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NeonatalTherapyNationalCertificationExaminationStudyGuide5/12/2020
©NeonatalTherapyNationalCertificationBoard 2020 2
I.DefinitionofNeonatalTherapyII.ContentofNeonatalTherapyNationalCertificationExaminationIII.Domain-SpecificContentIV.Self-AssessmentofDomain-SpecificContentV.SampleExaminationQuestionsVI.ExamPreparationTips
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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)
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II.ContentofExaminationTheNeonatalTherapyNationalCertificationExaminationassessesthebasicskillandknowledgerequiredforsafe,efficacious,evidence-based,andindependentpracticeintheNICUsetting.Theexaminationcoversabroadrangeofknowledgeandisbrokendownasfollows:
ExamBlueprint
Descriptionsofeachareaareprovidedbelow,alongwithaself-assessmenttoaideachapplicantindeterminingareashe/shemayneedtofocuson.
FoundationsforNeonatalTherapyPractice
NeonatalScreening,Assessment,EvaluationandDiagnosis
NeonatalTherapyInterventionsandFamily-CenteredCare
40%
30%
30%
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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
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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
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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
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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
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IV.Self-AssessmentofDomain-SpecificContent
Rateyourcurrentknowledgeandexperienceofneonataltherapytopicsbelowusingthefollowingscale.
RatingScale:0=Noknowledgeorskills-Unfamiliarwithconceptorpracticeoftheskill1=Generalknowledgethroughobservationandacademiclearning-FamiliarwithgeneralknowledgerelatedtotheskillthroughacademiclearningandobservationbuthavenothadanopportunitytoapplythisintheNICU2=Generalclinicalskillswithmentorship-FamiliarwithgeneralclinicalapplicationoftheskillandoccasionallyappliedthiswithmentorshipintheNICU3=NeonatalTherapypracticecompetence–ImplementedtheskillintheNICUsettingandcanbegintoguideothersinthispractice
Areasthatareassessedasa0or1mayrequireadditionaleducation;thosescoreda2mayrequirereview;andthosescoreda3indicategoodknowledgeinthatparticulararea.Refertothereferenceguideforstudymaterialsrelatedtodomain-specificcontentthatwerescored0,1,or2foradditionalreadings.
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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
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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
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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
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0 1 2 3Knowledgeofneonatalreflexes
0 1 2 3
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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
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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.
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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.
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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.
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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.
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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.
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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.
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