Neonatal Physiotherapy Assessment

Original Editor - Robin Tacchetti based on the course by Krista Eskay
Top Contributors - Robin Tacchetti

Introduction[edit | edit source]

Physiotherapists working in the neonatal intensive care unit (NICU) serve as an important interdisciplinary team member to support the newborn. Communication plays a large role as physiotherapists regularly interact with other NICU clinicians and family members to determine the baby's needs and beneficial interventions. [1] The aim of physiotherapists in the NICU is to promote motor development and bonding in the following ways:

  1. helping the infant bond with their family members
  1. facilitating good developmental skills
  2. offering supportive positioning and handling
  3. improving carryover of the therapeutic strategies

** Carryover of interventions occurs as the PT plays the role of educator to the nursing staff and family members. [2]

The NICU physiotherapy examination is performed once the infant is medically stable. Physiotherapists collaborate with the medical team to determine the least disruptive time for the infant. [2]

Subjective[edit | edit source]

The subjective portion the NICU assessment involves obtaining a thorough history.[2] This information can be collected through discussions with clinician, family members and a review of the medical chart. The following table below details topics that should be involved in the subjective portion of the exam and sub-topics within them:

Topics Questions Related to
Pregnancy History complications, date of birth, gestational age
Birth History birth weight, type of birth, complications, Apgar scores
Medical Procedures any procedures performed since birth
Social and Environmental History sleep habits, sleep location, how they are feeding, daily routine, positioning and which position they spend the most time in, who takes care of them, siblings
Challenges what challenges does infant face on daily basis, what skill attainment is most important to family, family strengths

Objective[edit | edit source]

Obtaining objective information in the NICU entails a considerable amount of observation along with standardised tests. The aim of the objective portion is to identify the infant's activity limitations and challenges. Infant participation in the NICU setting might include tasks such as:

  • to appropriately communicate
  • to be held by parents
  • to feed
  • to sleep
  • to grow[2]

Observation[edit | edit source]

Infants in the NICU are typically medically fragile and will not tolerate long periods of intervention. Thus, objective information is primarily gained through observation. Observing the newborn and their interaction within the environment is called neurobehavioural observation. The following table details areas to observe in the newborn and within those areas what is important information to take note of:

Areas to Observe Noteworthy Significance
Tone hypotonic, moving limbs against gravity, tight/stiff
Physiologic flexion can they get into and/or stay in physiologic flexion
Vitals heart rate, respiratory rate, skin colour, changes in vitals from interventions or stressors
Reflexes infant reflexes; do they get stuck in a reflex position (ATNR), clonus
Range of motion active and passive range of motion of various joints
Developmental positions checking various positions at different times; tone change in different positions,, tolerating change in position, posture appearance in different positions
Quality of movement smooth/rigid, frequent/sparse movement
Symmetry of movement symmetrical movement, does one side move more than another, alternating movement between upper and lower extremities
Head shape plagiocephaly (flattening), scaphocephaly (long and narrow), brachycephaly (widening and flat)
Self-regulate transition through behavioural states, can they maintain calm, alert, awake state
Reactions to stimuli auditory, visual, touch, pain* (NICU infants more sensitive to pain and have difficult time modulating pain)

Standardised Tests[edit | edit source]

Neonatal Behavioral Assessment Scale (NBAS)[edit | edit source]

The Neonatal Behavioral Assessment Scale (NBAS) is the most comprehensive neurobehavioural assessment for infants 35 weeks gestation to 2 months old. The NBAS proposes that infants are social beings communicating through behaviour in a non-random fashion. The scale assesses 53 items within the following categories:

  • Habituation (sleep protection)
  • Social Interactive responses and capabilities
  • Motor System
  • State Organisation and regulation
  • Autonomic System
  • Reflexes[3]

** The NBAS takes significant amount of time and training to administer limiting its practicality and accessibility[4]

Newborn Behavioral Observation (NBO)[edit | edit source]

The Newborn Behavioral Observation (NBO) is a shorter instrument designed to capture newborn behaviour and communication cues. The NBO is administered by NBO-trained healthcare practitioners and consists of 20 items that describe the infants' visual, auditory, perceptual and self-regulatory abilities. The family-centred NBO aims to promote a positive parent-infant relationship by increasing parental competence and confidence. [5][4]

Test of Infant Performance[edit | edit source]

The Test of Infant Motor Performance (TIMP) is a video-based instrument used on infants age 3-18 months. This 80 item scale records self-generated movements during a playful interaction between examiner and child. The TIMP evaluates motor skills and milestones along with the quality of motor behaviour.[6]

General Movement Assessment (GMA)[edit | edit source]

The General Movement Assessment (GMA) captures spontaneous movement of an alert, awake supine infant through a 3-5 minute video-recording or direct observation. [7][8] This instrument is widely accepted by various cultural and social backgrounds due to its non-intrusive nature. It is suitable for daily clinical applications because it is easier to perform than many other neurological tools.[8]

Alberta Infant Motor Scale (AIMS)[edit | edit source]

The Alberta Infant Motor Scale (AIMS) tool is used for evaluating quantitative and qualitative motor development for infants up to 18 months.[9] The focus of the AIMS is to observe the infant as they move into and out of prone, supine, sitting and standing. The items on the AIMS accent components such as antigravity movement, postural alignment and weight bearing that promote motor skills.[10]

PEABODY Developmental Motor Scales[edit | edit source]

The Peabody Developmental Motor Scales-Second Edition (PDMS-2) is a reliable and valid tool originally designed to detect developmental delay.[11] [12] This instrument assesses fine and gross motor skills along with identifying motor deficits and eligibility for intervention for children with and without disabilities. [12]

BAYLEY Scales of Infant and Toddler Development[edit | edit source]

The Bayley Scales of Infant and Toddler Development evaluates a child's development compared to the standardised norm.[13] [14] This tool can be used for infants and children 1 month-42 months and helps diagnose developmental delay. [13][14] This extensive formal instrument measures across five domains:

  1. cognitive
  2. language
  3. motor
  4. social-emotional
  5. adaptive behaviour[15]

Resources[edit | edit source]

References[edit | edit source]

  1. Doğan, İ.E., Balcı, N.Ç. and Gündüz, A.G., 2022. Physiotherapy and Rehabilitation Approaches to Premature Infants in Neonatal Intensive Care Units. Journal of Physical Medicine Rehabilitation Studies & Reports. SRC/JPMRS/168. DOI: doi. org/10.47363/JPMRS/2021 (4), 150, pp.2-5.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 Eskay, K. Infant Assessment and Intervention. Plus. 2023
  3. Brazelton Centre UK: Neonatal Behavioural Assessment Scale. 2023. Available from:
  4. 4.0 4.1 Congdon JL, Nugent JK, McManus BM, Coccia M, Bush NR. A Pilot Validation Study of the Newborn Behavioral Observations System: Associations with Salivary Cortisol and Temperament. Journal of developmental and behavioral pediatrics: JDBP. 2020 Dec;41(9):716.
  5. Høifødt, R.S., Nordahl, D., Landsem, I.P., Csifcsák, G., Bohne, A., Pfuhl, G., Rognmo, K., Braarud, H.C., Goksøyr, A., Moe, V. and Slinning, K., 2020. Newborn behavioral observation, maternal stress, depressive symptoms and the mother-infant relationship: results from the northern babies longitudinal study (NorBaby). BMC psychiatry, 20(1), pp.1-14.
  6. Machado LR, da Silva CF, Hadders-Algra M, Tudella E. Psychometric properties of the Infant Motor Profile (IMP): A scoping review protocol. Plos one. 2022 Nov 16;17(11):e0277755.
  7. Fontana C, Ottaviani V, Veneroni C, Sforza SE, Pesenti N, Mosca F, Picciolini O, Fumagalli M, Dellacà RL. An Automated Approach for General Movement Assessment: A Pilot Study. Frontiers in pediatrics. 2021:868.
  8. 8.0 8.1 Silva N, Zhang D, Kulvicius T, Gail A, Barreiros C, Lindstaedt S, Kraft M, Bölte S, Poustka L, Nielsen-Saines K, Wörgötter F. The future of General Movement Assessment: The role of computer vision and machine learning–A scoping review. Research in developmental disabilities. 2021 Mar 1;110:103854.
  9. Eliks M, Gajewska E. The Alberta Infant Motor Scale: A tool for the assessment of motor aspects of neurodevelopment in infancy and early childhood. Frontiers in Neurology. 2022;13.
  10. Jeng SF, Yau KI, Chen LC, Hsiao SF. Alberta infant motor scale: reliability and validity when used on preterm infants in Taiwan. Physical therapy. 2000 Feb 1;80(2):168-78.
  11. Rebelo M, Serrano J, Duarte-Mendes P, Monteiro D, Paulo R, Marinho DA. Evaluation of the Psychometric Properties of the Portuguese Peabody Developmental Motor Scales-: A Study with Children Aged 12 to 48 Months. Children. 2021 Nov 13;8(11):1049.
  12. 12.0 12.1 Valentini NC, Zanella LW. Peabody Developmental Motor Scales-2: The Use of Rasch Analysis to Examine the Model Unidimensionality, Motor Function, and Item Difficulty. Frontiers in Pediatrics. 2022 Apr 20;10:852732-.
  13. 13.0 13.1 Ballot, D.E., Ramdin, T., Rakotsoane, D., Agaba, F., Davies, V.A., Chirwa, T. and Cooper, P.A., 2017. Use of the Bayley scales of infant and toddler development, to assess developmental outcome in infants and young children in an urban setting in South Africa. International Scholarly Research Notices, 2017.
  14. 14.0 14.1 Balasundaram P. Bayley scales of infant and toddler development.[Updated 2021 Nov 24]. StatPearls [Internet]. StatPearls Publishing. 2022.
  15. Balasundaram P. Bayley scales of infant and toddler development.[Updated 2021 Nov 24]. StatPearls [Internet]. StatPearls Publishing. 2022.