NICU MEM: “Opening the Flood Gates” Infant Edema Management with Manual Edema Mobilization in the NICU and Beyond

Date: Friday-Sunday, August 9th through the 11th
Audience: OT, PT

priority will go to NICU therapists in a core position first followed by casuals. 

Course Level: Intermediate
Course time: Friday, August 9th: Check in time 3:30-4 pm 
Course time: 4-8 pm
Saturday, August 10th check in time: 7:30-8 am and Course time: 8-5:15 pm
Sunday, August 11th check in time: 7:30-8 am and course time: 8-12 pm
Location: Masonic children's Hospital
2450 Riverside Avenue, Minneapolis, MN 55454
Held in WILF auditorium
Continuing education hours: 15.5

Course Fee: $475.00

Group Discounts: 
If two people from the same organization register for a course, each person will receive a 10% discount using discount code REHAB10 and 3 or more registered will receive a 15% discount using code REHAB15. Please email or call ahead of time with the names of the people who will be registering as a group, [email protected] or 612-672-5607.

For Group discounts:  USE CODE rehab10 for 10% discount and rehab15 for 15% discount for group

PT: Course will be submitted to the MN Board of PT for approved credits. (submitting credits through the MN Board of PT does not guarantee full credits will be approved by the board

OT: You will receive a certificate of course completion with total CE contact hours. M HEALTH Fairview is not an approved provider through AOTA and has never been for distance learning. You may still submit the hours towards your licensure and receive a certificate of completion with all information provided to submit.  For additional information about CE requirements for license, please see MN Statute 148.6443: https://www.revisor.mn.gov/statutes/cite/148.6443
 
MN statutes 143.6443, subdivision SUBD.2 “Standards for determining the qualified education activities” will continue to be utilized in determining appropriate OT related CE courses.

(Submitting credits through the organizations does not guarantee approved credits or the full credits. All participants will receive a certificate of completion which you may be able to use towards your professional license).

Course Summary: 

Preterm and medically complex infants are surviving at younger ages due to medical advances utilized in the neonatal and cardiac/pediatric intensive care units. The co-morbidities of prematurity, post-surgical recovery, genetic conditions, and multi-system influences of these medical pathologies can place stress on the lymphatic system. Thus, fluid homeostasis is compromised, and neonatal/infant edema is the result. By integrating edema assessment and treatment techniques into the infant’s care plan, the neonatal therapist can improve positioning, self-regulation, movement, and functional skills. During this course, participants receive the most up-to-date and evidence-based literature regarding the role of the lymphatic system, edema assessment within the NICU, and specific co-morbidities that warrant edema management to maximize outcomes. Clinical education is provided regarding indications, contraindications, considerations during positioning/handling, oral motor facilitation, gross motor facilitation, pharmacological management, and additional interventions to support lymphatic transport of fluid. This course will provide hands-on lab time for superficial stimulation of the lymphatic system to facilitate fluid mobilization.  Clinical case studies with patient videos are shared to enhance the participants’ learning. Upon completion of this course, participants will have a deeper understanding of the lymphatic system, ability to integrate components of lymphatic care into clinical practice, use of edema assessment to create lymphatic care plans, demonstrate the hands-on skills for superficial lymphatic mobilization, and integrate oral/gross motor facilitation that will enhance lymphatic flow to reduce limitations in movement due to persistent edema.  This 2-day course is approved by Manual Edema Mobilization Associates and is taught by an endorsed MEM instructor.

Speaker:
Holly Schifsky, OTR/L, CNT, NTMTC, CBIS is an Occupational Therapist who has worked in pediatrics for the past 27 years with the past 16 years in a level IV NICU.  She is a Certified Neonatal Therapist, Certified Neonatal Touch and Massage Therapist, Certified Brain Injury therapist, an active member of National Association of Neonatal Therapists, and has completed 6-month mentorship in infant/child NDT.  She has worked within the NICU and NICU follow-up clinic to maximize patient and family outcomes for the most complex premature and medically fragile term infants.  Holly received her Bachelor of Science degree in Occupational therapy from the University of North Dakota in 1997.  She has dedicated her career to clinical care and advancing developmental care practice patterns for all multidisciplinary team members.  She has presented at many regional and national conferences including National Association of Neonatal Therapists, American Physical Therapy Combined Sections Meeting, Audrey Harris Vision NICU conference, and the University of Minnesota NICU conference.  She provides Developmental Care, Feeding Intervention, and NICU education throughout the country.  She is a faculty member for Neonatal Touch and Massage; an endorsed faculty member/instructor for Manual Edema Mobilization; and a faculty member for Education Resources Inc.  She is the recipient of the NANT Clinical Excellence award in 2018.
Financial Disclosures: Holly Schifsky receives a fee for speaking and instructing on this topic. 
Non-Financial Disclosures: Holly Schifsky has no relevant nonfinancial relationships to disclose.

 

Objectives:

  1. Participants will identify the role of the lymphatic system and gestational development as related to co-morbidities of prematurity, post-surgical interventions, and wound healing
  2. Participants will distinguish specific NICU/infant edema precautions, contraindications, and limitations to Manual Edema Mobilization
  3. Participants will apply individualized care planning with critical reasoning for the lymphatic flow of fluid regarding positioning, handling, and movement facilitation for premature and medically complex infants.
  4. Participants will assess premature/medically complex infant edema with consideration for type of edema and its influence on oral motor and gross motor movement to support development.
  5. Participants will demonstrate the five key components of MEM and application within the NICU:
    1. Diaphragmatic breathing
    2. Light manual lymphatic system stimulation with “Pump Points” and “Clear and Flow”
    3. Exercise
    4. Adjuncts
    5. Home program with caregiver training

Agenda:

Day 1:  Friday August 9, 2024

 

3:30-4:00 pm Registration and Pre-test 
4:00pm-6:00 pm:  Lecture: MEM & the lymphatic system
  • What is Manual Edema Mobilization and how does it fit with my care?
    • Mem core concepts
    • CDT vs MEM
    • Anatomy & Physiology of Fluid Homeostasis
      • Maturation of lymphatic system
      • Multi-system effects of lymphatic transport
        • Cardiac:  CHD, fetal heart anatomy
        • Pulmonary: pulmonary edema, PPHN
        • GI:  lacteals, enteric feeding
        • MSK: type I vs Type II muscle, diaphragm activation, lymphatic entrapment with prolonged immobility, early mobilization
        • Integumentary:  Vivien Dim information: skin buds
        • Nephrology: urine output, protein impact, med clearance
        • Neuro: Parasympathetic, glymphatic system
6:00pm-6:15pm   Break
6:15pm-6:45 pm Differential Diagnosis
  • Classification of edema:  high protein, low protein, and combination
  • Primary and secondary lymphedema:  Genetic conditions:
  • Lymphatic malformations
6:45pm-7:30 pm:  MEM Rationale and Key Components
  • Facilitate lymphatic transport (manual techniques, exercise, breathing)
  • Adjunct support to MEM
  • Influence on lymphatic transports to the body systems
7:30pm-8:00 pm  LAB
  • Lymphatic facilitation
  • Tactile input
  • Location of pump points
  • Direction of skin traction
  • Q and A
Day 2:  Saturday August 10, 2024
7:30am-8:00am REGISTRATION
8:00am-9:00am:  Clinical application of MEM in the NICU
  • NICU pathology with resulting edema
  • Pharmacological interventions paired with NICU edema
    • Diuretics
    • Sildenifel, Bosenten, Bumex
9:00am-9:45am:  Treatment Considerations for Edema Management in the NICU
  • Indications
  • Contraindication
  • Lab values
  • Gestational development of the lymphatic system
  • Skin maturation and lymphatic development/support
9:45am-10:00am BREAK
10:00am-12:00pm LAB with guided hands-on practice
  • Manual facilitation of pump points and Clear/Flow techniques
    • Trunk
    • Lower extremities
    • Upper extremities
    • Facial region and oral cavity
12:00pm-12:45pm    LUNCH
12:45pm-1:30pm Literature Review
  • Updates in literature, references, and resources for additional learning
1:30pm-3:00pm:  Lecture and Lab:  5 Key Components of Manual Edema Mobilization (MEM) Specific for neonates and infants
  1. diaphragmatic breathing (+ practice)
  2. light manual lymphatic system stimulation (+ practice)
  • Pump Points
  • Clear and Flow
  1. Movement (exercise) incorporation
  2. Adjuncts:
  • Compression/bandaging/garments
  • Elastic taping
  • Neutral warmth devices
  • Positioning: extension and elevation
  • Clothing considerations
  1. Home Program with caregiver training
3:00pm-3:15pm   BREAK 
3:15pm-4:15pm  LAB
  • Neutral warmth with manual facilitation
  • Isolated Pump Point: Roll Technique or “Blotter”
  • Lower abdominal sweep
 4:15pm-4:40pm  Lymphatic considerations for the Small Baby (32 weeks and younger)
  • Positioning concepts to support neonatal physiologic flexion and lymphatic support
  • Lymphatic considerations with positioning and neutral warmth to focused lymphatic bundles(what about bundles? Or tissues? Or that’s fine.)
  • Case example
4:40pm-5:15pm:  Video Demonstration 
  • Tactile input
  • Controlled sensory input
  • Monitor infant cues
Q and A
Day 3:  Sunday August 11, 2024
7:30-8:00am Registration
8:00am-8:45am:  Premature infant with Fluid Overload:  Case Study and Lab with participant skill demonstration
  • B lower extremity edema management
  • Pelvic floor and inguinal region edema
  • Facial edema
8:45am-9:30am:  Post Surgical edema and transition to chronic edema: Case Study and Lab with participant skill demonstration
  • Edema assessment
  • Line clearance
  • Isolated pump point “roll technique”
9:30am-10:00am:  Full Thickness IV infiltrate wound injury with lymphatic damage:  Case Study and Lab with participant skill demonstration.
  • Elevation
  • Focused MEM
  • Hand/foot clearance lab
  • Adjunct interventions
10:00am-10:15am    BREAK
10:15am-10:45am: Capillary Leak Syndrome/Anasarca: Case Study and Lab with participant skill demonstration
  • Pathology, labs
  • Positioning
  • Superficial lymphatic clearance
10:45am-11:15am Infant Lymphedema
  • Turners Syndrome
  • Lymphatic Malformation
  • Coordinated care with Certified Lymphedema Therapist
11:15am-11:45am MEM implementation
  • Guideline for intervention, training, scope
  • Discussion with medical team
  • Outcomes
  • Frequency of treatment
11:45am-12:00pm Summary, Post-test, Questions, Course Evaluation

REGISTER FOR THIS COURSE