Developmental Interventions In Neonatal Care Washington, DC 2006

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Developmental Interventions In Neonatal
CareWashington, DC 2006

• Highlights
• Patricia Boyle, PT
• LDSH NICH
• EI Consultant

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The Earliest Relationship The Nature of
Maternal-Fetal Synchrony

• Presented by Janet DiPietro, Ph.D a Developmental
  Psychologist in Baltimore Maryland
• Mothers and fetuses have a second by second
  relationship beginning at least at 20 weeks.
• Questions? Does preterm maternal-fetal synchrony
  set the stage for postnatal synchrony in
  maternal-child interaction?

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The Earliest Relationship

• Prenatally are mothers who are more
  physiologically responsive to fetal movements
  more responsive to their infants behaviour?
• Are fetuses who are more reactive to maternal
  stress more engaged and interactive as children?
• Are fetuses paying attention?

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The Earliest Relationship

• Mothers are given a stressful psychological test
  (Stroop test)
• Infants respond by becoming less motorically
  active and have increased variability in their
  heart rate
• Mothers given relaxation activities also causes
  decreased fetal movement and an increase in heart
  rate variability.
• Is the fetus orienting to differences in the
  intrauterine sensory environment?

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The Earliest Relationship

• Greater maternal anxiety and perceived stress
  during pregnancy has been associated with more
  ACCELERATED developmental skills at age 2.(Stress
  affects the development of the fetus in a
  positive way????)
• Women who were more negative ABOUT their
  pregnancy their infants had delayed motor
  development and poorer social engagement

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The Earliest Relationship

• Take home message???
• Embrace stress
• But be positive???
• More research needed

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The Earliest Relationship

• The Psychophysiology of the maternal-fetal
  relationship
• Psychophysiology,41 (2004),510-520
• DiPietro et al

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Effect of Movement and Posture on the Respiratory
and GI system

• John Chappel, MA PT, Morristown New Jersey
• Heidelise Als, PhD reveals in her Synactive
  Theory of Development the delicate interplay
  between the physiologic and motoric systems.

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Respiration and GI

• Any impulse entering the spinal cord at any level
  could cause any structure innervated by any
  neurological structure emanating from that level
  to be stimulated
• Hands on ribcage
• Respiratory system is a system that responds well
  when not restricted

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Respiratory and GI

• How does the babys physical environment impact
  respiration and GI
• NG tubes
• Extended upper extremity posture
• Excessive hip flexion
• Diaper Tightness
• The Vulcan Feeding Pinch

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The Vulcan Feeding Pinch
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The Hyoid bone

• Free floating bone with no other bony attachments
• Supports the tongue and muscles associated with
  speech and SWALLOWING
• Until six months of age the hyoid is at the level
  of C1
• C1 gets stuck with excessive extensive force

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The Hyoid bone

• Force to C1 a large amount of force over a
  short time precipitous delivery may be
  responsible for TTN (Transient tachypnea of the
  newborn)
• Force to C1 A small amount of force over a
  long period of time The Vulcan Feeding Pinch

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The Vulcan Feeding Pinch

• C1 gets jammed in extension over C2 and C3
• Pressure over C1 compresses the 4th ventricle
  which houses the vagal nerve
• Vagal nerve innervates the stomach, lungs affects
  heart rate, innervates the larynx which keeps the
  airway open for breathing, affects peristalsis