Sam's Notes (Week 4)

Question 1

What is the NICU, and who does it serve?

Answer 1

• The NICU is an intensive care unit for newborns with medical needs, serving both full-term (37 - 42 weeks) and preterm infants (< 37 weeks).
• Preterm = infants are at high risk medically and developmentally.

Question 2

What are some common comorbidities in babies who survive NICU care?

Answer 2

• Cerebral palsy (CP)
• sensory impairments
• intellectual learning challenges
• social/emotional challenges

Question 3

Describe Level 1 and Level 2 NICUs.

Answer 3

• Level 1 provides postnatal care and stabilization for infants born 35-37 weeks.
• Level 2 provides care for infants recovering after intensive care and offers CPAP or mechanical ventilation for < 24 hours.
• care for infants >/= 32 weeks gestation or >/= 1500g who do not need subspecialty care

Question 4

Describe Level 3 and Level 4 NICUs.

Answer 4

Level 3: NICU offers sustained life support and comprehensive care for critically ill infants.

• < 1500g (3.3lbs) or < 32 weeks

Level 4 includes complex surgeries and advanced neonatal care.

Question 5

What are some causes of prematurity?

Answer 5

Amniotic infection, maternal drug/alcohol use, increased maternal age, poor prenatal care, multiple gestations, preeclampsia, and genetic conditions.

Question 6

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Answer 6

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Question 7

What is the APGAR score and what does it assess?

Answer 7

The APGAR score is a newborn screening tool assessing

• appearance
• pulse
• grimace
• activity
• respiration

It is administered at 1, 5, and 10 minutes after birth.

Question 8

What equipment is commonly used in the NICU for temperature regulation?

Answer 8

Radiant warmers and isolettes (incubators) are used for infants to regulate body temperature.

Question 9

Describe gavage tubes used in the NICU.

Answer 9

• Gavage tubes, such as OG and NG tubes, are used to feed infants directly into the stomach.
• Transpyloric tubes are used for infants with GER or aspiration risks.

Question 10

What is ECMO and when is it used?

Answer 10

ECMO stands for extracorporeal membrane oxygenation, a heart and lung bypass machine used in cases of severe respiratory or cardiac failure.

Question 11

When does the vestibular nuclei fully develop?

Answer 11

fully developed by 20 weeks gestation

Question 12

Describe the auditory development in infants.

Answer 12

• By 28 weeks gestation, infants can hear at 40 dB.
• NICU noise should not exceed 45 dB to avoid disruptions in growth and cochlear damage.

Question 13

What are some environmental strategies for pain reduction in the NICU?

Answer 13

Dim lighting, reducing noise, swaddling, kangaroo care, and non-nutritive sucking.

Question 14

What are the Hammersmith and TIMP assessments used for in the NICU?

Answer 14

These assessments evaluate neuromotor development and motor performance in preterm infants to identify any neurological impairments.

Question 15

What is trauma-informed care in the NICU?

Answer 15

It involves understanding that families may be in crisis and aims to provide support that is sensitive to both the infant’s and family’s emotional needs.

Question 16

What are the signs of infant stress in the NICU?

Answer 16

Pale or flushed skin, glassy eyes, gasping for air, grimacing, fussiness, irregular breathing, and fluctuating muscle tone.

Question 17

What are the key roles of a physical therapist in the NICU?

Answer 17

Facilitating neurodevelopmental progress, providing positioning support, and educating families on infant care and therapeutic interventions.

Question 18

What is Bronchopulmonary Dysplasia (BPD) and its interventions?

Answer 18

• BPD is a chronic lung disease from underdeveloped lungs in preterm infants.
• Interventions include reducing environmental stimulation and supporting respiration.

Question 19

What orthopedic issues are common in the NICU?

Answer 19

• brachial plexus injury
• congenital hip dysplasia
• metatarsus adductus
• talipes equinovarus (clubfoot)

Question 20

What are common PT interventions for infants with orthopedic issues in the NICU?

Answer 20

ROM exercises, taping, splinting, and education on proper positioning to prevent contractures and promote motor development.

Question 21

Describe Moro and ATNR reflexes and their role in development.

Answer 21

• Moro reflex helps with fight-or-flight reactions
• ATNR assists with developing muscle tone and eye-hand coordination

Question 22

What are retained reflexes and their potential impacts?

Answer 22

Retained reflexes may indicate developmental issues, such as motion sickness, poor balance, or delayed rolling if not integrated by the typical age.

Question 23

What are some consequences of an unintegrated ATNR?

Answer 23

Poor midline development, difficulty with handwriting, and delayed rolling and crawling, which may lead to skeletal deformities.

Question 24

What is the Spinal Galant reflex, and what issues arise if it is not integrated?

Answer 24

• The Spinal Galant reflex helps with movement in the womb and during birth.
• If unintegrated, it can cause bed wetting, poor concentration, and scoliosis.

Question 25

Describe the Babinski reflex and its developmental significance.

Answer 25

* The Babinski reflex prepares feet for walking and influences lower extremity muscle tone. * Lack of integration may cause issues like flat feet or difficulty walking.

Question 26

What are the two phases of the gait cycle?

Answer 26

Swing (foot in the air) and stance (foot contact with the ground).

Question 27

What are the basic tasks of walking?

Answer 27

Weight acceptance, single limb support, and limb advancement.

Question 28

What are the subphases of gait during stance?

Answer 28

Initial contact, loading response, midstance, terminal stance, and preswing.

Question 29

What are the subphases of gait during swing?

Answer 29

Initial swing, midswing, and terminal swing.

Question 30

What factors contribute to the development of typical walking?

Answer 30

* stability in stance * foot clearance in swing * prepositioning of the foot * adequate step length * energy conservation

Question 31

What are the prerequisites for independent walking?

Answer 31

Adequate motor control, CNS maturation, sufficient ROM and strength, intact sensation, and muscle activation for pelvic stabilization.

Question 32

What are some characteristics of immature walking (ages 2.5 and younger)?

Answer 32

Decreased postural stability, decreased single leg stand time, slower walking speed, and a wide base of support.

Question 33

Describe biomechanical factors influencing gait development.

Answer 33

ROM, muscle strength, bone structure, and body composition, which all impact muscle activity and joint kinematics.

Question 34

What is a central pattern generator (CPG), and how does it relate to walking?

Answer 34

**CPG** circuits exist in the spinal cord and brainstem and organize the activation of muscles for locomotion.

Question 35

At what age does a mature gait pattern develop?

Answer 35

By **age 7**, with improvements in single stance duration, walking velocity, and step length.

Question 36

How do toddlers (9-15 months) typically walk?

Answer 36

Toddlers walk with small steps, increased cadence, wide base of support, and decreased postural stability.

Question 37

What happens to gait characteristics between 18-24 months?

Answer 37

Genu varus resolves, heel strike becomes consistent, and dynamic balance and strength improve.

Question 38

What gait characteristics are observed in 3-3.5-year-olds?

Answer 38

Narrowed BOS, tibiofemoral valgus, and a more mature heel-toe pattern.

Question 39

What are typical gait characteristics for a 6-7-year-old?

Answer 39

* neutral tibiofemoral angle * coordinated visual and vestibular systems * mature gait pattern

Question 40

What are the five determinants of mature walking?

Answer 40

Single stance duration, walking velocity, cadence, step length, and the ratio of pelvic span to ankle spread.

Question 41

How does body composition affect developmental gait in infants?

Answer 41

High fat content in infancy affects balance and muscle strength, which influences walking.

Question 42

What factors limit independent walking in toddlers?

Answer 42

Lack of extensor strength to support body weight during single limb stance and poor dynamic balance.

Question 43

How does motor control influence walking in early development?

Answer 43

Visual, proprioceptive, and vestibular systems must work together to bring the center of mass back to a stable position.

Question 44

How do visual and vestibular systems mature during gait development?

Answer 44

These systems mature between ages 10-12, enhancing postural control and motor activity.

Question 45

What is the significance of calcaneal eversion in toddlers?

Answer 45

Calcaneal eversion is present during early walking and resolves as balance and coordination improve.

Question 46

How do toddlers learn to navigate uneven surfaces?

Answer 46

They develop dynamic balance and strength, which lowers the center of mass and improves movement over obstacles.

Question 47

What is the importance of quad and gluteal muscle activation in gait?

Answer 47

These muscles provide stability in stance and are crucial for tasks like navigating stairs.

Question 48

What changes occur in gait between 3-7 years of age?

Answer 48

* improvements in postural control * decreased calcaneal eversion * better coordination of the lower extremities

Question 49

What are the benefits of video-assisted gait analysis in pediatrics?

Answer 49

It allows for multiple observations, frontal and sagittal views, and the ability to review gait mechanics in detail.

Question 50

How does muscle activation change with independent walking?

Answer 50

* Co-contraction of antagonist muscles decreases. * There is more selective activation of muscle groups during stance and swing phases.