a careful observation of the behavior of each premature or newborn baby as a basis of adapting an individualized intervention plan and unique environment needed for the child’s optimal development during his/her hospital stay.

 

The Intervention Process

The professional-therapeutic intervention process of occupational therapists is part of the multidisciplinary treatment program designed for each individual premature baby or newborn infant, according to his/her needs. The intervention process is dynamic and must constantly adapt to the changing needs of the baby and his/her family.

This process includes:

  • A initial evaluation is carried out through observation, gathering data and administering assessments. This evaluation process is then applied throughout the entire intervention process.
  • Building an intervention plan that is unique to each premature infant or neonate in coordination with the NICU staff.
  • Guidance and consultation for the parents according to their needs. This includes demonstration on how to encourage the appropriate stimulation needed to help the child achieve the developmental milestones according to his/her adjusted age.
  • Guiding and monitoring the baby and his/her family after discharge, with recommendations on to the proper way to adapt the home environment.
  • Continued treatment and monitoring of premature babies that have somatic injuries as a result of their premature birth (such as bleeding in the brain, anoxia, etc.) throughout the life cycle.

 

Results of professional-therapeutic intervention

The intended results of the therapeutic intervention of occupational therapists in their work with premature or newborn infants include, among other things:

  • Influencing and encouraging behavior patterns appropriate to the baby’s adjusted age.
  • Encouraging good communication between the parents and their child (bonding).
  • Developing the ability to take in and respond appropriately to stimuli, such as tactile, visual and auditory stimuli.
  • Encouraging visual focus and the development of social communication within the infant’s environment.
  • Developing the ability to self-regulate and self-modulate.
  • Developing the ability to take in nourishment through the mouth.
  • Developing the ability to maintain a flexed posture, forming a basis for the development of functional bilateral movement (with an emphasis on the hands).
  • Providing the parents with the tools they need to communicate with their baby, identify their baby’s needs and provide suitable developmental stimuli.

 

Who can benefit from the intervention of the Neonatal Occupational Therapist

  • Marked prematurity
  • Developmental concerns
  • Abnormal tone
  • Prolonged hospitalisation
  • Sensory impairments
  • Orthopaedic and neurological malformations
  • Feeding difficulties
  • Brachial plexus injuries
  • HIE
  • PVL
  • Parental anxiety

 

The Role of the Occupational Therapist after discharge from the NICU.

Concerns are typically raised when a child is experiencing difficulty with everyday functional tasks. These can range from functional difficulties in the classroom, difficulty using a scissors (for example) to difficulty dressing or toileting at home or academic challenges in the classroom. Difficulties with functional skills are most obvious and are easily identified when you compare the child to his peer group. If he is not able, or has difficulty, completing tasks that his peer group can manage, then it would be recommended that he be brought for an assessment or screening.

Best practice guidelines and evidence based research in occupational therapy confirm that Early Intervention (EI) and early detection of occupational performance difficulties will provide the child with the best possible chance of ameliorating their difficulties.

Occupational therapy intervention can address a range of developmental difficulties such as these listed below:

  • Visual Perceptual skills: essential skills for learning reading, writing, spelling and development of such.
  • Visual-Motor Integration Skills: coordinated use of eye and hands together, which affects functional skills such as handwriting, copying from the black board, and catching a ball.
  • Gross and Fine Motor Difficulties: gross motor (balance, ball skills), fine motor (finger strength, dexterity, control).
  • Handwriting Difficulties: pencil grip, letter formations, letter reversals, spacing.
  • Sensory Processing Difficulties: effecting attention and concentration skills, ability to sit still to a peer appropriate level, impulsivity.
  • Social Skills: developing appropriate play skills, confidence and variety of hobbies and interests, ability to initiate and expand conversations, make and maintain friendships.
  • Functional Skills: dressing, toileting, self-care, organisation

 

RED FLAGS for Families

  • Weak/stiff uncoordinated movements.
  • Awkward grasp or clumsy use of crayons, pencils, scissors, or other tools/utensils.
  • Excessive seeking or avoidance of movement or touch.
  • Absence of hand preference after age 6.
  • Difficulty with age appropriate self-help skills such as dressing and toileting.
  • Attention and organizational problems with school tasks.
  • Difficulty with feeding, food aversions or eats a very limited diet.
  • Poor balance skills.
  • Difficulty in sports, such as catching/throwing a ball.
  • Unable to ride bike independently by age 8.
  • Poor organizational skills.
  • Difficulty regulating activity level.
  • Frequent emotional outburst or “meltdowns” in behavior.
  • Lack of age appropriate play skills.

 

Developmental Milestones

0-6 months

  • Removes socks
7-12 months

  • Helps with dressing
  • Clasps hands
  • Finger feeds self
  • Imitates scribble
  • Stacks 2-3 blocks
13-18 months

  • Pulls pants & socks off independently
  • Drinks from cup
  • Brings spoon to mouth
  • Scribbles spontaneously
  • Uses both hands in midline
  • Sucks a straw
19-24 months

  • Scoops food & feeds self with spoon
  • Builds 4-6 cube tower
  • Zips/unzips large zipper
  • Sits on potty chair w/assistance
  • Imitates vertical/horizontal lines
2-3 years

  • Dresses with supervision
  • Dry during the day
  • Undoes large buttons/snaps/shoelaces/zippers
  • Cuts a piece of paper in half
  • Eats and drinks independently
  • Knows main body parts
  • May reject many foods
3-4 years

  • Buttons
  • Dresses without supervision
  • Helps with bathing
  • Matches pictures of like objects
  • Names colors
  • Responds to prepositions of over/under
  • Helps with bathing
  • Verbalizes need to use toilet
4-5 years

  • Distinguishes between front and back
  • Stays dry through the night
  • Recites numbers 1-10
  • Brushes teeth
  • Helps with bathing
  • Prints any 2 letters without model
  • Cuts a circle/square
  • Writes parts of name
5-6 years

  • Draws person with at least 7 parts
  • Ties shoes
  • Writes name
  • Recites numbers 1-20
  • Shows right hand
  • No toiletry accidents
  • Prints simple words without model
  • Cuts with knife and fork

 

USEFUL LINKS

www.informingfamilies.ie
www.hon.ch
www.sciencedaily.com
www.middletownautism.com
www.dyspraxia.ie