#122 - NICU, Early Intervention, Sensory and More with Amirra Johnson, from Marvelous Mirracles

by Jessica Hill, COTA/L & Rachel Harrington, COTA/L, AC October 07, 2020

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NICU, Early Intervention, Sensory and More with Amirra Johnson, from Marvelous Mirracles

Today we are talking with Amirra Johnson, an incredible Occupational Therapist currently practicing in Early Intervention in Phoenix, AZ. She is also the founder of Marvelous Miracles, a platform designed to empower and equip therapists and families with the tools and resources to provide capable and confident care for infants and toddlers. She also has a passion for addressing racial health disparities that affect participation in meaningful occupations. 

 Dr. Amirra Johnson, OTD, OTR/L is a graduate of MGH Institute of Health Professions where she completed her Doctor of Occupational Therapy degree with a focus in pediatrics. Her doctoral research was conducted at Seattle Children’s Hospital to explore the role of OT in the Neonatal Intensive Care Unit, as well as involvement with the Pediatric Intensive Feeding Program. Currently, Amirra specializes in the treatment of infants born premature, infants born substance-exposed, and infants and children with sensory processing challenges. She has experience working with a variety of diagnoses, conditions, and syndromes to develop unique treatment plans that facilitate improvements in all areas of early childhood development. 


Nicu Early Intervention Sensory And More With Amirra Johnson From Marvelous Mirracles

Amirra is a highly skilled pediatric occupational therapist and certified newborn care specialist. With a specialization in early intervention for children aged birth to three years old, Amirra provides invaluable support to children facing various diseases, diagnoses, and conditions that impact their development.

Her expertise spans many areas, including physical development, gross motor skills, fine motor skills, cognitive skills, communication, social skills, emotional skills, and sensory processing. Through Amirra's compassionate and comprehensive approach, she empowers children to reach their full potential in all aspects of their growth and development.


Journey To Occupational Therapy

Amirra has always had a deep affection for children, particularly infants and toddlers, so she chose a career path as an occupational therapist. Initially, Amirra aspired to be a pediatrician; however, her ardor for the field intensified, leading her to discover a profound fascination with neonatology.

Specifically, she yearned to explore the intricate realm of premature births and their compassionate treatment within the neonatal intensive care unit (NICU). Over time, Amirra realized that medical school was not the right path for her.

As she contemplated her next steps, she started working as a nanny for an occupational therapist, allowing her to delve deeper into this profession. Amirra found herself irresistibly drawn to this captivating field.


Passion Ignites For Early Intervention

Amirra's extensive research and experience in the NICU have provided her invaluable insight into the challenges families face in this environment and its profound impact on various aspects of child development. Upon realizing that the primary objective in the NICU was to prepare the babies for discharge, it ignited Amirra's curiosity about what lies beyond.

This encounter ignited a steadfast dedication to continuously supporting these families in the long term. Amirra swiftly recognized the paramount importance of early intervention in fostering a child's growth and development.


The NICU Impact On The Sensory System

The NICU, although unfamiliar to some, encompasses many factors that can impact the development of infants. Nevertheless, it is crucial to emphasize the significance of the NICU environment in ensuring the well-being, development, and eventual transition home of premature infants.

Babies in the NICU may experience the following effects:

  • Bright lights can disrupt the sleep-wake cycle, affecting the development of a healthy circadian rhythm.
  • Heightened sensitivity to noise and can become easily overwhelmed.
  • Frequently experience pain due to exposure to different handling procedures.
  • Experience a wide range of emotions due to the unfamiliar and unpredictable environment.
  • Develop a reliance on external stimulation for comfort.


Supporting Sensory Needs In Early Intervention

Amirra utilized various techniques to address sensitivity, such as:

  • Dry brushing and applying deep pressure to their muscles.
  • Incorporating palm massages.
  • Enhance playtime sensory experience with textures like velcro dots or interactive toys.

Babies in the NICU frequently face challenges with their vestibular and proprioceptive systems. Their movement and compression are restricted by the small beds they are confined to, which can impact their development.

To tackle this, Amirra recommends specific activities, such as:

  • Utilizing different surfaces and postures to stimulate their vestibular system.
  • Wrap snugly with a blanket to provide compression and deep pressure.
  • Facilitate movement in an upright position by sitting on the parent’s lap or therapy equipment.
  • Incorporating auditory and visual sensory stimulation through sounds, music, and videos.


The NICU & Neuro-Behavioral Organization

Prematurely born infants often face difficulties with neuro-behavioral organization. At its core, neuro-behavioral organization encompasses how infants receive and process sensory input, such as sound, touch, balance, and other stimuli, and respond accordingly.

Recognizing the significance of organization and regulation is crucial for effectively participating in essential tasks. Patients lacking neuro-behavioral organization may encounter difficulties engaging in daily activities, such as eating, resting, and socializing with their caregivers.

This particularly applies to children who exhibit heightened sensitivity and are still in the developmental stage. Early intervention plays a crucial role in addressing these sensory challenges.


The NICU & Feeding Issues

In the NICU, infants often undergo weight gain and developmental progress to enhance their feeding abilities. Consequently, the relationship between feeding and using a nasogastric (NG) tube plays a crucial role in the discharge process.

Breastfeeding or bottle feeding enhances oral motor skill development and provides overall stimulation, surpassing the NG tube's benefits. Additionally, the feeding routine seldom exposes them to hunger, leading to a limited understanding of hunger cues.

Moreover, the imperative of safeguarding infants from dislodging vital lines and tubes may impede their innate inclination to explore objects with their hands and mouths. This restriction denies them the opportunity to engage with diverse textures, aromas, and interception.


The Benefits Of Early Intervention

The importance of early intervention in the NICU can not be overstated. It plays a vital role in ensuring that children reach their full potential across various aspects of development. This includes physical, cognitive, social-emotional, and language development.

Early intervention allows parents to play a vital role in their child's growth and development. This lets them know their child’s behavior, learning style, interests, attitudes, strengths, and needs.

Furthermore, early intervention gives families access to resources supporting long-term health and development outcomes. It can also give families the knowledge and skills necessary to aid their children's cognitive, physical, and social-emotional growth.


Racial Disparities In The NICU

Numerous studies have revealed a heightened risk of preterm birth among black and brown communities. This inequality stems mainly from insufficient access to prenatal care, which deprives families of the essential support they need.

The geographical location can significantly influence their access to high-quality healthcare. Unfortunately, numerous communities experience notable disparities in healthcare services, leading to varying levels of quality.

Infants from minority groups often receive lower-quality care in certain institutions due to inadequate funding and limited resources. The nurse-to-patient ratio can be high, resulting in missed opportunities for proper maintenance and less emphasis on essential practices like breastfeeding.

Other studies have brought attention to a distressing inequality, revealing that black infants face a significantly higher mortality risk than their counterparts. This heartbreaking reality underscores the urgent imperative to increase awareness and enact meaningful systemic changes in healthcare.


Racial Disparities In Early Intervention

The statistics reveal an interesting aspect of caseload diversity in early intervention. Amirra noticed a significant absence of black children on her caseload, which raised concerns considering the higher rate of preterm births among black infants.

She also raised concerns about the possible lack of representation of black children who may need early intervention services. This observation sparked a thorough investigation into the existing gaps and delved into how mothers of black and brown children perceive child development when seeking assistance from others.

To bring about meaningful change, it is vital to carefully consider your practice setting, whether outpatient pediatrics, acute care, or inpatient rehab. This presents a significant opportunity for occupational therapists to raise awareness of critical issues, starting from within their communities.


The Primary Challenge In Early Intervention

In Amirra's position within early intervention, she frequently operates autonomously, encountering various impromptu problem-solving scenarios. Nonetheless, she acknowledges that she finds it incredibly demanding when confronted with unfamiliar subjects and doesn't have the answers.

Amirra has come to acknowledge that as an Occupational Therapist, there will be instances where she may not possess all the answers. However, she has learned to embrace these moments as valuable personal growth and development opportunities.

Consistently keeping up with research and interventions is a perpetual source of motivation. By expanding her knowledge base, Amirra elevates her skills and expertise, constantly striving for improvement.


Amirra's Drive in Early Intervention

Amirra finds immense value in progress and growth in her role and the lives of the families and children she supports. Witnessing their remarkable development, celebrating their milestones, and seeing them thrive, learn, and engage in play is awe-inspiring and an everlasting source of motivation.

Being an occupational therapist is a continuous journey of self-improvement and personal growth. Working in this unique setting alongside families who have experienced NICU stays has revealed to Amirra the profound impact on their development.

Being a part of the solution and helping them reach their milestones despite the challenges they faced at birth is genuinely fulfilling. Amirra's greatest motivation lies in supporting families and empowering parents with the necessary tools.


Final Words Of Wisdom

Amirra's most profound counsel would be to venture beyond your comfort zone and wholeheartedly embrace the endeavors that may elicit fear or apprehension. Her cherished expression, "Do it scared," has become a guiding principle in her life.

As someone naturally introverted and shy, Amirra tends to hesitate when putting herself out there; however, she continues to challenge herself to step out of her comfort zone and embrace new experiences.

This transformative journey has enriched her life and brought about positive change in the lives of families and therapists. Amirra encourages you to embrace discomfort, for it is in those moments that actual growth and fulfillment await.






While we make every effort to share correct information, we are still learning. We will double check all of our facts but realize that medicine is a constantly changing science and art. One doctor / therapist may have a different way of doing things from another. We are simply presenting our views and opinions on how to address common sensory challenges, health related difficulties and what we have found to be beneficial that will be as evidenced based as possible. By listening to this podcast, you agree not to use this podcast as medical advice to treat any medical condition in either yourself or your children. Consult your child’s pediatrician/ therapist for any medical issues that he or she may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Under no circumstances shall Rachel Harrington, Harkla, Jessica Hill, or any guests or contributors to the podcast, as well as any employees, associates, or affiliates of Harkla, be responsible for damages arising from use of the podcast.

Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We try our best to keep things fair and balanced, in order to help you make the best choice for you.

This podcast should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast.

Jessica Hill, COTA/L & Rachel Harrington, COTA/L, AC
Jessica Hill, COTA/L & Rachel Harrington, COTA/L, AC

Rachel Harrington, COTA/l, AC, CPRCS, and Jessica Hill, COTA/L, CPRCS are Harkla's in-house Certified Occupational Therapy Assistants (COTA) and Certified Primitive Reflex Clinical Specialists. They have been working with children for over 6 years in outpatient settings. They specialize in creating easy-to-digest, actionable content that families can use to help their child's progress at home. Jessica and Rachel are the in-house experts, content creators, and podcast hosts at Harkla! To learn more about Jessica and Rachel, visit the Harkla About Us Page. Make sure to listen to their weekly podcast, All Things Sensory by Harkla for actionable, fun advice on child development.

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