Early Brain development

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

•Neurogenesis & Neurulation•Migration•Neuronal Differentiation and Pathfinding•Synaptogenesis•Maturation and Pruning•Glialgenesis/ Mylenination

Fetal Brain Development

Drawing by Tom Prentiss, Cowan MW 1979. The development of the brain. Scientific American 113; 113-133

Migration

Forms elevations (gyri) and depressions (sulci) 2 hemispheres bridge6 layers of cerebral cortex divide into frontal, parietal, temporal and occipital lobes

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

Migration

Forms elevations (gyri) and depressions (sulci) 2 hemispheres bridge6 layers of cerebral cortex divide into frontal, parietal, temporal and occipital lobes

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

Synaptogenesis

• Rapid overproduction of synapses• Synapse elimination • Experience dependent

Volpe,JJ: Neurology of the Newborn, 4th ed. Phiildelphia:WB Saunders, 2001

Neuronal differentiation and pathfinding

• Experience dependent• Effected by myelination

Volpe,JJ: Neurology of the Newborn, 4th ed. Phiildelphia:

WB Saunders, 2001

Myelination

Begins at 6 months gestation & continues into adulthoodGlial cells produce myelin

Fatty covering coats & insulates axonsSpeeds conduction of impulsesAllows 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

Plasticity

• The capactiy to adapt in very specific ways to the changing demands

• Reorganization of the brains structure and/or function

Volpe, 2001

“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

STRATEGIES FORINDIVIDUALIZED DEVELOPMENTAL CARE

Key Components of Developmentally Supportive Care

•Parent support•Consistency in

caregiving•Structuring caregiving•Pacing of caregiving•Support during

transitions in care

•Positioning•Feeding support•Kangaroo care•Pain

management•Environmental

considerations

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

Behavioral changes

Physiological changes

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.

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

DIRECT INTERVENTIONBODY POSITIONING

• Infants born prematurely will have an immature musculoskeletal system that can be influenced by their positioning

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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

Developmental Abnormalities caused by poor positioning

• Elevated and retracted scapula• “W” position• “Frog” position• Hyperextension

PRONE

• Helps develop flexion pattern (Connaly, Montgomery 1987)

• Facilitates development of early head control (Bobath 1972)

• Improves oxygenation (Martin et al 1979)

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