Introducing the i-Rainbow©: An Evidence-Based, Parent-Friendly Care Pathway Designed for Critically Ill Infants in the NICU Setting.

PURPOSE: This study investigated the feasibility and effectiveness of a novel, evidence-based developmental care pathway to be used by health care providers and parents in the neonatal intensive care unit (NICU) setting. The i-Rainbow is based on current evidence and responds to individual infant health status. It is not based on infant age. METHODS: After development and implementation of the i-Rainbow, pre- and postimplementation nurse and parent survey data were collected and pre- and post-developmental care rates were compared. RESULTS: After i-Rainbow implementation, disagreement among providers on appropriate developmental care interventions significantly decreased, total minutes of daily developmental care and swaddled holding increased significantly, and parents reported that they would recommend the tool. CONCLUSION: The i-Rainbow is a unique, parent-friendly, infant-based tool that guides sensory interventions in the NICU by staging infants based on cardiorespiratory status and physiologic maturity, not age. The i-Rainbow improved the delivery of developmental care activities in our unit and was well received by parents and nurses. VIDEO ABSTRACT: Supplemental Digital Content available at: http://links.lww.com/PPT/A516.

Risk Assessment and Early Mobilization Pathway Following Pediatric Tracheostomy: A Pilot Study.

OBJECTIVES/HYPOTHESIS: To confirm the standard of care pertaining to postoperative mobilization practices following initial tracheostomy, to establish face validity of novel early mobilization tools, and to conduct a safety and feasibility pilot study. STUDY DESIGN: Multi-institutional survey and prospective cohort study. METHODS: Experts at our tertiary-care children's hospital developed an Early Pediatric Mobility Pathway for tracheostomy patients utilizing a novel risk-assessment tool. Surveys were distributed to professional colleagues in similar children's hospitals to establish face validity and incorporate respondent feedback. Additional surveys were disseminated to tertiary-care children's hospitals across the country to establish the current standard of care, and a pilot study was conducted. RESULTS: Seventy-seven percent of respondents from tertiary hospitals across the country confirmed the standard of care to defer mobilization until the first trach change. Greater than 83% of the respondents used to establish face validity of the tools agreed with the clinical components and scoring structure. The safety and feasibility of early mobilization prior to initial trach change was confirmed with a pilot of 10 pediatric patients without any adverse events. CONCLUSIONS: Mobilization of pediatric patients prior to initial trach change is feasible and can be safe when risk factors are assessed by a multidisciplinary team. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E653-E658, 2021.

Effects of Instruction on Parent Competency During Infant Handling in a Neonatal Intensive Care Unit.

PURPOSE: The primary purpose of this study was to investigate the effectiveness of 3 different methods for delivering instruction on infant handling to parents in the neonatal intensive care unit (NICU). METHODS: Ninety-six parents in the NICU received instruction. Parents were taught the same 3 infant-handling techniques after random assignment to the (1) direct, (2) video, or (3) written-pictorial instructional groups. After baseline competency assessment, parents received instruction according to their group. A masked evaluator assessed parent performance, and parents rated instructional effectiveness. RESULTS: All groups significantly improved handling performance. The direct and video groups performed 2 handling activities significantly better than the written-pictorial group. No significant differences were found between the direct and video groups. All groups perceived the instruction as effective. CONCLUSIONS: Direct and video instructions are equally effective in teaching parents to perform simple whole motor tasks in the NICU, and parents welcome the instruction.

Physical therapy observation and assessment in the neonatal intensive care unit.

This article presents the elements of the Observation and Assessment section of the Infant Care Path for Physical Therapy in the Neonatal Intensive Care Unit (NICU). The types of physical therapy assessments presented in this path are evidence-based and the suggested timing of these assessments is primarily based on practice knowledge from expert therapists, with supporting evidence cited. Assessment in the NICU begins with a thorough review of the health care record. Assessment proceeds by using the least invasive methods of gathering the behavioral, developmental, physiologic, and musculoskeletal information needed to implement a physical therapy plan of care. As the neonate matures and can better tolerate handling, assessment methods include lengthier standardized tests with the psychometric properties needed for informing diagnosis and intervention planning. Standardized tests and measures for screening, diagnosis, and developmental assessment are appraised and special considerations for assessment of neonates in the NICU are discussed.

Physical therapy intervention in the neonatal intensive care unit.

This article presents the elements of the Intervention section of the Infant Care Path for Physical Therapy in the Neonatal Intensive Care Unit (NICU). The types of physical therapy interventions presented in this path are evidence-based and the suggested timing of these interventions is primarily based on practice knowledge from expert therapists, with supporting evidence cited. Physical therapy intervention in the NICU is infant-driven and focuses on providing family-centered care. In this context, interventions to facilitate a calm behavioral state and motor organization in the infant, address positioning and handling of the infant, and provide movement therapy are presented.

Consensus among experts in pediatric occupational and physical therapy on elements of individualized education programs.

PURPOSE: The aim of this study was to establish consensus among a sample of expert occupational therapy and physical therapy practitioners on characteristics necessary for individualized education program (IEP) objectives to be educationally relevant, measurable, and appropriate in content. METHODS: The Delphi technique was used to survey 38 board-certified clinical specialists from New Jersey, Pennsylvania, and New York. Nine physical therapists and 29 occupational therapists agreed to participate. RESULTS: The results of a three-round survey process revealed six characteristics of measurability, six characteristics of educational relevance, and seven characteristics related to content that were agreed on by 75% or more of the respondents. CONCLUSIONS: While IDEA is being readied for its next reauthorization, knowledge of these characteristics may be helpful to related service professionals in their participation for developing higher quality IEPs.