The Pediatric Section of the American Physical Therapy Association (APTA) supports the provision of services to high-risk infants in the neonatal intensive care unit (NICU) by qualified personnel. Therapists need advanced education and clinical skills in working with this population since intervention, if inappropriately applied, has the potential to cause significant stress to the critically ill infant.1-4
With technological advances in newborn medicine, infants with very low birth weight or acute illness are surviving. Most medically fragile newborns requiring intensive care are transported to tertiary care centers for specialized neonatal services, including physical therapy. Increasing requests for neonatal physical therapy services are also coming from neonatal staff in general hospitals oriented to acute care. In either setting, the physical therapist must possess advanced clinical competencies to manage the medically fragile neonatal population before initiating screening, assessment, or treatment.4,5
Physical therapists interested in practicing in the NICU must have experience in assessing normal infant development and treating infants with developmental disabilities. Treatment skills in pediatrics are best acquired with less vulnerable children before working with babies who are acutely or critically ill. Direct observation and clinical preceptorship with an experienced clinician in the NICU should precede independent assessment and treatment experiences. The entry-level graduate, physical therapy generalist, or physical therapist assistant should not provide service in the NICU without adequate supervision.
It is recognized that the competencies described overlap in some areas with those of other disciplines, such as occupational therapy and developmental psychology. The physical therapist working in a NICU must participate in program planning with other team members to negotiate areas of overlap so as to avoid unnecessary duplication of services. The areas most unique to physical therapy include assessment and treatment of movement and postural dysfunction and pulmonary hygiene. All therapy for children, however, must be provided within an overall developmental framework common to several disciplines. The competencies for NICU physical therapists reflect this concern by emphasizing provision of developmentally and physiologically appropriate physical therapy that is sensitive to the environmental and social needs of the child and his or her family.1,5,6
The purpose of this document is to provide the APTA with a policy statement that defines competencies for therapists practicing in the NICU. The document is idealistic. Competent clinicians may not have formal training in all of the knowledge areas listed. However, the competent clinician (1) meets the criteria in at least Sections I to IV, (2) seeks training in her or his areas of weakness, (3) does not attempt to provide service to a client when her or his knowledge is insufficient to recognize the risks, and (4) refers infants needing service to a competent clinician.