The Role of Rehabilitation Specialists in Canadian NICUs: A 21st Century Perspective

Abstract

Rehabilitation specialists are an integral part of the team in the neonatal intensive care unit (NICU). New approaches to rehabilitation practice in the NICU have evolved over the past decade that aim to promote child health and development. Aims: The aim of this study was to describe the current roles of the occupational therapist (OT), physical therapist (PT) and speech-language pathologist (SLP) in Canadian NICUs as compared to the roles documented in an earlier national survey conducted 15 years ago. Methods: A telephone survey was conducted across Canadian NICUs and each telephone interview was recorded by a research assistant. In total, 42 questionnaires were completed across 25 health care institutions. Results: Eighty percent of the PT, 93.7% of OT and 50% of SLP provided direct services to neonates in the NICU. The results demonstrated that the therapists were involved with case discussion (85.7%), decision-making (97.6%), referrals to other services (97.6%) and discharge planning (97.6%). Splinting (87.5%) and feeding (100%) were most often carried out by OT, whereas chest physiotherapy (65%) and range of motion (100%) were predominantly provided by PT. Changes in the role of rehabilitation specialists over the last decade predominantly included enhanced collaboration with the NICU team, more frequent use of standardized outcome measures and use of interventions supported by evidence. Conclusion: In comparison with results of the previous survey of rehabilitation practices in Canadian NICUs, rehabilitation specialists now have more dedicated time in the NICU and more frequently use standardized measures and apply interventions that are supported by recent scientific studies.

Impact of restrictions on parental presence in neonatal intensive care units related to coronavirus disease 2019

“…While some sites offered telehealth options for these services, the efficacy of telehealth in this setting is unknown. In addition to direct patient care, the developmental team plays an important role in educating parents on key techniques to implement on a daily basis both in the hospital and post-discharge [34,35]. While possibly implemented in an effort to minimize the spread of COVID-19 to vulnerable patients, diminished social work, and developmental care services to premature infants may have long-term adverse consequences.…”

Impact of Restrictions on Parental Presence in Neonatal Intensive Care Units Related to COVID-19

“…While some sites offered telehealth options for these services, the efficacy of telehealth in this setting is unknown. In addition to direct patient care, the developmental team plays an important role in educating parents on key techniques to implement on a daily basis both in the hospital and post-discharge [33, 34]. While possibly implemented in an effort to minimize the spread of COVID-19 to vulnerable patients, diminished social work and developmental care services to premature infants may have long-term adverse consequences.…”

Clinical challenges to the concept of ectogestation

“…Calling the Biobag an ‘artificial womb’ (or ‘AAPT’) is certainly useful for illustrating the improvements on traditional NIC that the Biobag would make possible, but the functions and processes of a natural womb and placenta that the Biobag cannot replicate are legion. For example, during the second and third trimesters, uterine contractions and fetal movement against the uterine wall are vital for development of the fetal musculature necessary for cardiorespiratory regulation after birth 30 31. The Biobag has no means of replicating these spontaneous contractions.…”