Pediatrics Test 2 | NICU & Cerebral Palsy
Define NICU physical therapy: specialized care to medically fragile or premature infants in the Neonatal Intensive
Care Unit (NICU)
What is the goal of NICU physical therapy? support motor and sensory development during a critical period of growth
Typical patients in the NICU: •Premature infants (<37 weeks gestation)
•Infants with genetic or neuromuscular disorders
•Infants with orthopedic abnormalities (e.g., clubfoot, brachial plexus injury)
•Babies requiring prolonged intubation or surgeries
•Infants with congenital conditions or birth trauma
What is the role of a NICU physical therapy? •Promote normal motor development
•Encourage midline orientation, flexion, and self-regulation
•Support positioning and handling
•Monitor muscle tone, reflexes, and postural control
•Educate families and caregivers on safe handling, positioning, and bonding
•Collaborate with a multidisciplinary team to ensure holistic care
Role of a NICU physical therapist: motor development
Promote normal _______ development
Role of a NICU physical therapist: - midline orientation
Encourage ________ orientation, (flexion/extension), and - flexion
self-regulation
Role of a NICU physical therapist: handling
Support positioning and ________
Role of a NICU physical therapist: - reflexes
Monitor muscle tone, _______, and ______ control - postural control
Role of a NICU physical therapist: - safe handling
Educate families and caregivers on: - positioning
- bonding
Role of a NICU physical therapist: holistic
Collaborate with a multidisciplinary team to ensure
________ care
Primary goals of physical therapy in the NICU: discharge
Prepare infants for successful ________
Primary goals of physical therapy in the NICU: bonding
Empower caregivers through education and ________
Primary goals of physical therapy in the NICU: atypical
Prevent deformities and __________ posture
Common PT interventions in the NICU: - Positioning
- Handling
- Environmental Mod
- Family support
Grade A+ | Updated
, Pediatrics Test 2 | NICU & Cerebral Palsy
Common PT interventions in the NICU: - sidelying
Positioning: - flexed
- contained positions (nesting)
Common PT interventions in the NICU: - Gentle PROM
Handling: - midline orientation
- tummy time preparation
Common PT interventions in the NICU: - light and sound reduction
Environmental Mod: - swaddling
Common PT interventions in the NICU: - skin-to-skin
Family support: - caregiver coaching
- feeding
- positioning
Level 1: Basic newborn care- Healthy full-term infants (>35 - routine care
weeks gestation) - stabilization of sick newborn until transfer
Capabilities:
Level 1: Basic newborn care- Healthy full-term infants (>35 - general pediatricians
weeks gestation) - basic resuscitation and equipment
Staff and equipment:
Level II: Specialty Care- Premature (>32 weeks) - short term ventilation
moderately ill infants - IV therapy
- phototherapy
Capabilities: - stabilization for transfer
Level II: Specialty Care- Premature (>32 weeks) - pediatricians & neonatologists
moderately ill infants - CPAP, IV fluids, feeding support
Staff and equipment:
Level III: Subspecialty NICU- >32 weeks gestation or - advanced respiratory support (including mechanical ventilation)
critically ill newborns - minor surgical procedures
Capabilities
Level III: Subspecialty NICU- >32 weeks gestation or - full time neonatologists
critically ill newborns - access to pediatric sub-specialists
Staff and equipment:
Level IV: Regional NICU (highest level)- All infants - full range of neonatal care
including extreme prematurity and complex cases - on-site complex surgery
- ECMO and high-frequency ventilation
Capabilities:
Level IV: Regional NICU (highest level)- All infants - 24/7 neonatology & pediatric surgical specialists
including extreme prematurity and complex cases - advanced imaging
Staff and equipment:
Level I Nursery is as defined as..... well-baby nursery
Level I Nursery: newborns that require minimal observation or care
This is for what populations?
Grade A+ | Updated
, Pediatrics Test 2 | NICU & Cerebral Palsy
Level I Nursery: stabilization
Can perform resuscitation and ________ of a late preterm
infant
Level I Nursery: isolette
Warming done in an ________, phototherapy, circumcision
Level I Nursery: small community hospitals
Where are these located?
Level II Nursery (specialty): immediate care
this is ________ care
Level II Nursery (specialty): level III
Step down from a level _______ nursery
Level II Nursery (specialty): - IV medications
Things done here are ______ medications, tube ________ - tube feedings
,and _______ support - oxygen support
Level II Nursery (specialty): - neonatologists
What kind of staff work here? - neonatal nurses
Level II Nursery (specialty): community hospitals
This level of nursery is contained in what areas?
Level II Nursery (specialty): interim
The two levels are based on the capacity to provide
assisted ventilation for an ________ time
Level III Nursery (subspecialty): NICU at specialized hospitals
This level is defined as what kind of facility?
Level III Nursery (subspecialty): the sickest and most fragile
This facility provides highly specialized services for who?
Level III Nursery (subspecialty): - neonatologists
Who would you find working in this area? - fellows
- specially trained nurses
Level III Nursery (subspecialty): - advanced diagnostic testing
This facility provides complex medical interventions, - respiratory support
advanced ________ testing, surgery, and ________
support
Level III Nursery (subspecialty): as long as needed
Able to sustain life support for how long?
Level IV- Regional NICU (highest level): - all infants
What patients can be found here? - extreme prematurity and complex cases
Grade A+ | Updated
, Pediatrics Test 2 | NICU & Cerebral Palsy
Level IV- Regional NICU (highest level): full-range
This instituted provides a ___________ range of neonatal
care
Level IV- Regional NICU (highest level): complex surgery
On-site _______ surgery
Level IV- Regional NICU (highest level): high-frequency ventilation
May provide ECMO and ____________ ventilation
Level IV- Regional NICU (highest level): - 24/7 neonatology
Who works here? - pediatric surgical specialists
Level IV- Regional NICU (highest level): advanced
These institutes utilize _______ imaging
Evolution of the philosophy of care in the NICU: - cultural and technological
Over the last 30 years, significant advances have been - evidence-based practice
made in what areas?
Evolution of the philosophy of care in the NICU: - mortality
there has been a decrease in _______ and ________ in - morbidity
the last decade
Evolution of the philosophy of care in the NICU: follow-up programs
there has been an increase in _________ programs and
early intervention
Optimal NICU care in the 21st century looks like what? - developmentally supportive
- family focused
- culturally sensitive
- evidence based
Physical Therapy in the NICU: - functional
This addresses _________ and _______ integrity of body - structural
parts and systems
Physical Therapy in the NICU: motor activities
This promotes the development of postural and
_________ activities
Physical Therapy in the NICU: the infant and the environment
This promotes appropriate interaction between what two
things?
Physical Therapy in the NICU: - Family
Promotes interaction with what caregivers/providers? - NICU staff
- Consultants
Synactive Theory: Psychologist Heidelise Als (Boston's Children's Hospital)
Who proposed the synactive theory?
Synactive Theory: understand and interpret the behavior of preterm infants
The synactive model was used to do what?
Grade A+ | Updated
Define NICU physical therapy: specialized care to medically fragile or premature infants in the Neonatal Intensive
Care Unit (NICU)
What is the goal of NICU physical therapy? support motor and sensory development during a critical period of growth
Typical patients in the NICU: •Premature infants (<37 weeks gestation)
•Infants with genetic or neuromuscular disorders
•Infants with orthopedic abnormalities (e.g., clubfoot, brachial plexus injury)
•Babies requiring prolonged intubation or surgeries
•Infants with congenital conditions or birth trauma
What is the role of a NICU physical therapy? •Promote normal motor development
•Encourage midline orientation, flexion, and self-regulation
•Support positioning and handling
•Monitor muscle tone, reflexes, and postural control
•Educate families and caregivers on safe handling, positioning, and bonding
•Collaborate with a multidisciplinary team to ensure holistic care
Role of a NICU physical therapist: motor development
Promote normal _______ development
Role of a NICU physical therapist: - midline orientation
Encourage ________ orientation, (flexion/extension), and - flexion
self-regulation
Role of a NICU physical therapist: handling
Support positioning and ________
Role of a NICU physical therapist: - reflexes
Monitor muscle tone, _______, and ______ control - postural control
Role of a NICU physical therapist: - safe handling
Educate families and caregivers on: - positioning
- bonding
Role of a NICU physical therapist: holistic
Collaborate with a multidisciplinary team to ensure
________ care
Primary goals of physical therapy in the NICU: discharge
Prepare infants for successful ________
Primary goals of physical therapy in the NICU: bonding
Empower caregivers through education and ________
Primary goals of physical therapy in the NICU: atypical
Prevent deformities and __________ posture
Common PT interventions in the NICU: - Positioning
- Handling
- Environmental Mod
- Family support
Grade A+ | Updated
, Pediatrics Test 2 | NICU & Cerebral Palsy
Common PT interventions in the NICU: - sidelying
Positioning: - flexed
- contained positions (nesting)
Common PT interventions in the NICU: - Gentle PROM
Handling: - midline orientation
- tummy time preparation
Common PT interventions in the NICU: - light and sound reduction
Environmental Mod: - swaddling
Common PT interventions in the NICU: - skin-to-skin
Family support: - caregiver coaching
- feeding
- positioning
Level 1: Basic newborn care- Healthy full-term infants (>35 - routine care
weeks gestation) - stabilization of sick newborn until transfer
Capabilities:
Level 1: Basic newborn care- Healthy full-term infants (>35 - general pediatricians
weeks gestation) - basic resuscitation and equipment
Staff and equipment:
Level II: Specialty Care- Premature (>32 weeks) - short term ventilation
moderately ill infants - IV therapy
- phototherapy
Capabilities: - stabilization for transfer
Level II: Specialty Care- Premature (>32 weeks) - pediatricians & neonatologists
moderately ill infants - CPAP, IV fluids, feeding support
Staff and equipment:
Level III: Subspecialty NICU- >32 weeks gestation or - advanced respiratory support (including mechanical ventilation)
critically ill newborns - minor surgical procedures
Capabilities
Level III: Subspecialty NICU- >32 weeks gestation or - full time neonatologists
critically ill newborns - access to pediatric sub-specialists
Staff and equipment:
Level IV: Regional NICU (highest level)- All infants - full range of neonatal care
including extreme prematurity and complex cases - on-site complex surgery
- ECMO and high-frequency ventilation
Capabilities:
Level IV: Regional NICU (highest level)- All infants - 24/7 neonatology & pediatric surgical specialists
including extreme prematurity and complex cases - advanced imaging
Staff and equipment:
Level I Nursery is as defined as..... well-baby nursery
Level I Nursery: newborns that require minimal observation or care
This is for what populations?
Grade A+ | Updated
, Pediatrics Test 2 | NICU & Cerebral Palsy
Level I Nursery: stabilization
Can perform resuscitation and ________ of a late preterm
infant
Level I Nursery: isolette
Warming done in an ________, phototherapy, circumcision
Level I Nursery: small community hospitals
Where are these located?
Level II Nursery (specialty): immediate care
this is ________ care
Level II Nursery (specialty): level III
Step down from a level _______ nursery
Level II Nursery (specialty): - IV medications
Things done here are ______ medications, tube ________ - tube feedings
,and _______ support - oxygen support
Level II Nursery (specialty): - neonatologists
What kind of staff work here? - neonatal nurses
Level II Nursery (specialty): community hospitals
This level of nursery is contained in what areas?
Level II Nursery (specialty): interim
The two levels are based on the capacity to provide
assisted ventilation for an ________ time
Level III Nursery (subspecialty): NICU at specialized hospitals
This level is defined as what kind of facility?
Level III Nursery (subspecialty): the sickest and most fragile
This facility provides highly specialized services for who?
Level III Nursery (subspecialty): - neonatologists
Who would you find working in this area? - fellows
- specially trained nurses
Level III Nursery (subspecialty): - advanced diagnostic testing
This facility provides complex medical interventions, - respiratory support
advanced ________ testing, surgery, and ________
support
Level III Nursery (subspecialty): as long as needed
Able to sustain life support for how long?
Level IV- Regional NICU (highest level): - all infants
What patients can be found here? - extreme prematurity and complex cases
Grade A+ | Updated
, Pediatrics Test 2 | NICU & Cerebral Palsy
Level IV- Regional NICU (highest level): full-range
This instituted provides a ___________ range of neonatal
care
Level IV- Regional NICU (highest level): complex surgery
On-site _______ surgery
Level IV- Regional NICU (highest level): high-frequency ventilation
May provide ECMO and ____________ ventilation
Level IV- Regional NICU (highest level): - 24/7 neonatology
Who works here? - pediatric surgical specialists
Level IV- Regional NICU (highest level): advanced
These institutes utilize _______ imaging
Evolution of the philosophy of care in the NICU: - cultural and technological
Over the last 30 years, significant advances have been - evidence-based practice
made in what areas?
Evolution of the philosophy of care in the NICU: - mortality
there has been a decrease in _______ and ________ in - morbidity
the last decade
Evolution of the philosophy of care in the NICU: follow-up programs
there has been an increase in _________ programs and
early intervention
Optimal NICU care in the 21st century looks like what? - developmentally supportive
- family focused
- culturally sensitive
- evidence based
Physical Therapy in the NICU: - functional
This addresses _________ and _______ integrity of body - structural
parts and systems
Physical Therapy in the NICU: motor activities
This promotes the development of postural and
_________ activities
Physical Therapy in the NICU: the infant and the environment
This promotes appropriate interaction between what two
things?
Physical Therapy in the NICU: - Family
Promotes interaction with what caregivers/providers? - NICU staff
- Consultants
Synactive Theory: Psychologist Heidelise Als (Boston's Children's Hospital)
Who proposed the synactive theory?
Synactive Theory: understand and interpret the behavior of preterm infants
The synactive model was used to do what?
Grade A+ | Updated
