rehabilitation in the NICU

prmenrs, RN · Oct 11, 2008

OT's and Speech Path's work in NICU's to facilitate oral-motor development and other stuff like that. Some units use OTs, some use speech. My experience w/OTs has been good, the one Speech person I've worked w/I'm very NOT impressed.

You could check w/the larger hospitals in your area and find out what they use and how. You could possibly shadow one of them. If it's a big enough unit, they should have the OT attached to their unit, not be sharing him or her w/the hospital rehab dep't. Watch out for that situation, cause the hospital rehab will try to pre-empt the NICU frequently: "Do that feeding later, go eval that Burn Unit pt 1st..." Aggravates the therapist, the nurse taking care of the baby, even the baby!

LoveTheNICU · Oct 11, 2008

We most certainly do have rehab people involved in our NICU. Physical therapy, occupational therapy and speech/language pathologists all are involved in the care of some of our infants. Specifically, speech language pathologists come to work on feeding therapy with infants who are having difficulty acquiring bottle-feeding skills. Since these therapists are specialists in how the lips, tongue and jaw move, they can be very helpful in this! They are also involved in performing swallowing studies, which determine if a baby is at risk for inhaling fluids into their lungs when they eat. This helps us decide whether a baby needs their milk thickened.

PT is used a little less often, usually with infants who have been there long term- think a 24 week infant who is now 3-4 months old. These babies need help maintaining their range of motion and developmental milestones such as holding their head up, etc. since they have often been on a ventilator long term or had other treatment related things that have impaired their normal abilities. PT is also involved with babies that have a specific condition limiting their range of motion- for instance, today I was caring for an itty-bitty boy that has some necrosis of his fingers and toes related to a central line placement. Because those necrotic areas do not move normally, PT is helping him maintain whatever function he can in those extremities.

OT is probably the most rarely used rehab service in our NICU. They will sometimes be involved in caring for our long term babies, like mentioned above, and I have seen them work on skills such as learning to feed from a spoon. That baby had been in the NICU for about 9 months when they attempted that, however. Just today, in caring for my tiny man, OT was consulted to help work on hand movements, since fine motor rehab is a skill they frequently use in the adult population.

In terms of how much time the therapists spend in the NICU, I would say that at any given time, 5-10 of our 50-60 patients are being seen by one rehab service or another. I probably see a therapist each shift I work, but not necessarily one from each discipline. However, I work in a children's hospital, so the therapists also cover general pediatrics, PICU, PICU/NICU stepdown units and outpatient rehab for kids in the community, so I suspect they stay very busy. I would say, if you feel your interests lie in caring for NICU kids, go for it! Attempt to arrange a shadowing opportunity with a therapist, or see if a local NICU has volunteer opportunities, just to see if NICU could really be your thing. Good luck!:)