5/2/2017 Welcome to the NICU Consortium April 26, 2017 Agenda Building Partnerships 9:00 am Welcome, Announcements 9:15 am Primitive Reflexes: Implications for infants and children home from the NICU Jennifer Spiric, PT, DPT • 2016-2017 Pregnancy-related depression & 10:15 am Break anxiety public awareness campaign 10:30 am Early Intervention and Family Centered Developmental Care; servicing NICU graduates and their families. Why is this approach best practice? Petora Manetto-Spratt, PT, DPT, PCS 11:30 am Adjourn May 5, 2017 10 am to 11:45 am Jefferson County Department of Public Health NICU Consortium Steering Committee and NICU Consortium Partnership Meeting March rch of Dimes es Colo lora rado do Mission sion improve the health of babies by preventing birth defects, premature birth and infant mortality. Healthy Start • Our goal is to reduce Colorado’s current premature birth rate from 8.7% to 8.1% by 2020 and 5.5% by 2030. “ Healthy Babies, Strong Families” • To reach these goals, our priorities for 2017-2020 are: 1. Increasing access to progesterone shots (“17P”) for women with a previous preterm Families Forward Resource Center (FFRC) has an birth opportunity to engage African American/Black women in an 2. Optimizing birth spacing and pregnancy intentionality open discussion about the rising infant mortality rate in our 3. Expanding access to group prenatal care 4. Improving health equity to reduce the number of preterm births among the non- community. Healthy Start addresses the underlining issues to Hispanic black population infant mortality such as: poverty, psychosocial issues, drugs “17 P” - What are progesterone shots? (AKA “17P”) • and health. Research has shown that infant mortality rate in Synthetic form of progesterone (a key pregnancy hormone) given by injection • Reduces a woman’s risk of recurrent preterm birth by 33% on average 3 times higher for African American/Black woman • One of the strongest clinical risk factors for preterm birth is a prior preterm birth 1 in our community than for any other race. • Maternal history of preterm birth confers a 1.5-fold to 2.0-fold increased risk for preterm birth in a subsequent pregnancy 1 Pediatric Physical Therapist Movement specialist Child-led therapist Primitive Reflexes Developmental analyst Implications for infants and children home from the NICU Mommy Jennifer Spiric, PT, DPT Kids In Motion Of Spiric Therapies, LLC Kids in Motion, of Spiric Therapies, LLC 1
5/2/2017 So what is a reflex?? Objectives 1. Understand the concept of a primitive reflex Stimulus 2. Learn integrated movement patterns associated with three important primitive reflexes 3. Understand the difference between an integrated and non- Movement integrated primitive reflex pattern 4. Learn how to identify signs and symptoms of non-integrated reflexes in children who spent time in the NICU 5. Learn several strategies to help children integrate reflexes to move and learn more freely A reflex is an unconscious, protective movement pattern based on sensory stimuli from the environment. Kids in Motion, Kids in Motion, of Spiric Therapies, LLC of Spiric Therapies, LLC And what are primitive reflexes? Primitive Reflexes are… • Unconscious movements • Based on genetic motor programs typical for all humans • Variable in their presentation, integration, and form • Foundational for coordinated conscious movements throughout childhood and adulthood • Related to all areas of development (motor, vision, sensory system, speech/language, cognitive, emotional, behavioral) • Permanent motor plans, but more or less visible/strong based on life events Kids in Motion, Kids in Motion, of Spiric Therapies, LLC of Spiric Therapies, LLC Asymmetrical A few primitive reflexes Tonic Neck Suck- swallow- breathe Automatic gait Reflex (ATNR) Rooting Protective extension Asymmetrical Tonic Neck (ANTR) Trunk extension • “Fencer Pose” Typically active until age 4- • Symmetrical Tonic Neck (STNR) Hands/toes grasp 6mo • Foundational for rolling Tonic Labyrinthine (TLR) Robinson Hands Grasp • Impacted by torticollis • Commonly affected in pre- Spinal Galant Leg Cross Flexion-Extension maturity • Essential for auditory Pull to sit Foot tendon guard development • Important for auditory-visual Moro Bauer crawling coordination Landau Babkin Palomental Kids in Motion, Kids in Motion, of Spiric Therapies, LLC of Spiric Therapies, LLC Babinski Spinal Perez 2
5/2/2017 Non-integrated ATNR reflex symptoms WAIT! • Difficulty with attention/focus • Difficulty with sleep “Non - integrated”?? • Difficulty eating Poor memory • • Easily over-stimulated in loud environments • Difficulty reaching across midline • Difficulty remembering R and L sides Mixed hand dominance • • Difficulty with throwing and catching • Impacted coordination with running, swimming, skating Poor handwriting • Kids in Motion, of Spiric Therapies, LLC Non-integrated TLR reflex Tonic Labyrinthine symptoms (TLR) • When lying on tummy, arms and • Fetus descended or C-section birth due to breech position legs are bent. When lying on back, • Muscle reactivity or spasticity neck extensors and hip extensors (kicking muscles) are active. • High or low muscle tone • Typically integrates at age 4 mo • Decreased head righting reactions • One of the biggest purposes of this • Poor posture reflex is to move through the birth • Fear of heights or poor depth perception canal Affects muscle tone • Impaired coordination • • Lays foundation for rolling, • Late crawling and/or late walking crawling and walking • Dislikes swings, slides, gets dizzy/car sick easily • Decreased endurance/early fatigue during physical activity Non-integrated Spinal Spinal Galant Galant reflex symptoms • Activated when infant is lying on stomach or side and is Incorrect hip rotation (apparent hip dysplagia) • touched on the right or left side of spine • Scoliosis • Typically integrates by age 5- • Enuresis, incontinence (including bedwetting), constipation, 9mo irritable bowel syndrome • Impacted by torticollis • Difficulty with hands and knees crawling (prefers butt • Affects digestion scooting, or non-reciprocal army crawl) Foundational for trunk • • ADHD rotation in hands/knees • Difficulty following instructions, decreased auditory crawling and arm swing in processing walking • Impacts sensory integration • Unable to sit still • Poor posture Kids in Motion, Kids in Motion, of Spiric Therapies, LLC of Spiric Therapies, LLC 3
5/2/2017 Impact of NICU environment on reflexes • Noise level • Sleep/wake cycles • Trauma (emergent birth, infection, illness, decreased time with biological mother, difficulty feeding/breathing, Integration Extinction sensory overstimulation, etc) Surgeries • • Lines, tubes, machines • Sudden or frequent unexpected movements • Positioning • Decreased proprioceptive input on all sides of neonate (front, back, sides), than other fetuses experiencing in the womb Kids in Motion, Kids in Motion, of Spiric Therapies, LLC of Spiric Therapies, LLC • Identify non-integrated primitive reflexes EARLY and refer infant/child to physical, occupational So…now that you’ve identified or other movement therapist non-integrated or affected • Complete reflex integration continuing education primitive reflexes… • Utilize positioning tools and blankets to provide neonates and infants with natural What can you do? proprioceptive inputs (comfortable tightness) in body alignments that make sense from a reflexive standpoint Make tummy time frequent and FUN!! • • Help infants smoothly move from one position to another during functional routines (lots of gentle rolling, frequent visual tracking and reaching opportunities, pulls to sit from diaper changes, sitting up flowing through sidelying or hands and knees instead of just placing child in sitting, etc) Kids in Motion, Kids in Motion, of Spiric Therapies, LLC of Spiric Therapies, LLC Tummy time ideas Promote symmetry, symmetry, symmetry !!! Kids in Motion, Kids in Motion, of Spiric Therapies, LLC of Spiric Therapies, LLC 4
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