Neonatal Therapy National Certification Examination Study Guide 5/12/2020
NeonatalTherapyNationalCertificationExaminationStudyGuide5/12/2020
©NeonatalTherapyNationalCertificationBoard 2020 2
I.DefinitionofNeonatalTherapyII.ContentofNeonatalTherapyNationalCertificationExaminationIII.Domain-SpecificContentIV.Self-AssessmentofDomain-SpecificContentV.SampleExaminationQuestionsVI.ExamPreparationTips
©NeonatalTherapyNationalCertificationBoard 2020 3
I.DefinitionofNeonatalTherapyNeonataltherapyistheartandscienceofintegratingtypicaldevelopmentoftheinfantandfamilyintotheenvironmentoftheNICU.Neonataltherapypracticeincorporatestheoriesandscopesofpracticefromtherespectivedisciplinesofoccupationaltherapy,physicaltherapy,andspeech-languagepathology.Neonataltherapypromotesoptimallong-termdevelopmentaloutcomesandnurturesinfant-parentrelationshipsbyaddressingthefollowingsynergisticneurodevelopmentalsystems:neurobehavioral,neuromotor,neuroendocrine,musculoskeletal,sensory,andpsychosocial.Thesesystemsprovidethefoundationforthedevelopmentoffunctionalskills.NB:This definition was created by the National Association of Neonatal Therapists Professional Collaborative (NPC)
©NeonatalTherapyNationalCertificationBoard 2020 4
II.ContentofExaminationTheNeonatalTherapyNationalCertificationExaminationassessesthebasicskillandknowledgerequiredforsafe,efficacious,evidence-based,andindependentpracticeintheNICUsetting.Theexaminationcoversabroadrangeofknowledgeandisbrokendownasfollows:
ExamBlueprint
Descriptionsofeachareaareprovidedbelow,alongwithaself-assessmenttoaideachapplicantindeterminingareashe/shemayneedtofocuson.
FoundationsforNeonatalTherapyPractice
NeonatalScreening,Assessment,EvaluationandDiagnosis
NeonatalTherapyInterventionsandFamily-CenteredCare
40%
30%
30%
©NeonatalTherapyNationalCertificationBoard 2020 5
III.Domain-SpecificContentDomain1:FoundationsforNeonatalTherapyPracticeThis domain outlines the foundational knowledge required by neonatal therapists to underpin their practice in the NICU. An understanding of neonatal care principles, infant development and theories of neonatal practice, are important in supporting the advanced clinical reasoning necessary for the provision of neonatal therapy for high-risk infants and their families in the NICU.
Knowledgerequired:
• Scientificknowledge-Degree/depthofknowledgerequiredvariesbycomponent.Sometopicsrequireonlyconceptualunderstandingwhileothersrequirefullintegrationofthecomponent–i.e.abletoteach,analyze,andreflectupon.
• Atypicalandtypicalpretermandterminfantdevelopmentincludingneurobehavioral,sensory,feedingandswallowingdevelopment
• Basicanatomy&physiologyoftheneonate• Embryology• Environment(includingequipment)• Fetal/Neonatalbraindevelopment/Theoryofneuronalgroupselection• Medicalequipment/Commercialinfantproducts(hospitalandretail)• Medicalprocedures• Medicalterminologyanddiagnoses• ModelsofcareandtheoryintheNICU:attachmenttheory,dynamicsystemstheory,synactivetheory
• Neurodevelopment(motor,sensory,autonomic)• Neurobehavior• Neurodevelopmentaloutcomesofpretermandhigh-riskinfants• NICUenvironmentandculture
©NeonatalTherapyNationalCertificationBoard 2020 6
Domain2:NeonatalScreening,Assessment,EvaluationandDiagnosisThisdomainoutlinesthecoreknowledgerequiredforthedevelopmentofappropriateapproachesforthescreening,assessmentandevaluationofinfantsintheNICUsetting.Itconsiderstheclinicalreasoninginterplayofindividualizedevaluationoftheinfantwiththedevelopmentofappropriateinterventionstrategies.KnowledgeRequired:
• Acuteandchronicpain• Assessment/Evaluation–standardized,observational,non-standardized,continuous/ongoing
• Interpretingresults• Maternalriskfactors,exposures&complications(medical,psychosocial)• Medications–potentialimpactoninfant• Musculoskeletalassessment• Neurobehavioralassessment• Neuromotorassessment• Oralfeedingandswallowing(non-instrumentalassessment)• Painassessmentandmanagement• Pre-feedingskills• Sensory• Statesofarousal• Synthesizeinformation• Treatmentplanning
o Determinefrequencyanddurationoftreatmento Setdiscipline-specificgoals
• Utilizingcriticalthinkingskills
©NeonatalTherapyNationalCertificationBoard 2020 7
Domain3:NeonatalTherapyInterventionsandFamily-CenteredCareThisdomainoutlinesthecoreknowledgerequiredtodeliverevidence-basedinterventionswithinfantsandtheirfamiliesintheNICUsetting;bothintermsofprovidingneuro-protectivesupportandinterventionfortheinfant,aswellaspromotingthedeliveryoffamily-centeredcare.KnowledgeRequired:
• Evidence-basedinterventionswithneonateandfamily• ImpactoftheNICUstayonthefamilyunit• Family-centeredcare
o Educate/Guide/Promoteparentalparticipationandindependenceinearlyparentingskillsthroughtransitiontohome.
o Providepsychologicalsupport.o Facilitatebondingandattachment.o Parentengagement
• ADLso Feedingo Facilitate/Support
§ Oral-sensory-motordevelopment§ Pre-feedingskills§ Transitiontooralfeeding(notincludinginstrumentalassessment)
§ Breastfeedingsupporto Sleep
§ Protectingsleep§ Facilitate/support
• Transitiontosleep• Safesleeppractices
o Bathing§ Facilitate
• Stateregulation• Self-regulation• Neuromotorstability
©NeonatalTherapyNationalCertificationBoard 2020 8
o Play/Interaction§ Assistwithattainmentofageappropriatedevelopmentalskillsthroughguidedexplorationofandinteractionwiththeenvironment
§ Infantcommunication§ Parent-infantinteraction
• Environment
o Modifyandadapttheenvironment• Neurobehavioral
o Facilitate/Support§ Autonomicregulation§ Motorregulation§ Statetransition/regulation§ Attention/interaction§ Self-regulation
• Neuromotoro Facilitate/Support
§ Neurodevelopmentalpositioning§ Neurodevelopmentalhandling/positivetouch§ Developmentofnormalmovementpatterns§ Normalreflexdevelopment§ Normaltonedevelopmentandtonalchanges
©NeonatalTherapyNationalCertificationBoard 2020 9
IV.Self-AssessmentofDomain-SpecificContent
Rateyourcurrentknowledgeandexperienceofneonataltherapytopicsbelowusingthefollowingscale.
RatingScale:0=Noknowledgeorskills-Unfamiliarwithconceptorpracticeoftheskill1=Generalknowledgethroughobservationandacademiclearning-FamiliarwithgeneralknowledgerelatedtotheskillthroughacademiclearningandobservationbuthavenothadanopportunitytoapplythisintheNICU2=Generalclinicalskillswithmentorship-FamiliarwithgeneralclinicalapplicationoftheskillandoccasionallyappliedthiswithmentorshipintheNICU3=NeonatalTherapypracticecompetence–ImplementedtheskillintheNICUsettingandcanbegintoguideothersinthispractice
Areasthatareassessedasa0or1mayrequireadditionaleducation;thosescoreda2mayrequirereview;andthosescoreda3indicategoodknowledgeinthatparticulararea.Refertothereferenceguideforstudymaterialsrelatedtodomain-specificcontentthatwerescored0,1,or2foradditionalreadings.
©NeonatalTherapyNationalCertificationBoard 2020 10
1:FoundationsofNeonatalTherapyPracticeKnowledgeoffetalphysical,sensory,feedingandneurologicdevelopment
0 1 2 3Knowledgeofco-morbidities&sequelaeofpretermbirth
0 1 2 3KnowledgeofmedicaldiagnosesthatmayrequireNICUadmission
0 1 2 3Knowledgeofcardio-pulmonarymonitoringthresholds
0 1 2 3KnowledgeofandabilitytointerpretmonitorsusedintheNICU
0 1 2 3Knowledgeofequipment&medical/nursingcareintheNICU
0 1 2 3KnowledgeofsynactivetheoryandothertheoriesusedintheNICU
0 1 2 3KnowledgeofcommonmedicationsusedintheNICU,impactonthepremature/medicallycomplexinfant
0 1 2 3KnowledgeofcommonmedicalinterventionsusedintheNICUandpotentialimpactonthepremature/medicallycomplexinfantsuchasphototherapy,head/bodycooling,intubation,CPAP
©NeonatalTherapyNationalCertificationBoard 2020 11
0 1 2 3Knowledgeofmedical/surgicalproceduresandthepotentialimpactonthepremature/medicallycomplexinfantsuchasPDAligation,TEF/EArepair,chesttubes,gastroschisis/omphaloceleclosure,gastrostomytubeplacement,Nissenfundoplication
0 1 2 3KnowledgeofNICU“culture”
0 1 2 3KnowledgeofcommonNICUterminology
0 1 2 3
©NeonatalTherapyNationalCertificationBoard 2020 12
2:NeonatalScreening,Assessment,EvaluationandDiagnosisKnowledgeofpainassessmentandmanagement
0 1 2 3Knowledgeofstandardizedandnon-standardizedassessmentsusedintheNICU
0 1 2 3Knowledgeoffeeding/swallowingskillsintypicallydevelopingterminfant
0 1 2 3Knowledgeofco-morbidities&sequelaeofpretermbirthonfeeding/swallowingdevelopment,includingdifferencebetween“healthy”premature/immatureinfantandextremelypremature/lowbirthweightand/ormedicallycomplexinfant
0 1 2 3Knowledgeofcommoncomorbidities,diagnosesandpotentialimpactonoutcome
0 1 2 3Knowledgeoffeedinginterventionsforextremelypremature/medicallyfragileinfants
0 1 2 3KnowledgeofmodelsofcareusedintheNICU
0 1 2 3KnowledgeoftheimpactofNICUhospitalizationonthefamily
0 1 2 3Knowledgeofthestatesofarousal,behavioraldevelopmentinthecontextofpostmenstrualage
©NeonatalTherapyNationalCertificationBoard 2020 13
0 1 2 3Knowledgeofneonatalreflexes
0 1 2 3
©NeonatalTherapyNationalCertificationBoard 2020 14
3:NeonatalTherapyInterventionsandFamily-CenteredCareKnowledgeofstrategiestosupportoralfeedingskillacquisition
0 1 2 3Knowledgeoffamilyexperienceofpretermbirth
0 1 2 3KnowledgeofevidencedbasedinterventionsintheNICU
0 1 2 3Knowledgeofpatternsofsleepandmethodstoprotectsleep
0 1 2 3Knowledgeofappropriatepositioningforhighriskinfants
0 1 2 3Knowledgeofmethodsandtoolsavailabletopositionhigh-riskinfantsintheNICU
0 1 2 3Knowledgeofstrategiestodecreaseorincreasetone,facilitatefeeding,improvestateregulation,empowerparents,fosterreflexdevelopment,andultimatelyimproveoutcomes
0 1 2 3Knowledgeaboutmethodstomodifytheenvironment
0 1 2 3
©NeonatalTherapyNationalCertificationBoard 2020 15
V.SampleExaminationQuestionsExaminationquestionsaremultiplechoicewith4options.Readthequestioncarefullyandchoosetheoptionthatbestanswersthequestion.Belowaresomesampleexaminationquestions,inadditiontotheonesprovidedintheexaminationmanual,toassistyouinbecomingfamiliarwiththeformatandstyle.Explanationsforcorrectanswersareprovidedforyourreferenceafterthesamplequestions.1. Atwhichgestationalagedoesafetusfirstdemonstrateanemergingtactilesystem?
a. 12-15weeks.b. 16-19weeks.c. 20-23weeks.d. 24-27weeks
2. WhatistheMororesponse?a. Whenyoustrokethesideoftheinfant'smouth,andtheinfantturnstowardthestimulus.
b. Whenyouextendtheknee,anddeterminetheangleofkneeflexionatthepointofresistance.
c. Whenyoutaporstrokeonthesideoftheinfant’sspine,andtheinfant’strunkflexestowardthatside.
d. Whenaninfantistiltedbackwardsfromupright,andhis/herarmsabductandextend,followedbyreturn.
3. Whichofthefollowingdiagnosesisariskfactorforpossiblestructuralanomaliesthatmayimpactswallowfunction?a. Fetalalcoholsyndrome.b. Hypoxicischemicencephalopathy.c. Polyhydramnios.d. Intraventricularhemorrhage.
4. Whatarepossiblesideeffectsofpatentductusarteriosusligationthataneonataltherapistshouldconsider?a. Thisprocedurecanleadtopulmonaryhypertension,whichcanresultinlimitedenduranceforfeedingandotheractivities.
b. Thisprocedurecanexacerbatelungdiseasebydecreasingpulmonarycompliance,resultinginbronchopulmonarydysplasia.
c. Thisprocedurecancauseincreasedriskofdesaturationepisodes,whichshouldbecarefullymonitoredduringtherapyactivities.
d. Thisprocedurecanleadtovocalcordparalysis,resultinginrespiratoryissues,increasedriskofaspiration,dysphagia,andreflux.
©NeonatalTherapyNationalCertificationBoard 2020 16
5. Whichisacommoncharacteristicofapretermbaby,comparedtoafull-terminfant?
a. Hyperactivereflexes.b. Moreextendedpositioning.c. Morefatstores.d. Lackofhair.
6. Forinfantsbornextremelypreterm,whataresomepatternsrelatedtofeedingthatareoftenobservedduringlaterinfancyandtoddlerhood?a. ParentalreportthatNICUgraduatesshowimprovedtoleranceofintroductionofnew,solidfoodsatearlyages.
b. Alteredparent-infantinteractionduringfeeding,withpraiseforeatingmoreandminimalresponsetoinfantcues.
c. Reducedparentalemphasisonweightgainandamountoffoodintake,withapreferenceforadlibfeedingschedules.
d. Heightenedparentsensitivitytoinfantfeedingbehavior,payingcloseattentiontoinfantfeedingcues.
7. Whichofthefollowingsourcesofnutritionwillbemostlikelyutilizedforaninfantwhois24-weekspostmenstrualage?a. Totalparenteralnutrition.b. 22-calorieformula.c. Mother’sbreastmilk.d. Nonutritionwouldbeneeded.
8. WhichofthefollowingNICUassessmentscanbedescribedas“observationsofbehaviorsrepeatedat2-minuteintervalsbefore,during,andaftercaregivingeventstoassesstheinterplayoftheinfantbehavioralsubsystemstotheenvironmentorcaregivingenvironment?”a. NaturalisticObservationoftheNewborn.b. Prechtl’sGeneralMovementAssessment.c. TestofInfantMotorPerformance.d. BrazeltonNeonatalBehavioralAssessmentScale.
©NeonatalTherapyNationalCertificationBoard 2020 17
Correctanswersandrationale:Question1:CorrectanswerisA.Thetactilesystemisthefirstsensorysystemtodevelopembryologically,and12-15weeksistheonlyoptionthatreflectsthecorrecttimeline.Question2:CorrectanswerisD.TheMororesponseiselicitedbytippingthechildbackwards,andinvolvesabductionandextensionoftheupperextremitiesfollowedbyreturntotheinitialposition.AnswerAdescribestherootingreflex.AnswerBdescribesmeasurementofthepoplitealangle.AnswerCdescribestheGalantreflex.Question3:CorrectanswerisC.Thefetusswallowsamnioticfluidand“primes”theintestinesforfeeding.Onecauseofpolyhydramnios(excessamnioticfluid)iswhenthefetusisnotswallowingamnioticfluid,suchasinthecaseofesophagealatresia,cleftsorstructuralproblemsimpactingswallowing.FetalAlcoholSyndromepresentswithmicrocephalyandsomefacialdifferences,butswallowingstructuresareintact.Bothhypoxicischemicencephalopathyandintraventricularhemorrhageareinjuriestothebrainwhichdonotinfluenceswallowingstructures.Question4:CorrectanswerisD.Oneriskfactorofsurgicalclosureofpatentductusarteriosus(PDA)isleftvocalfoldparalysis,whichcanleadtovocalcordparalysisandotherfactorslistedinanswer“D.”Answer“A”describespulmonaryhypertension.Wheninfantsexperiencepulmonaryhypertension,thereisapressuregradientthatmakesitdifficulttomovebloodtothelungsforoxygenationandtheneonatemayshuntbloodfromtherightsideofthehearttotheleft,keepingthePDAopen.Inanswer“B”,anopenPDAcancontributetoincreasedrateofBPD;thereforeifthePDAisclosed,lungfunctionshouldbeimproved.Inanswer“C,”therearemultiplereasonsforoxygendesaturation,notjustPDA.AfterPDAclosure,theinfantshouldoxygenatebetter,asnormalcardiaccirculationcanoccurratherthanshuntingbloodthroughthePDA.Question5:CorrectanswerisB.Prematureinfantshavelowermuscletoneandlessabilitytofightgravity,resultinginmorelikelihoodforextendedpositioningpatterns.AnswerAisincorrectbecauseprematureinfantstendtohavehypoactive,nothyperactive,reflexes.AnswerCisincorrectbecauseprematureinfantshavelessfatthanfull-terminfants.AnswerDisincorrectbecauseterminfantstypicallyhaveshedtheirlanugo,orithasthinnedconsiderably.
©NeonatalTherapyNationalCertificationBoard 2020 18
Question6:CorrectanswerisB.Severalauthorshavedescribedalteredparent-infantinteractionaroundfeedingwheninfantsarebornprematurely.Parentsoftheseinfantsdemonstratemorefocusonvolumeintake,andareconcernedaboutweightgain.Therefore,parentshavedifficultyfollowinginfantcuesduringfeeding,andthispersistsintotoddlerhoodandpreschoolages.OptionBcorrectlydescribestheseissues.OptionsCandDareincorrectbecausetheyimplythatparentsgivelessimportancetointakeandweight,andmoreimportancetoinfantcues.OptionAisincorrectbecausetheseinfantsalsodemonstratedifficultieswithintroductionofsolidfoods, particularlyiftheyhavelumpytextures.Question7:CorrectanswerisA.Forachildat24-weekspostmenstrualage,totalparenteralnutritioncanprovidethechildwiththenecessarynutrients(optionA).A24-weekinfantcannottakefeedingsbymouth(incorrectoptionsBandC)becausetherooting,swallowing,andsuckingreflexesemergearound28weeks(andeventhen,theyarestillbesloworimperfect).OptionDisevidentlyincorrect,asasourceofnutritionneedstobeprovided.Question8:CorrectanswerisA.TheNaturalisticObservationoftheNewborn(NONB)wasdevelopedaspartoftheNeonatalIndividualizedDevelopmentalCareandAssessmentPlan(NIDCAP),basedonDr.HeideliseAls’synactivetheory.Thisassessmentisobservationalwithbehaviorsrecordedover2minuteintervals.Thecliniciansummarizesresultsandwritesatreatmentplanforthebabybasedoninfantresponsestohandlingandtheenvironment.WhiletheGeneralMovementAssessment(GMA)usescriticalskillsofobservationforassessment,itisnottimeincrementalover2minuteperiodsandfocusesmorespecificallyonmotorquality.Thelasttwoassessments-theTestofInfantMotorPerformance(TIMP)andtheBrazeltonNeonatalBehavioralAssessmentScale(NBAS)-requirethattheclinicianhandletheinfantandassessresponsestohandlingandinteraction.
©NeonatalTherapyNationalCertificationBoard 2020 19
VI.ExamPreparationTips1. Reviewthereferencelistprovidedtoyouatthetimeyoucompletedyourapplication.
TakeNICU-relatedcontinuingeducationcoursesand/orreviewmaterialrelatedtoneonataltherapy.
2. Usetheself-assessmenttoolsinthisstudyguide,andthesamplequestionsintheexaminationmanualandthestudyguide,tohelpdirectyourstudy.
3. Planaheadandpaceyourself–makeaschedulethathelpsyouorganizeyourstudysessionsandsticktoit.
4. Don’tfeellikeyouhavetoblocklargechunksoftimeforeachstudysession.Studyingforshorterperiodsbutmorefrequentlymayworkbetterintermsofstickingtoaschedule,anditcanhelpyoubetterretaininformation.
5. Selectanenvironmentwithoutdistractionssoyoucanfocusonyourstudying.6. Allowyourselfbreaksasneeded,butifyoufeellikeyouaretakingtoomanybreaks,it
maynotbeagooddayforstudying.Itisoktomodifyyourscheduleaslongasyoukeepmakingprogress.
7. Startwithoneortwotopicsthatyoufeelmostcomfortablewith,toreinforcewhatyouknowandtostartonapositivenote.Thenmovetoatopicthatisabitmorechallenging.
8. Usetheresourcelisttohelpyouexpandyourknowledgeinareaswhereyoufeellesscomfortable.
9. Focusonrelevantclinicalknowledge–thingseveryneonataltherapistwhohasseveralyearsofexperienceshouldknow–ratherthanrandomfacts.
10. Asyoustudy,thinkofpossiblequestionsrelatedtothematerial.Whatarethenuggetsofinformationthatarecriticalinthematerialthatyouarereading?Ifyouhadtocheckifsomeoneknowsthistopic,whatwouldyouaskthem?
11. Makeflashcardswithimportanttopics,orwritequestionsrelatedtothematerial–thencomebackafterafewweeksandseeifyoucananswerthem.
12. Getsupportfromotherswhoarepreparingfortheexam!Groupstudyingcanhelpreinforceinformationwhenyouquizoneanotheroryousharewhatyouknowonatopic.Youcanalsohelpkeepeachotherontrack.
13. Arriveearlyatthetestingcentersoyoudon’tfeelrushed.Getafullnight’ssleepthenightbeforesoyouarerestedandfocused.
14. Eatsomethingbeforeyoucome.Nofoodordrinksareallowedatthetestingcenter.
©NeonatalTherapyNationalCertificationBoard 2020 20
FeedbackfromCNTsoncompletingtheexaminationprocessCertifiedneonataltherapistswhohavesuccessfullycompletedtheexaminationprocesshaveprovidedfeedbackontheirexperienceofpreparingforandundertakingtheexamination,whichyoumayfinduseful.
• “Thetypeofknowledgeprovidedwasmoregeneralthanexpected”Rememberthattheexaminationisdesignedtoascertain coreknowledgerequiredforsafe,efficacious,evidence-based,andindependentpractice.TheexaminationisnotdesignedtotestknowledgeofinfrequentorrareclinicalpresentationsintheNICU.Theexaminationalsodoesnotcontainquestionswithcontentthatdoesnothavesupportingevidence.Youshouldhaveacomfortablelevelofknowledgeacrossthecoredomains,builtfromyouryears/hoursofexperienceintheNICU,personalreading/studyandtheNICUspecificeducationandmentoringprocessesyouhaveundertakentodate.
• “Takethetimetoreadthroughtherecommendedarticles…focusoncontentoverdetails”
Previousapplicantshavefoundthereferencelistinthefollowingsectionhelpful,althoughitcanfeellikealargeamountofreadingtoreview.Inplanningtheirstudyapproach,CNTsnotedthatitwasimportanttounderstandthemainknowledgeconstructsdiscussedinthepapers,butnotnecessarilytofocusonspecificstudydetails.
• “Reviewareaswithwhichyouhavelessclinicalexperience”
CNTsrecognizedthatdependingontheirdomainofpracticeandthedifferentteammembersworkingwithintheirNICUsetting,theymayhavemorepracticeexperienceinsomecoredomainsthanothers.Thisappearstoparticularlyapplytoareassuchasfeedingandneurodevelopmentalassessment.Theexaminationisdesignedtoassessyourunderstandingofcoreknowledgeinthesedomains,soyouwillbefamiliarwithmanyofthem,evenitifdoesn’tconstitutepartofyourdailyneonataltherapypracticeonaregularbasis.CNTssuggestedthatitishelpfultoapproachthereviewofthereferencelistbyensuringgreaterfocusonthoseareaswheretheyhadlessclinicalexperience,andthereforemaybelessfamiliarwithsomeoftheevidencesupportingneonataltherapypracticeinthosedomains.Theapplicantcandotheself-assessmenttobetterisolatecoreareastofocustheirstudyon.