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Clinical Practice Protocol of Creative Music Therapy for Preterm Infants and Their Parents in the Neonatal Intensive Care Unit
Published on: January 7, 2020
Factors Influencing Receipt and Type of Therapy Services in the NICU
Christiana D Butera1, Shaaron E Brown2, Jennifer Burnsed3
1Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90033, USA.
Insights
Neonatal intensive care unit (NICU) therapy services for very preterm infants vary. Referral predictors include medical and developmental factors, not just initial assessments, to ensure optimal outcomes.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Rehabilitation Medicine
Background:
- Optimizing long-term outcomes for very preterm infants requires understanding current neonatal intensive care unit (NICU) therapy services.
- Identifying predictors for therapy referral is essential for effective intervention in this vulnerable population.
Purpose of the Study:
- To analyze the type and frequency of NICU therapy services provided to very preterm infants.
- To determine predictors of referral for occupational therapy, physical therapy, and speech therapy.
Main Methods:
- Retrospective analysis of medical records for 83 very preterm infants (<32 weeks gestational age).
- Data included race, neonatal medical index, neuroimaging, and therapy session frequency.
- Standardized assessments administered: Test of Infant Motor Performance (TIMP) and General Movement Assessment (GMA).
Main Results:
- Therapy session frequency (occupational, physical, speech) varied significantly by type and discharge week.
- Infants identified as high-risk for cerebral palsy via baseline GMA received more therapy sessions.
- Baseline GMA scores predicted occupational therapy sessions, but not physical or speech therapy.
- Neonatal Medical Index and TIMP scores did not predict overall therapy service utilization.
Conclusions:
- Referral for NICU therapy services should be based on a combination of medical and developmental risk factors, alongside therapy assessment outcomes.
- General Movement Assessment is a valuable tool for predicting the need for occupational therapy in very preterm infants.
- Further research is needed to refine referral criteria for comprehensive therapy services in the NICU.
Abstract:
Understanding the type and frequency of current neonatal intensive care unit (NICU) therapy services and predictors of referral for therapy services is a crucial first step to supporting positive long-term outcomes in very preterm infants. This study enrolled 83 very preterm infants (<32 weeks, gestational age mean 26.5 ± 2.0 weeks; 38 male) from a longitudinal clinical trial. Race, neonatal medical index, neuroimaging, and frequency of therapy sessions were extracted from medical records. The Test of Infant Motor Performance and the General Movement Assessment were administered. Average weekly sessions of occupational therapy, physical therapy, and speech therapy were significantly different by type, but the magnitude and direction of the difference depended upon the discharge week. Infants at high risk for cerebral palsy based on their baseline General Movements Assessment scores received more therapy sessions than infants at low risk for cerebral palsy. Baseline General Movements Assessment was related to the mean number of occupational therapy sessions but not physical therapy or speech therapy sessions. Neonatal Medical Index scores and Test of Infant Motor Performance scores were not predictive of combined therapy services. Medical and developmental risk factors, as well as outcomes from therapy assessments, should be the basis for referral for therapy services in the neonatal intensive care unit.
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