Proposal on an evaluation form for the standardized indication of physiotherapy and occupational therapy and scientific application in neonatology

Backround: Indication of physiotherapy and occupational therapy in neonatology oftentimes underlie quite subjective criteria. A standardized reference instrument could therefore be used to identify children, that require therapy (discriminative function), and to evaluate changes over time (evaluative function), based on defined criteria. Furthermore, such assessment tool could serve for prospective evaluation in intervention studies of physiotherapy and occupational therapy in neonatology as measure for patient inclusion and stratification of neurological abnormalities.

Methods: Patients are beeing assessed at defined age ranges (up to 30+6, 31–34+6, 35–38+6 weeks GA) with respect to five modalities:

• spontaneous movements and posture,

• vigilance, behaviour and reaction to stimuli and environment,

• General Movements according to Prechtl/Hadders-Algra,

• Orofacial competence and feeding,

• respiration.

Each subdomain can be scored with 0–3 points, additionally a total score of 0–18 points is generated. Primitive Reflexes and joint deformities can complementary be documented, but do not contribute to the total score.

Scoring of each subdomain indicates the necessety of therapy, its intensity and the adequate form of therapy. The total score permits conclusions on the degree of global neurological abnormality of a child and allows a rough graduation.

Conclusion: Given the requirements described above, we have developed an evaluation form, that serves as a semi-standardized assessment tool to easily and clearly quantify neurological findings of neonates. Subscores provide decision criteria for the indication of physiotherapy and occupational therapy and serve to keep records of the child's development. The collected data can be a basis for longitudinal and interventional trials.