Tools

In addition to the education materials and week-by-week guide, log sheets for parents, the medical team, and volunteers are provided to track the positive sensory exposures that are implemented each week. Although specific doses of positive sensory exposures are identified in the guide, it can be individualized for each infant based on the preferences of the family and/or the medical status/tolerance of the infant. An assessment of sensory tolerance is also included in the SENSE program package. This weekly infant assessment, which can be conducted more often when needed, aims to ensure that the infant tolerates the week-by week sensory exposures as described, and it also provides guidance on how to identify adaptations to sensory exposures when necessary. The weekly infant assessment is designed to be conducted by a physical or occupational therapist with neonatal expertise or by another designated health care professional.

Rationale: High-risk infants who receive care in the neonatal intensive care unit (NICU) are exposed to significant stressors that include painful procedures, disruption of normal sensory experiences, and stress related to parent-infant separation. There is growing concern that these alterations in the early environment, during a period of rapid brain development, can negatively impact developmental outcomes.

In an environment where stimuli are primarily negative, positive sensory exposures and parent-infant interaction are crucial and can have life-long implications on learning, memory, emotions, and developmental progression. It is well understood that multi-dimensional sensory exposures are present in utero in the final months and weeks of pregnancy, but an infant born preterm misses those potentially important, timed exposures that may be absent or altered in the NICU environment.

While the use of positive sensory exposures, such as massage, auditory exposure, and skin-to-skin care have been related to better parent and infant outcomes, a guideline that describes specific doses and targeted timing of positive multi-modal sensory exposures across all the days, weeks or months of hospitalization was needed. The SENSE program was developed to fill that need.

Applications: The SENSE program is a comprehensive, standardized guideline on providing developmentally appropriate and timed sensory exposures for preterm and high-risk infants who are hospitalized in the NICU. The guideline can be initiated immediately after birth and used throughout NICU hospitalization. Education materials are designed for the family. The weekly infant assessment is designed to be conducted by a physical or occupational therapist with neonatal expertise or other designated medical professional.

Advantages:

• Descriptive and comprehensive education aimed at informing and engaging parents in providing developmentally appropriate sensory exposures to their infant(s).
• Evidence-based week-by-week sensory interventions that adjust with postmenstrual age.
• Materials that can be individualized based on the needs of each NICU.
• The written materials available in the SENSE package include: a booklet for parents, log sheets to track sensory exposures, and a weekly infant assessment. An electronic version of SENSE is also available that enables education materials to be pushed to a personal computer, iPhone, or tablet. The electronic version has videos that demonstrate the described interventions.

Stage of Development: This SENSE program is currently being utilized in a randomized control trial at St. Louis Children’s Hospital. Additional revisions may be made upon the completion of the randomized control trial.

*The week-by-week guide was developed after a rigorous process of protocol development. This  included an integrative review that outlined 88 articles on sensory-based interventions (auditory, tactile, vestibular, visual, kinesthetic, and olfactory/gustatory) that were used with preterm infants to improve outcome, expert input from a multidisciplinary group of 108 health care professionals that defined sensory interventions implemented across different NICUs, 3 multidisciplinary focus groups that provided a critical review of the guidelines, and interviews with 20 parents of preterm infants who gave input on the feasibility of implementing the SENSE guideline in the NICU. The week-by-week guide ensures that the type and timing of different sensory exposures are tailored to infants based on their developmental needs. A pilot study of 30 preterm infants using the finalized SENSE protocol demonstrated feasibility and preliminary evidence of a positive impact on parent confidence. A randomized clinical trial, which will identify infant and parent outcomes longitudinally, is currently underway.