Outpatient Certifications

Below I included some of the most common certifications therapists had obtained and talked with me about while spending time at outpatient pediatric clinics.

Sensory Integration (SI) Training/Courses -
- A couple outpatient therapists at the clinics I visited had completed further sensory integration training.  One course in particular was an intense 3 month course in California through Jean Ayres.  From speaking with them, they shared that after attending the SI class, they felt it further shaped the way they provided occupational therapy services.  Sensory integration further evaluates the way a child is able to process and adapt to the sensory interactions that are going on in a child's environment and within themselves.
For further information on the SI course offered in California I have provided a link:
http://chan.usc.edu/academics/continuing-education/sensory-integration

NDT training -
-Many therapists shared they had also attended a multiple day course on Neuro-Developmental Treatment (NDT).  They shared that this course had given them greater confidence when handling patients and a greater knowledge base to draw from for interventions during treatment sessions.  

Alert Program - "How fast is your engine running?"
-The Alert Program was a program I learned about that focuses primarily on self regulation and emotional regulation.  This program a therapist can attend a course on or get mentored by another therapist who has received proper training.  This program enables the child to identify when their "engine" is running too slow, too fast, or just right.  Therapists explained that this program is a great way to raise awareness for the child and is a positive home program for families.  Many therapists have seen great success when utilizing this program.
To read further about the Alert Program:
http://www.alertprogram.com/

Handwriting without tears courses
-While spending time in an outpatient setting, I realized how common it is for an OT to work with children on handwriting.  Whether it be letter formation, fine motor strengthening, proper pencil grasp, attention, etc.  There are many aspects that can impede a child's ability to learn handwriting in a school setting. A curriculum that I specifically learned about was Handwriting Without Tears.  This program was designed by an OT specifically and is utilized in many schools as well.  From my experience and after talking with therapists, children tend to have success with this multi-sensory way of learning handwriting.  Therapists shared that the Handwriting Without Tears materials are easy to understand and children enjoy working through it.
Handwriting without tears link:
https://www.hwtears.com/hwt

There are many more certifications therapists can obtain when working in an outpatient pediatric setting.  The therapists I spoke with shared that the continuing education courses they attended and the certifications they had strongly impacted the way they delivered OT services and planned treatment sessions.  Seeking out continuing education courses is a way to provide evidence based interventions and stay up to date on what is working for children outside of the clinic you work at.

Images found on Google.

Assessments and Interventions within the NICU

As my rotation comes to an end, I cannot believe everything I have learned and how thankful I am for the time I was able to spend in the NICU.  Below I am including some information regarding helpful assessments and interventions I used during those four months.

Assessments - Within the NICU I was at, a huge component used for assessment is clinical observation.  With the babies being so fragile and sick, we are constantly observing their vitals, stress cues, and reaction to our presence.  We are continually assessing their movements, head shape, tolerance, etc. and documenting on those observations.  We can then reflect on change over time within our documentation and continue to facilitate their progress during their hospitalization.  
Another assessment which was occasionally utilized was the HELP (Hawaii Early Learning Profile) assessment.  This assessment was commonly used for the long term babies who required prolonged hospitalization.  This assessment consists of six domains which include: cognitive, language, gross motor, fine motor, social-emotional, and self-help.  These enable therapists to better understand where the baby is developmentally and specific skills to continue addressing during treatment sessions.  

Interventions - There are a number of interventions utilized within the NICU.  Below I have included some common ones I became familiar with over the past four months. 
The focus of the treatment session and the response from the baby dictates greatly what our interventions will include.
If we are focusing on tactile/proprioceptive system development we may include positive touch, infant massage, proprioceptive joint input, ROM, or containment holds for example. 
As we continue to progress the sensory system we may introduce bouncy swings for short periods of time to stimulate the vestibular system.  As the babe is developmentally progressing we may also incorporate auditory stimulation such as music therapy as an intervention.  Visually, when is a babe is age appropriate to begin visually tracking, we may encourage the babe to follow the therapist's face or a motivating toy.  
As an infant grows and develops we may also progress to incorporating multiple sensory interventions to allow the babe to explore their environment and develop a greater capacity to take in their surroundings.  
Additional interventions provided include: head shaping techniques and positioning devices, environmental modifications, parent education, boundary support within isolette to promote a womb like position.

These interventions and many more enable therapists to provide positive developmental care within the NICU and be a key member of the interdisciplinary team in the hospital!

Ladder Approach

The ladder Approach was developed by an occupational therapist specifically for treating patients in the NICU.  Lisa Bader developed this tool to assist therapists in the NICU to have more direction and confidence when treating babies.  I personally found this tool helpful because it enabled me to think through my intervention sessions more clearly.

The ladder approach breaks down sensory development and describes it as steps of the ladder. A baby first begins developing their tactile system within the womb, and this system is the first to fully develop.  When treating premature infants, this system is the first to be addressed during interventions before progressing to other sensory systems in case an infant's brain, developmentally, is not ready to progress.  As stated in the manual, the tactile/proprioceptive system develops first, followed by vestibular, olfactory/gustatory, auditory and finally the visual system.

My therapy sessions always began addressing the tactile system to give me an opportunity to read the infant's cues and better understand what they could tolerate during the session.  If appropriate, I would then progress up the ladder to continue working on other sensory systems.  Within each sensory system there are various interventions and techniques which can be applied.

I was thankful to have found the ladder approach and have the opportunity to use it as a supplement to this rotation.  It further developed my understanding and knowledge when working with my mentor in the NICU.  This approach allowed me to better organize treatment sessions and better treat my patients.

For more information visit: http://www.otptinthenicu.com/