Pre-clinical FTP 303 and 304 Importance of dev phases, dev delay and PREMATURITY Jan 2024.pdf

Milestone revision & developmental delay Anri Human Child health and Paediatrics Physiotherapy department  Milestone revision Please watch videos available on pathways.org: 0-3 months: adapt to outside world 4-6 months: F, E against gra...

Milestone revision & developmental delay Anri Human Child health and Paediatrics Physiotherapy department  Milestone revision Please watch videos available on pathways.org: 0-3 months: adapt to outside world 4-6 months: F, E against gravity 7-9 months: Locomotion, mobile (rotation) 10-12 months: Refine mvt, balance (dissociation) Document your observation for each: what do you see? what is new/surprising? Link with reflexes and other outcome measures  Importance of developmental phases Head control (near senses) new perspective, promotes eye control (explore), overflow, other mvts Hip F, trunk rotation (Pedalling up and downhill) Strength, balance, rotation, other mvts Rolling (mm memory, mobile) Trunk mobility (L & R), stability, dissociation, WBL [which side do you prefer to roll to?]  Importance of developmental phases cont. Crawling (obstacle course) L & R side, integrate Sitting (BOS, weightshift, trucks) Postural reactions, balance Grasping (massage) Hands linked with language centres, total development, ADL Positive re-inforcement/praise maximises learning process (1:18) BabyGym: brain and body gym for babies (Dr. Melodie de Jager)  Objective outcome measures Alberta infant motor scale (AIMS) (until 18 months) 4 positions (prone, supine, sitting and standing); 58 items Motor, posture, WB and ant-gravity movement Bayley Scales of Infant Toddler development III (1-42 months) Developmental fx: Cognitive; language; motor; social-emotional and adaptive behaviour NB: For a list of Paediatric Ax tools (ICF) www.pediatricapta.org Hammersmith [HNNE; HINE]  Facilitation of developmental delay Group work (n=7) ❑ Head control ❑ Rolling ❑ Sitting (and reaching out) ❑ Crawling ❑ Sit to stand ❑ Cruising, Walking ❑ Hand function (Fine motor) Complications of prematurity Anri Human Child health and Paediatrics  PREMATURITY ? Please also revise “In the womb” and “Science of babies” questionnaires  Let’s have some fun! PVL ROP CLD BPD IVH PDA IRDS  Learning objectives Know the classifications according to birth weight Know the definition of prematurity Know the indications for admitting a patient to NICU Understand and know the complications of prematurity and associated conditions (acute, medium and long-term) Know and understand definitions related to complications of prematurity Know and understand the role of the physiotherapist (assessment, contra-indications and principles of treatment) Adapt for prematurity (corrected age) Importance of kangaroo care  Introduction and Your background thoughts? Born at 23 weeks and 6 days (National Geographic) https://www.youtube.com/watch?v=sL24-nwMQ6Q Follow up on 27 week born premature baby (Oprah) https://www.youtube.com/watch?v=3DOrdP4H8SA  Prematurity & birth weight < 37 w LBW < 2500g (normal range?) VLBW < 1500g Extremely LBW < 1000g Incredibly LBW < 750g  Risk factors (etiology) History of prematurity Intra-uterine infection; Intra-uterine growth restriction (IUGR) Multiple births Pre-eclampsia (HT; proteinurea) Gestational diabetes Problems with cervix, placenta, uterus Preterm premature ruptures of membranes (PPROM) Lifestyle/health/nutrition Remember to add these to your history taking  NICU (general) Aims: ❑ decrease stress, decrease mech. vent time, decrease O2 requirements (remember meconium aspiration?) ❑ increase weightgain - Premature: special care - Very Low Birth Weight (majority) “feeders & growers” - Extremely Low birth weight stay longer! - Many changes regarding survival rate, 30-90 days NICU - Rx such as steroids (cortisone): surfactant, cardiopulmonary complications, risk of IVH (72 hours)  NICU (Indications) When are they mostly admitted? ✓ Prematurity, low birth weight Can affect autonomic system, movement, state and social ✓ Meconium aspiration/birth asphyxia interaction ✓ Perinatal problems (jaundice/hyperbilirubinaemia) ✓ Congenital abnormalities/malformations ✓ (DS, SB) ✓ HIV (HIVE) ✓ Infections (pneumonia, meningitis) ✓ GIT/metabolic complications (NEC) ✓ Respiratory complications (IRDS) ✓ Cardiovascular complications (PDA; Tetralogy of Fallot) ✓ CNS/convulsions/HIE ✓ Swallowing, temperature regulation  Complications All systems can be affected…. GIT: Necrotising enterocolitis (NEC) Cardiac: Patent ductus arteriosus (PDA) Main pulm. artery, desc. aorta,