Neonatal Therapy National Certification …...The Neonatal Therapy National Certification Examination assesses the basic skill and knowledge required for safe, efficacious, evidence-based,

NeonatalTherapyNationalCertificationExaminationStudyGuide5/12/2020

©NeonatalTherapyNationalCertificationBoard 2020 2

I.DefinitionofNeonatalTherapyII.ContentofNeonatalTherapyNationalCertificationExaminationIII.Domain-SpecificContentIV.Self-AssessmentofDomain-SpecificContentV.SampleExaminationQuestionsVI.ExamPreparationTips


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)


II.ContentofExaminationTheNeonatalTherapyNationalCertificationExaminationassessesthebasicskillandknowledgerequiredforsafe,efficacious,evidence-based,andindependentpracticeintheNICUsetting.Theexaminationcoversabroadrangeofknowledgeandisbrokendownasfollows:

ExamBlueprint

Descriptionsofeachareaareprovidedbelow,alongwithaself-assessmenttoaideachapplicantindeterminingareashe/shemayneedtofocuson.

FoundationsforNeonatalTherapyPractice

NeonatalScreening,Assessment,EvaluationandDiagnosis

NeonatalTherapyInterventionsandFamily-CenteredCare

40%

30%

30%


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


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


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


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


IV.Self-AssessmentofDomain-SpecificContent

Rateyourcurrentknowledgeandexperienceofneonataltherapytopicsbelowusingthefollowingscale.

RatingScale:0=Noknowledgeorskills-Unfamiliarwithconceptorpracticeoftheskill1=Generalknowledgethroughobservationandacademiclearning-FamiliarwithgeneralknowledgerelatedtotheskillthroughacademiclearningandobservationbuthavenothadanopportunitytoapplythisintheNICU2=Generalclinicalskillswithmentorship-FamiliarwithgeneralclinicalapplicationoftheskillandoccasionallyappliedthiswithmentorshipintheNICU3=NeonatalTherapypracticecompetence–ImplementedtheskillintheNICUsettingandcanbegintoguideothersinthispractice

Areasthatareassessedasa0or1mayrequireadditionaleducation;thosescoreda2mayrequirereview;andthosescoreda3indicategoodknowledgeinthatparticulararea.Refertothereferenceguideforstudymaterialsrelatedtodomain-specificcontentthatwerescored0,1,or2foradditionalreadings.


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


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


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


0 1 2 3Knowledgeofneonatalreflexes

0 1 2 3


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


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.


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.


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.


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.


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.


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.

Documents

Neonatal Therapy National Certification …...The Neonatal Therapy National Certification Examination assesses the basic skill and knowledge required for safe, efficacious, evidence-based,