1. Early Brain development

2. Development of the Brain’s Wiring • Neurogenesis: Manufacturing of brain cells. • Migration: Moving cells to their pre-determined place on the cortex. • Neuronal differentiation and pathfinding: Growing axons and dendrites to link with other neurons. • Synaptogenesis: Developing synapses with other cells. • Maturation and pruning: Refining synapses. • Gliagenesis (Myelination): Forming of supportive tissue that surrounds neurons and promotes communication between cells. Neurons to Neighborhoods, 2000

3. Fetal Brain Development • Neurogenesis & Neurulation • Migration • Neuronal Differentiation and Pathfinding • Synaptogenesis • Maturation and Pruning • Glialgenesis/ Mylenination Drawing by Tom Prentiss, Cowan MW 1979. The development of the brain. Scientific American 113; 113-133

4. Migration • Forms elevations (gyri) and depressions (sulci) • 2 hemispheres bridge • 6 layers of cerebral cortex divide into frontal, parietal, temporal and occipital lobes

5. Synapse Formation • Begins about 8 weeks gestation and continues as neurons proliferate, differentiate, and migrate • Both axons and dendrites grow and “branch” making connections for transmission of information • This is a prerequisite for interaction to occur in the CNS

6. Migration • Forms elevations (gyri) and depressions (sulci) • 2 hemispheres bridge • 6 layers of cerebral cortex divide into frontal, parietal, temporal and occipital lobes

7. Synapse Formation • Begins about 8 weeks gestation and continues as neurons proliferate, differentiate, and migrate • Both axons and dendrites grow and “branch” making connections for transmission of information • This is a prerequisite for interaction to occur in the CNS

8. Synaptogenesis • Rapid overproduction of synapses • Synapse elimination • Experience dependent Volpe,JJ: Neurology of the Newborn, 4th ed. Phiildelphia: WB Saunders, 2001

9. Neuronal differentiation and pathfinding • Experience dependent • Effected by myelination Volpe,JJ: Neurology of the Newborn, 4th ed. Phiildelphia: WB Saunders, 2001

10. Myelination • Begins at 6 months gestation & continues into adulthood • Glial cells produce myelin • Fatty covering coats & insulates axons • Speeds conduction of impulses • Allows more complex functioning • True maturity of CNS only occurs after myelineation process has fully developed Volpe,JJ: Neurology of the Newborn, 4th ed. Phiildelphia: WB Saunders, 2001

11. Plasticity • The capactiy to adapt in very specific ways to the changing demands • Reorganization of the brains structure and/or function Volpe, 2001

12. “In full term infants, axonal and dendritic proliferation … and cell growth and differentiation … occurs in an environment of mother mediated protection from environmental perturbations, with a steady supply of nutrients, temperature control, and the presence of multiple hormonal regulating systems …” Als, 1997

13. STRATEGIES FOR INDIVIDUALIZED DEVELOPMENTAL CARE

14. •Parent support •Consistency in caregiving •Structuring caregiving •Pacing of caregiving •Support during transitions in care •Positioning •Feeding support •Kangaroo care •Pain management •Environmental considerations Key Components of Developmentally Supportive Care

15. Why are caregiving approaches so critical? The newborn responds to changes in the environment and to caregiving interventions with: Behavioral changes Physiological changes

16. NURSERY ENVIRONMENT • increase space for each bedside area, • weather stripping on cabinets and doors, • sound absorbent materials on all surfaces that are appropriate, • rubber trash cans • carpet • incubator covers • single patient rooms.

17. Collaboration of Care Providers • Primary team- includes the family, nursing, medicine, respiratory therapy, social work, OT/SP • Developmental specialist support primary teams in developmental care planning and implementation; provide resources

18. DIRECT INTERVENTIONBODY POSITIONING • Infants born prematurely will have an immature musculoskeletal system that can be influenced by their positioning #59

20. Positioning for Optimal development of the Neonate • Improves alertness and assists with organization • Improves alignment of hips and shoulders • Comfort • Promotes normal development • Minimizes abnormal movement patterns • Encourage balance between flex/ext • Promote symmetry

21. Developmental Abnormalities caused by poor positioning • Elevated and retracted scapula • “W” position • “Frog” position • Hyperextension

22. PRONE • Helps develop flexion pattern (Connaly, Montgomery 1987) • Facilitates development of early head control (Bobath 1972) • Improves oxygenation (Martin et al 1979)

23. PRONE • Hips and knees flexed with knees under hips • Arms flexed with hands near head • Hand to mouth • Head turned to one side • Boundaries at sides and feet with foot support to allow neutral position of ankle