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Occupational therapists have provided services in the (neonatal intensive care unit (NICU) since the 1970s (Vergara, 1993). This role has evolved over the years as the result of research and as more efficient treatment options and modes of practice have been identified. As with many areas of practice, the specific responsibilities of occupational therapists in the NICU vary from facility to facility and across the country (Davis, Sweeney, Turnage- Carrier, Graves, & Rector, 2004); however, some general trends have been identified. This article examines the trends in addressing the sensory components to promote growth and development as part of an occupational therapy program within the NICU.
Historical Pathway
Traditionally, occupational therapists have provided services to infants in the NICU who were identified as being at high risk for or given a confirmed diagnosis of cerebral palsy, congenital abnormality, developmental delay, or other motor deficits (Vergara, 1993). Before the 1970s, the occupational therapy role was based on a rehabilitative model. The therapist received an order from the physician, performed an evaluation, and provided direct treatment (Davis et al., 2004), which typically consisted of developmental stimulation (Hunter, 2001). Therapists also provided services to certain infants for strengthening, range of motion, feeding, abnormal tone, extreme irritability, and splinting (Hunter, 2001; Vergara, 1993; Vergara & Bigsby, 2004). At this time, the survival rate of these fragile infants was very low until technological advancements allowed infants born as early as 24 weeks to survive longer (Vergara, 1993). With the increase in the survival rate of premature infants came a need for more specialized nursing facilities to provide care and for greater involvement from other health professions. These needs resulted in health professionals becoming more specialized, which led to the evaluation of the effectiveness of treatment interventions, such as developmental stimulation (Vergara, 1993).
Concerns about the effects of the NICU on premature infants and their long-term developmental outcomes facilitated the increased involvement of occupational therapists over the next decade (Hunter, 2001). These concerns were sparked by medical personnel in the NICUs who noticed that the subsequent development of premature infants was qualitatively and quantitatively different from full- term infants. In the 1970s, this difference was attributed to the shorter exposure to the intrauterine environment, which provides constant stimulation and physical...