Neonatal Physiotherapy Assessment

Introduction

Physiotherapists working in the neonatal intensive care unit (NICU) strive to support movements and posture for the infant that are applicable to the gestational age. Working in this setting, physiotherapists regularly interacts with the family and other NICU clinicians to determine the baby's needs and the most beneficial approaches to meet those needs. Regular interaction with the NICU clinicians is key to providing the best care possible. The role of the physiotherapist in the NICU setting is as follows:

1. help the infant bond with their family members

1. facilitate good developmental skills
2. officer supportive positioning and handling
3. improve carryover of the therapeutic strategies

** It is important that the interventions have carryover to family and nursing staff, therefore PTs play a large role in education

The NICU physiotherapy examination is composed of many facto

** The evaluation always takes into account what is important for the family and what their goals are

Subjective

Topics	Questions Related to
Pregnancy History
Birth History
Medical Procedures
Social History
Environmental History

Objective

Observation

The following chart details areas to observe in the newborn and within those areas what is important to see and take note of.

The following chart provides a summary of areas to observe with the newborn and within those areas what information if relevant and impo

Areas to Observe	Noteworthy Significance
tone	mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
Physiologic flexion
Vitals	heart rate, respiratory rate, skin colour
Reflexes
Posture
Developmental positions
Quality of movement
Symmetry of movement
Head shape
Reaction to Stimuli

NBO

The Newborn Behavioral Observation (NBO) is a relationship-based intervention delivered by NBO-trained health practitioners aiming to sensitise parents to the infant’s capacities, uniqueness and behavioural communication cues [5]. By increasing parental competence and confidence the intervention may contribute to more sensitive parenting and a positive parent-infant relationship.

he NBO is a family-centered, developmentally supportive instrument that was designed to elucidate newborn neurobehavior for the purposes of crafting interventions that promote optimal newborn self-regulation and caregiver-infant interaction. The NBO is based on an appreciation of the richness and complexity of the newborn’s behavioral repertoire and the agency of the baby in shaping parent-infant interactions.7,13 NBO items focus on the baby’s behavior and communication cues, which are a window into the baby’s mental state. The twenty neurobehavioral items are designed to capture the infant’s visual, auditory, perceptual, and self-regulatory abilities as the infant attempts to stabilize autonomic, motor, and state behavior across the first weeks and months of life. The NBO has been shown to improve caregiver-infant interactions13,14 and provider confidence.15

NBAS

Functional developmental outcomes of generally healthy neonates are perhaps better predicted using a neurobehavioral approach than the established clinical neurologic assessments. Neurobehavior encompasses state and emotion regulation, which predict a variety of developmental outcomes, including psychopathology and social functioning later in childhood.6 The Neonatal Behavioral Assessment Scale (NBAS)7 was one of the early instruments that utilized a neurobehavioral model to evaluate neonates, marking an important step forward in the understanding of and ability to measure early infant development. The NBAS has been widely studied and shown to predict later developmental outcom. However significant time required for training and administration of both the NNNS and NBAS limit their practicality and accessibility to most clinicians and researchers, leading NBAS author Nugent and colleagues to create a shorter clinical tool, the Newborn Behavioral Observations (NBO) system.

Test of Infant Performance

The Test of Infant Motor Performance (TIMP) can be used across cultures, and item difficulty can be used to detect small subtle changes in motor performance in infants born both preterm and term in Brazil. Parent education needs to be targeted to the age and the needs of the child. The IMP is a video-based instrument for infants aged three to 18 months, or rather to the moment when the child is able to walk independently for some months. It is based on the infant’s self-generated movements during a playful interaction with the assessor. The IMP consists of 80 items that provide information on the infant’s motor behavior in five domains: variation, adaptability, symmetry, fluency and performance. The domains of variation and adaptability are based on the Neuronal Group Selection Theory. The three other domains are traditional domains of motor development. This also means that the IMP has four domains evaluating the quality of motor behavior and one domain that evaluates performance, i.e., motor skills or motor milestones. The IMP results in five domain scores and one total score. The assessment itself takes about 15 minutes and its off-line scoring about 10 minutes. Recently, the IMP-manual became available, including many video examples, an app to calculate the scores and IMP-norms (percentile values) [14]. Additionally, the IMP does not require a specific tool kit, but toys that can be easily acquired

GMA

s GMA requires only 3−5 minutes observation of an infant’s spontaneous movement (i.e., the infant needs not to be touched by the assessor), it is an evaluation far easier to be carried out than most assessments for neurological development. Hence GMA is suitable for daily clinical applications, particularly in low-resource settings. Being entirely non-intrusive, GMA is widely accepted by caregivers with divergent social and cultural backgrounds

GMA is performed through direct or video-recorded observation by a specifically trained operator, resulting in a qualitative description of the motor performance of the infants. However, the need for a trained examiner to accurately classify GMs over the

General Movements Assessment (GMA), developed by Dr. Heinz Prechtl first in 1979 [9, 10]. This assessment describes the repertoire of complex, highly variable, whole-body movements which emerge in the fetus and continue until the first 4 to 5 months of life [11, 12]. Specific patterns exist at set developmental stages (preterm, writhing, and fidgety), and patterns of stereotypy have also been identified that are associated with CP

AIMS

One of the standardized tools for evaluating motor development is the Alberta Infant Motor Scale (AIMS). The AIMS considers both quantitative (e.g., occurrences of motor skills) and qualitative characteristics (e.g., the manner of motor performance). The scale may be applied by healthcare professionals involved in infants' development screening up to 18 months of age for either clinical or research purpose

PEABODY

The Peabody Developmental Motor Scales-Second Edition (PDMS-2) is a valid and reliable instrument used in several countries, including Brazil, to assess gross and fine motor skills and identify motor deficits and eligibility for intervention for children with and without disabilities. Ho

BAYLEY

Bayley Scales of Infant and Toddler Development is an extensive formal developmental assessment tool for diagnosing developmental delays in early childhood

Assessment

• positioning
• handling

Resources

• Understanding Newborn Behaviour
• Neonatal Intensive Care Unit (NICU)
• Neonatal Respiratory Distress Syndrome