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LEARNING OBJECTIVES
On completion of this chapter, the reader will be able to:
Describe the evolution of the neonatal physical therapy subspecialty and origin of neonatology fellowship training for pediatric physical therapists.
Recognize the high risk of providing neonatal therapy practice without mentored clinical training and the restrictions for student therapists, new graduates, and generalist physical therapists.
Identify complex medical conditions associated with preterm birth and describe long-term motor and developmental outcomes.
Determine critical family and cultural factors for inclusion in neonatal physical therapy practice.
Discuss components of the examination/evaluation and intervention processes used by physical therapists in the neonatal intensive care unit.
Analyze the neonatal physical therapist role in transition of hospitalized infants to home and coordination of unique outpatient service needs.
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This chapter provides an overview of neonatal physical therapy for infants with complex medical conditions requiring neonatal intensive care. Selected neonatal physical therapy examination and intervention procedures are reviewed. Throughout the chapter, themes of collaborative partnership with parents and interdisciplinary team members are emphasized as well as individualization of neonatal developmental care and neuroprotection during neonatal physical therapy procedures. This individualization occurs through judicious selection of procedures depending on the maturation level, medical acuity, physiologic stability, and behavioral tolerance of the infant combined with the subspecialty training and experience levels of the therapist.
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NEONATAL PHYSICAL THERAPY SUBSPECIALTY
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In the United States, the pediatric subspecialty of neonatal physical therapy emerged in the early to mid-1970s. With increasing survival of infants born prematurely, pediatric physical therapists working in large, regional hospitals and children’s hospitals were invited to participate as care team members to address musculoskeletal and developmental needs of this increasing population of hospitalized newborns and infants. In nationwide surveys of practice in 19801 and 1990,2 examination and intervention for high-risk infants were categorized by pediatric physical therapists as procedures in advanced-level practice requiring advanced-level competencies. The advanced practice perspective was derived from pediatric physical therapists’ recognition that unique knowledge and skills for ethical practice in neonatal care units were essential for minimizing risks and adverse reactions from unintended overstimulation and cardiorespiratory consequences (eg, oxygen desaturation, bradycardia, tachypnea) during and after neonatal therapy procedures by well-intentioned therapists with general pediatrics or adult therapy competency.
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The first clinical practice guidelines for physical therapists working in neonatal intensive care units were developed in 1989 and 1999 by expert panels representing the American Physical Therapy Association, Section on Pediatric Physical Therapy.3,4 In subsequent revisions, the advanced practice roles and competencies were expanded,5 and theoretical and evidence-based practice frameworks6 were added to the Neonatal Physical Therapy Practice Guidelines. Appropriate physical therapy student observational experiences in neonatal intensive care units were later described and prepared as an addendum to the practice guidelines by Rapport et al.7
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Postgraduate clinical training models with mentored, individualized ...