Neonatal Physiotherapy Assessment

Introduction[edit | edit source]

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. [1] 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[2]

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[2]

Exam is done once the infant is medically stable[2]

Subjective[edit | edit source]

The subjective portion the NICU assessment involves getting a thorough history. The following chart below details areas that should be involved in the subjective portion of the exam and topics you may want to cover:

[2]
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

Objective[edit | edit source]

The goal of the objective portion of the physiotherapy assessment is to identify what activity limitations the infant is facing. In Using an ICF model, examples of activities for the infant to participate in the NICU include:

  • appropriately communicate,
  • held by parents,
  • feed,
  • sleep
  • ability to grow.[2]

Objective findings in the NICU entails a considerable amount of observation along with standardised exams.

Observation[edit | edit source]

The NICU setting relies heavily on observation as the infants are typically medically fragile and will not tolerate too much intervention time. Observing the newborn and their interaction within environment is called neurobehavioural observation. The following chart details areas to observe in the newborn and within those areas what is important information to take note of:

[2]
Areas to Observe Noteworthy Significance
Tone hypotonic, moving limbs against gravity, tight/stiff
Physiologic flexion can they get into physiologic flexion
Vitals heart rate, respiratory rate, skin colour, changes in vitals from interventions, stressors
Reflexes notice any; do they get stuck in a reflex position (ATNR), clonus
Range of motion active and passive range of motion of various joints
Posture tolerate a change in position
Developmental positions checking various positions at different times-what does tone
Quality of movement is it smooth, frequent or 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. * (providing supports when introducing stimuli)

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 postulates that infants are social beings communicating through behaviour in a non-random way. The scale assesses 53 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 a administered by NBO-trained healthcare practitioners and consists of 20 items that elucidate the infants visual, auditory, perceptual and self-regulatory abilities. The family-centred NBO aims to increase parental confidence and competence to promote a positive parent-infant relationship. [5][4]

Test of Infant Performance[edit | edit source]

The Test of Infant Motor Performance (TIMP) is video-based instrument for infants aged 3-18 months. Self-generated movements are recorded over an 80 items scale while the has a playful encounter with the examiner. for infants aged three to 18 months. regarding infant motor behaviour. The TIMP evaluates motor skills or motor milestones along with the quality of motor behaviour.[6]

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

The General Movement Assessment (GMA) is performed using a 3-5 minute video-recording or a direct observation of an alert infant spontaneous movement while lying awake on their back .[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 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. Due to its observation only procedure, the AIMS is clinically feasible.[10]

PEABODY Developmental Motor Scales[edit | edit source]

The Peabody Developmental Motor Scales-Second Edition (PDMS-2) was originally designed to detect developmental delay.[11] This tool is a reliable and valid instrument to assess fine motor and gross motor skills and to identify 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 assesses a child's development compared to the standardised norm. This extensive formal tool is used for infants and children 1 month-42 months. and helps diagnose developmental delay. [13][14]

Assessment[edit | edit source]

  • positioning
  • handling

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: https://www.brazelton.co.uk/courses/nbas/
  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. ↑ 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. ↑ 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. ↑ Balasundaram P. Bayley scales of infant and toddler development.[Updated 2021 Nov 24]. StatPearls [Internet]. StatPearls Publishing. 2022.
Retrieved from "https://www.physio-pedia.com/index.php?title=Neonatal_Physiotherapy_Assessment&oldid=325472"