Nicole VanderZouwen, MS, OTRMeghan Sweitzer, MS, OTRDenise Meier, MA, OTR/L

Grand Valley State University

“Occupational Therapists’ Views Regarding Premature Infant Transition and Care”

GVSU Graduate OT StudentsNicole VanderZouwen Meghan Klos Sweitzer

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Objectives To discuss the OT role in transition process of

premature infant from NICU to home To report what OTs working in this capacity feel is

important regarding roles, assessments, and interventions

To add to current OT research regarding premature infants

To collaborate with other EI professionals about training and education

To demonstrate how “questions” can be answered by this level of research

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What is Occupational Therapy?

Occupational therapists assist people across the lifespan to participate in activities they want and need to do through use of therapeutic occupations (aota.org): Self Care Play/Leisure Work Rest

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OT and Early Intervention

Referral Process Initial Evaluation Determine areas of need Intervention Discharge or Referral for other services

Focus on Community-Based practice

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Introduction How did this study come to be?

This research was funded by Part C of the Individuals with Disabilities Education Act through a Faculty Grant from the Early On Center for Higher Education, an Innovative Project of Clinton County Regional Educational Service Agency.

How does it apply to professionals in the field?

Background • Approximately 1 in 8 children born prematurely

• Infants initially cared for by health professionals in the NICU

• Occupational therapist member of NICU team

• Infants in the NICU being discharged earlier

• Needs at time of discharge:

-Sensory modulation -Oral motor development

-Motor development -Feeding

-Coping behaviors -Play

How do caregivers feel at time of discharge?

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Research Questions

• What services do occupational therapists most frequently provide and deem most beneficial for premature infants and their families up to 12 months post-discharge from the NICU?

• What are the primary roles perceived to be valuable by OTs working with premature infants up to 12 months post-discharge?

• What evaluation tools do OTs feel are most beneficial for assessing premature infants up to 12 months post-discharge?

Problem Statement

• Limited research concerning premature infants’ transition.

• Limited research produced regarding the benefits of OT services and the role of the OT in providing treatment for premature infants after being discharged from the NICU.

• Therefore, a clear understanding of OT services, roles, and assessments with premature infants in the community is needed.

Purpose

• Add to the current literature of occupational therapy services provided to premature infants during their transition to the home setting

• Provide a base for future research concerning the most beneficial OT services for premature infants and their caregivers

• Provide support for OT’s role in premature infant’s transition from the NICU to the home setting

Significance

• Guide NICU and community based OTs with treatment practices

• Provide evidence about favorable services for the premature infant population will also provide a strong rationale as to the importance of OT services in the NICU and community

• Support OT roles and services for third party reimbursement

• Inform stakeholders about specific training and education wanted and needed

Literature Review Vulnerabilities of Preterm InfantsBlackburn (1995)- Common complications : Infection, cardiorespiratory problems, sudden infant death syndrome (SIDS), gastrointestinal difficulties, hernias, anemia, physical deformities due to NICU care, tone and movement abnormalities, learning problems, delayed fine motor abilities, and sensory disorders (e.g. vision, hearing, speech)- “At risk” population who may require services short- or long-term

Case-Smith, Butcher, and Reed (1998)- Significant difference between preterm infants’ and full-term infants’ Sensory Rating Scale summary scores (i.e. total of touch, movement, hearing, vision, and temperament) and sensitivity to touch

Literature ReviewNICU vs. Home Environment

Aucott, Donohue, Atkins, & Allen (2002); American Occupational Therapy Association (2006); Cantu (2004)- NICU environment vastly different from the womb- NICU vastly different from the home environment

Segal and Beyer (2006)- Barriers to home program interventions- Parental adherence to home treatment programs were evaluated

Literature ReviewTransitioning from NICU to Home Setting

Griffin and Abraham (2006)

- Parents need time to practice to transfer skills from NICU to the Home

Sheikh, O’Brien, & McCluskey-Fawcett (1993)

- Disconnect between staff and parent views of teaching practices and learning during discharge from the NICU

Literature ReviewThe Role of the OT

Colyvas, Sawyer, & Campbell (2010)

- To provide education about premature infant roles, routines, occupations through participatory approaches

Caretto, et al. (2000)

- To provide parent education for infant feeding

Literature ReviewServices Provided by OTs Assessments/EvaluationsSubramaniam and Reid (2003); Coata, Engel-Hoek, & Bos, (2008); Howe, et al. (2008); Einarsson-Backes and Stewart (1992)- Assessment : observations, feeding assessment, and neuromotorassessments

InterventionsHwang, et al. (2010); Cochrane (1986); Koldewijn, et al. (2005)- Feeding support, help regulate sensory input (vestibular-proprioceptive), and provide neurodevelopmental support

Importance to Study

• Transition from the well supported and resourceful NICU to the home setting is demanding time for families

• Many evaluation tools utilized (observation)

• Specific areas of need for premature infants and their caregivers

• Evidence regarding OT services most useful post NICU discharge will allow stakeholders to provide education and learning opportunities

Study Design • Phenomenological, retrospective, cross-sectional study

• Gather qualitative data through an interview format

• Telephone interviews

• Series of 10 questions

Participants & Sampling Methods • Sample population: 7 practicing, community-based

occupational therapists working with premature infants in Michigan

• Inclusion criteria: • Licensed & registered OT treating premature infants within 12

months post-discharge from NICU

• Michigan

• Have 3+ years of experience treating premature infants

• Self-designed interview

• Qualitative data

• Pilot test

• The interviews took approximately 15-20 minutes

• Conducted from Cook DeVos Center for Health Sciences

Instrumentation

Validity • Pilot Study

• Both researchers involved in interview

• 3 OT professionals to interpreted and analyzed the interview questions, study design, and methodology

• Participants were e-mailed a summary of the findings from their respective interview

• Research committee reviewed all phases of the study

Procedures • Obtaining participants -intermediate school districts, early intervention programs,

and NICUs in Michigan

• Contacted the participants by phone to obtain initial consent

• Emailed confirmation

• Informed consent forms included

• Phone interview at designated time

• Recorded

• Written script for interviewers

• Summary emailed to the interviewee to determine the accuracy of the data

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Results

Themes & 9 sub-themes

ccupational Therapy InterventionsSub-themes: Evaluation

Feeding

Physical Treatment

Sensory Treatment

esults (cont.)

SupportSub-themes: Medically-based Professionals

Occupational Therapists

Education

Results (cont.)

FamilySub-themes: Fears

Needs

Discussion uestion 1:at do community-based occupational therapists believe their roles are erning the transition process for premature infants up to 12 months post-

harge?”

pport

erpersonal relationship

ucator

monstration, Facilitation & Discussion (educate)

ticipation-based approach

les established through experience, co-workers, & continuing education

Question 2:What services do community-based occupational therapists most

quently provide and deem most beneficial for premature infants and eir families up to 12 months post-discharge from the NICU?”

ducation - most frequently used

eeding techniques

ositioning

esources & support

Question 3:What evaluation tools do community-based occupational therapists feel e most beneficial for premature infants up to 12 months post-charge?”

Observation – most frequent

Peabody Developmental Motor Scale

Infant/Toddler Sensory Profile

A need for more appropriate assessment tools

Application to OT and Early On Training and education for OTs and other personnel Specific intervention techniques in the areas of positioning, feeding and sensory abilitiesExplore use of more standardized assessment techniquesDevelop relevant evaluation tools Prepare service providers to function as support and information givers during transition processConsider how to bridge the transition from NICU to home based services

Limitations Small sample size

Female OTs represented

Sample from Michigan only

Participants treated low numbers of premature infants

Self-report interviews

Retrospective study

Conclusions Transition from NICU to the community is a difficult experience for a premature infant and family

OT vital member of treatment team

OT may provide support to ease the transition

Services commonly include: evaluation, feeding, physical treatment & sensory treatment

Need more evidenced-based research

Questions?

Referencesican Occupational Therapy Association. (2006). Specialized skills for occupational therapy practice in the neonatal intensive care unit. American Journal of Occupational Therapy, 60(6), 659‐668.

tt, S., Donohue, P. K., Atkins, E., & Allen, M. C. (2002). Neurodevelopmental care in the NICU. Mental Retardation and Developmental Disabilities Research  Reviews, 8, 298‐308.

burn, S. (1995). Problems of preterm infants after discharge. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 24(1), 43‐49.

, C. O. (2004). OT in the NICU: Newborn intervention. Exceptional Parent, 34(8), 60‐62.

to, V., Topolski, K. F., Linkous, C. M., Lowman, D. K., & Murphy, S. M. (2000). Current parent education on infant feeding in the neonatal intensive care unit: The role of the occupational therapist. American Journal of Occupational Therapy, 54(1), 59‐64.

Smith, J., Butcher, L., & Reed, D. (1998). Parents’ report of sensory responsiveness and temperament in preterm infants. American Journal of Occupational Therapy, 52(7), 547‐555.

as, J. L., Sawyer, B., & Campbell, P. H. (2010). Identifying strategies early intervention occupational therapists use to teach caregivers. American Journal of Occupational Therapy, 64(5), 776‐785.

, S. P., Engel‐Hoek, L. & Bos, A. F. (2008). Sucking and swallowing in infants and diagnostic tools. Journal of Perinatology, 28, 247‐257.

sson‐Backes, L. M. & Stewart, K. B. (1992). Infant neuromotor assessments: A review and preview of selected instruments. American Journal of Occupational Therapy, 46(3), 224‐232.

n, T. & Abraham, M. (2006). Transition to home from the newborn intensive care unit: Applying the principles of family‐centered care to the discharge process. Journal of Perinatal & Neonatal Nursing, 20(3), 243‐249.

T., Lin, K., Fu, C., Su, C., & Hsieh, C. (2008). A review of psychometric properties of feeding assessment tools used  n neonates. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 37, 338‐349.

 Y., Lin, C., Coster, W., Bigsby, R. & Vergara, R. (2010). Effectiveness of cheek and jaw support to improve feeding performance of preterm infants. American Journal of Occupational Therapy, 64(6), 886‐894.

wijn, K., Wolf, M. J., van Wassenaer, A., Beelen, A., de Groot, I. J. M., & Hedlund, R. (2005). The infant behavioral assessment and intervention program to support preterm infants after hospital discharge: A pilot study. Developmental Medicine and Child Neurology, 47(2), 105‐112.

R. & Beyer, C. (2006). Integration and application of a home treatment program: A study of parents and occupational therapists. American Journal of Occupational Therapy, 60(5), 500‐510.

, L., O’Brien, M., & McCluskey‐Fawcett, K. (1993). Parent preparation for the NICU‐to‐home transition: Staff and parent perceptions. Children’s Health Care, 22(3), 227‐239.

maniam, K. & Reid, D. (2003). Knowledge use among occupational therapists for infant feeding assessments. Canadian Journal of Occupational Therapy, 70(4), 243‐249.

References, cont.