Clinical Bottom Line
“How should I apply this information?”
This study is consistent with the Newborn Individualized Developmental Care and Assessment Program principles due to its individualized approach: stress level was limited, which makes circulation and blood flow to the brain more stable and leads to less abrupt change in circulation and cerebral perfusion. This will facilitate the process of weaning from mechanical ventilation.
This article shows us that children are quite capable of moving and responding within their own physiological limits, as there were no differences in heart rate, respiratory rate, and oxygen saturation as long as the children determined their position as well as their activities in different positions. This article suggests that we should respect this self-limiting strategy of children with chronic cardiorespiratory insufficiency.
“What should I be aware of in applying this information?”
“The PT intervention,” as it is referred to in this study, suggests that the children in this study were stimulated in their motor development. Since it is not entirely clear to what extent these children are exposed to physically challenging tasks to stimulate their motor development and to what extent this affects the cardiorespiratory response, we should be careful in applying any intervention that brings children to their physical limits. From this study, it remains unclear what happens to the oxygen saturation, heart rate, and respiratory rate when children are encouraged to explore their own limits. Further research into what extent more challenging tasks affect cardiorespiratory response would be useful. Until that answer is known, all children should be closely monitored at any time to determine the intensity of therapy. The pediatric physical therapist should consider the child's physiological limitations and provide meaningful challenges for the children at the same time.
Maaike Sprong, PPT, MSc
Janjaap van der Net, PPT, PhD
University Children's Hospital, University Medical Center Utrecht
Utrecht, The Netherlands