Reflection

Reflections on making this blog and learning about Sensory Stimulation, the SCBU, and the OT role:
When I first started this blog I thought that Sensory Stimulation was just the same as Sensory Integration and although it does have similar concepts around the just right challenge and sensory diet, it is in fact different. I was so convinced that it was the same thing that initially my first few posts were all about Sensory Integration. It wasn’t until I ran into one of my Lecturers in the Library and managed to ask her a question about it that I found out they are not the same things. She explained to me that SI is for once you have identified the child as having a sensory disorder of some kind and that it would not be appropriate to use this on newborn babies as:
1. You take a while to form a diagnosis so placing one on a new born is not ethical, and
2. Babies get overwhelmed very easily as sensory sensations are all new to them. So using the SI approach where you try and engage as many sensory systems as possible in order to achieve neuroplasticity, is not really possible.
She then went on to further explain that Sensory Stimulation is more along the lines of doing like trying to regulate sleep patterns by turning the lights on and off at various times, providing physical contact with family to establish connection, and helping with the skills necessary for feeding. Upon Reflection I should have conducted better research before going on a completely different tangent. Luckily for me I am experienced in using a blog as have learnt how to use one through my course and could go back and edit all my posts so that they best suited the aim of this blog which was to identify Sensory Stimulation not Sensory Integration.
From doing this Blog I can see the benefits of Sensory Stimulation and how it will be of great aid for the Baby and their family. Through trying to find Youtube videos for my blog I saw how traumatic it can be for parents whose child is in SCBU and I definitely understand the need for OTs, as we are trained to be able to help support family and provide education so that they will be prepared for their ultimate goal which is getting baby home. My research leads me to conclude that SCBU wards should have an OT as part of their team if they don’t already, as well as that Sensory Stimulation should continue to be used with infants in the SCBU ward as it can really help their development as well as helping parents needs.

Summary of what i have learnt so far

This post is a summary of what I have learnt so far. The aim of this blog was to learn more about Sensory Simulation and how it is used in the Special Care Baby Unit (SCBU), as well as the OTs role within the Unit. I believe that the blog I’ve created has helped me to meet this goal. Sensory Stimulation is a form of therapy used by Occupational therapists and other professionals (eg Nurses) to treat babies in the SCBU. Its focus is to help to modify the sensory diet by using ‘just right challenges’ so that the baby will start to develop some sensory skills as soon as possible. When treating the infant its important not to overwhelm them by overloading their senses as this often has a negative effect on the child rather than a helpful one. In order not to overload it’s important that therapist knows what the baby’s cues are eg. When getting overwhelmed breathing will increase and baby will avoid eye contact. Through my research I have discovered that there is definite room for an OT role in the SCBU unit. The OT role involves dealing with treatment, the environment, providing education, and helping to support family. Mainly though the OT role is focused on getting the baby and family ready for home.

Interview with anonymous OT

The following Interview was conducted with an qualified Occupational Therapist (OT) that currently works in a Special Care Baby Unit. Permission was gained to publish this information but due to this interview being published over the web the Source wishes to remain anonymous. So in this post the Interviewee shall be referred to as SCBU-OT.

Questions and Answers:
1. What is your role as an OT in the SCBU?

SCBU-OT:

• A neurodevelopmental assessment is completed with every baby that is referred (hammersmith neonatal neurological examination).


• Education to prevent excessive or inappropriate sensory aspects of the environment.


• Education with development of age-appropriate occupations (ie. feeding), sensorimotor processes, parent child bonding, and neurobehavioral milestones.


• positioning of the infant in the bassinet as well as educating parents in supportive ways to hold the infant, including "Kangaroo Care".


• Implementation of sensory programs.


• Liaison with nursing staff and other allied health staff.


• Referral and liason with the visiting neurodevelopmental therapist.

2. Who are your typical clients?

SCBU-OT

• marked prematurity < 31 weeks gestation


• Under 1500g


• Developmental concerns


• Questionable or abnormal tone or posturing i.e. poor head and trunk control, asymmetries, hyper - hypotonicity


• prolonged hospitalisation


• sensory impairments

3. How do you integrate Sensory Integration in your approach to treatment?

SCBU-OT: Do not over stimulate. Use one stimulus at a time. For example, when holding/touching, or rocking do not sing or make eye contact at the same time. Or when making eye contact do not talk or sing. Use or engage one sense at a time. Overtime, and as the infant develops and grows, increasing stimuli to say rocking and singing may be better tolerated.

4. What do you do with babies? and how do you help their families?

SCBU-OT: By watching cues, and engaging in appropriate stimulation you can begin to help babies develop their senses in a way that will aid in their physical and emotional growth as well as creating parent-child bonds. Interacting with the child during this period also gives parents a sense of belonging and accomplishment in tending to the needs and care of their child.

Treatment in the form of Infant Massage

Massage is often used in the Special Care Baby Unit. Providing Massage is a form of treatment that stimulates the Baby and well encourage overall healthy development. A therapist is shown giving a baby massage therapy in this video but its important to note that Parents or Carers are also encouraged to give their baby massage as it "helps the development of early bonding and encourages parents to positively touch their baby's" (Moyse, 2005, p 31)

Cues and Treatment

Noticing cues is an important part of Sensory Stimulation as you want to know when the infant is ready to be stimulated and when they are becoming overstimulated.

Cues to look for:
Overwhelmed and not ready to interact:

• increased heart and breathing rate.



• closing eyes and avoiding eye contact.



• facial grimace.



• irritability



• frowning



• stiffening and extending limbs as well as arching back.



• showing signs of fatigue by yawning, hiccuping, or coughing.
  

Ready to interact:

• Steady breathing and heart rate.



• Holding eye contact with people and alert
  
  

Treatment:

Warren, (1994) states that these are the treatment processes for Sensory Stimulation on the SCBU ward:

• Positioning and Handling: educate family on appropriate positions to reduce stress, improve self regulation, and to normalise muscle tone.




• Stimulation/Adaptation: Educating parents on appropriate stimulation, monitoring, background noise, and lighting. Also adapting the environment to modify sensory input and minimise stress.




• Developing Feeding Skills: Using Sensory Stimulation to prepare the child for feeding and handling and positioning during feeding.




• Interaction with others: Help Parents/Caregivers understand behavioural cues. Provide techniques such as massage that facilitate parent-child interaction.




• Caregiver Support: Provide appropriate support for parents. This could be in terms of education, information, reassurance, encouragement, and referring them to other services if needed.

OTs Role in SCBU

Quick Summary of OT Role in SCBU:
From my research these are some of the basic things that I think an OT would do in SCBU:

• 
  
  Deals with positioning and handling of infant
  



• 
  
  Prepares Baby and Family for home environment.
  



• 
  
  Provides education to parents and family.
  



• 
  
  Conducts assessments where appropriate.
  



• 
  
  Helps family with Transition from hospital to home.
  
  

More in depth explanation of OT Role:

"Special Care Baby Units (SCBUs) provide care for preterm, low birth weight infants and for neonates who are sick... occupational therapists have started to establish roles within these units" (Warren, 1992, p 218). Occupational therapists main area of concern is to enable people (this includes infants) to carry out activities of daily living. For an Infant these activities could be things such as feeding or helping the infant to develop the appropriate developmental skills through sensory stimulation.

Warren, (1994) states that the aims of an OT in the SCBU are to monitor the babies needs and adapt the environment accordingly, as well as to facilitate interaction of baby and carer. Warren, (1992) states that OTs will get involved in treatment by using Positioning, Handling, Stimulation, Assessing infants skill, helping with feeding, providing parent support, and finally helping with transition to home ans well as follow-up.

In my Opinion there is definitely reason for OTs to work in the SCBU with infants. I believe OTs have the perfect knowledge and skill base for this area as we are well trained in education approaches and we are used to incorporating family members into our treatment plans. Furthermore OTs are used to their role overlapping with other professions and working collaboratively as part of a team.

What is a SCBU?

A Special Care Baby Unit (SCBU) is a “unit for babies who are catching up on growth or development after a premature birth or those who are getting better after more complex treatment” (Baby Centre, 2011).

Generally Babies that meet the criteria for being in SCBU are premature by at least 36 weeks gestation (York Special Care Baby Unit Support Unit, 2008). Other criteria are babies with growth restrictions, developmental concerns, sensory impairments, or who are in for a prolonged period of time in the hospital. The main focus of SCBU is to prepare the baby and family for home life after the hospital.