I. Gross motor development
Role of the neonatal physical therapist
The role of the physical therapist (PT) in a neonatal intensive care unit (NICU), transitional care unit, or follow-up clinic is to evaluate and treat the sensorimotor function of the developing infant. Physical therapists trained to work in this clinical area are not only considered specialists in the multifaceted aspects of infant development, but are also acute care specialists, with extensive clinical expertise in dealing with critically ill pediatric patients. The purpose of an evaluation by a neonatal PT is to
Recognize musculoskeletal impairments.
Identify positioning techniques to improve flexion.
Determine ways to enhance neurobehavioral organization through adaptations in the infant's environment.
The physical therapist's goal of promoting an infant's sensorimotor development needs to be addressed as soon as the parent and the infant are stable after birth. Providing positioning and environmental recommendations to the parents and nursing team can be instrumental in preventing posture and movement deviations typically seen in acutely ill infants. A PT is often one of the first team members to educate parents on the specific developmental needs of the “high-risk infant.”
The typical patient population seen by the neonatal PT can be divided in two main categories: preterm and sick term infants. These patients are often termed high-risk infants because, although their early life experiences are very different, they show similar posture and movement deviations that can lead to delays in gross motor development. These deviations include
An overall extension bias in both posture and movement (Figure 44-1)
Lack of varied and vigorous spontaneous movement, especially flexion against gravity
These tendencies are the result of the infant's medical diagnoses, as well as a result of prolonged illness/immobility in the NICU.
Extension bias of lower extremities. (Image used under license from Shutterstock.com)
Normal developmental sequence of gross motor skills
The fetal environment can strongly influence physiologic development throughout infancy and early childhood. The following is a general guideline for motor milestones typically achieved in the first 6 years of life. Variability within the provided ranges can be expected.
0 to 2 Months
Kicks legs alternately while in supine
Bends and straightens arms
From right or left side, rolls to supine
Turns head cheek to cheek in prone
May lift head to ~45? in prone
Bears weight through flat feet in supported standing with knees bent
Holds head upright in supported sitting for several seconds
3 to 4 Months
Holds head in midline and brings hands to midline/mouth while in supine
Smooth (alternating or together) movements in arms and legs
Grabs knees by flexing trunk
Lifts head/trunk 45? to 90? off the surface in prone with weight on forearms
Rolls from prone to supine and may be able to roll supine to prone
Holds head steady ...
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