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Neuro Developmental Therapy

Dr.C.B.Senthilkumar
BPT.,MPT.,PhD(Paediatric Neurology).,
Lecturer-Physical Therapy

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Bobath Vs NDT
Lennon S, Ashburn, A. The Bobath concept in
stroke rehabilitation: a focus group study of
the experienced physiotherapists'
perspective.Disability and Rehabilitation.
2000; 22(15): 665-674.
NDT\The Bobath
concept in stroke rehabilitation_ a focus grou
p study of the experienced physiotherapists' pe
rspective.pdf

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 Berta Bobath (physiotherapist) and
Karel Bobath (psychiatrist/neurophysiologist).
Berta Bobath Karel Bobath

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 NDT
Advancedhandsonapproachtotheexaminati
onand
treatmentofindividualswithdisturbancesoff
unction,movementandposturalcontroldueto
alesionofthe centralnervoussystem(CNS)
Usedprimarily with childrenwho
havecerebral palsy (CP) and adults with
cerebro vascular accidents (CVA)
Practiced by PT, OT, SLP who completed
advanced training in NDT
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A 360o treatment plan..
Physiotherapy
e.g. To reduce orincrease muscle tone, improve
mobility injoints, control posture
Occupational therapy
e.g. to help with tasks that improve
independence such as gettingdressed, holding
a pencil
Speech & Language therapy
e.g. to developways of communicating
andhelping with eating and drinking

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NDT Evolution(1940-1990):
Decreasing muscle tone through the use of
reflex inhibiting postures
Incorporation of hierarchical motor sequences
into therapy, with one activity following another
during facilitation (head control, rolling, sitting,
quadruped, kneeling)
Facilitation of automatic movement sequences
as opposed to isolated developmental skills
Currently, it is recognized the need to direct the
treatment towards specific functional situations

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NDT Assumptions:
Impaired patterns of postural control and movement
coordination are the primary problems in clients with
CP
These system impairments are changeable and
overall function improves when the problem of motor
coordination are treated by directly addressing
neuromotor and postural control abnormalities in a
task specific context
Sensorimotor impairments affect the whole individual
the persons function, place in the family and
community, independence and overall quality of life

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 A working knowledge of typical adaptive motor

development and how it changes across the life

span provides the framework for assessing function
and planning intervention.
NDT clinicians focus on changing movement
strategies as a means to achieve the best energy-
efficient performance for the individual within the
context of the age appropriate tasks and in
anticipation of future functional tasks.
Movement is linked to sensory processing

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 Intervention strategies involve the individuals
active initiation and participation, often combined
with therapists manual guidance and direct
handling
NDT intervention utilizes movementanalyzesto
identify missing or atypical elements that link
functional limitation to system impairments
Ongoing evaluation occurs throughout every
treatment session
The aim of NDT is to optimize function
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Key Concepts:
I. Normal development

Principles of normal development

Cephalo-caudal, proximal-distal, gross to fine

Sensory-motor-sensory feedback system

Components of normal development

a.Interplay between stability and mobility

b. Effects of postural reflex mechanism on movement

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 Postural tone
Muscle tone
Reciprocal innervation - interplay between agonist
and antagonist muscles during coordinated muscle
movement
Righting and equilibrium reactions:
Righting reactions- restore and maintain the vertical
position of the head in space, the alignment of the
head and trunk and trunk and limbs
Equilibrium reaction- serve to maintain or regain
balance during a shift in the center of gravity
The ability dissociate movements
Development of postural control in the three planes
of space
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 Sequences of motor development:
Gross
Fine
Language/communication
Social

II. Abnormal development

III. Sensory input (proprioception, vision,

auditory system, tactile, olfactory, vestibular
system) as a means of bringing about
change
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Examination:
NDT Focus:
To identifyconstrainsthat limit the clients
ability to perform functional activities.
Components:
Present and anticipated functional skills or
limitation of skills
Posture and movement components and
compensatory strategies
Anatomical and physiological status of those
systems that contribute to functional limitations
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Examination
Functional Skills
Gross and fine motor control, communication,
and control of behavior and emotions
Functional abilities and limitations
Potential to change function
Clusters of function and activity limitations
Relationship between participation and
activity level
Assistive devices, splinting and orthothics

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Examination.
Observation of posture, movement and
compensatory strategies
Spontaneous posture and movement

Typical and atypical posture and movement

Compensatory movement strategies

Alignment, weight bearing, balance, coordination,

muscle and postural tone, and movement

components
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Examination..
Individual systems related to function:
Neuromuscular system
Musculoskeletal system
Sensory, perceptual, cognitive systems
Regulatory system (arousal, attention,
emotional and behavioral responses)
Limbic system (emotions, fear, pain)
Respiratory, cardiovascular system
Integumentary system (skin)

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Measurement Tools:
Norm-referenced tests (WeeFIM)

Criterion-referenced tests (Canadian

Occupational Performance Measure)

Non-standardized tests (compare the

performance at the beginning and at the end

of the session)
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Evaluation:
The therapist observes, describes and formulates
hypothesis, linking treatment planning with
outcomes.
Clients internal and external resources
Functional limitations and participation restrictions
The relationship between posture and movement
components
Hypotheses regarding impact of impairments on
daily life function
Potential to change
Intervention plan developed
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Intervention:
Handling is graded input provided by the therapists
hands at key points of control on the childs body.
and results in active control or movement (Kramer,
1993, p. 78).
Sequence of Intervention:
Preparatory activities for passive movement or body
alignment
Selection of the key points for therapeutic handling
according to the childs postural tone
Facilitation of active or automatic movement patterns
by applying graded and varied therapeutic input

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Principles:
1. Establish a treatment plan with anticipated outcomes
that include specific, observable functions within a specific
time frame under specific environmental conditions.
2. Therapy utilizes clients strengths, recognizes that each
individual has competencies and disabilities.
3. Set anticipated outcomes and impairment goals in
partnership with the family, the client, and the
interdisciplinary team.
4. Treatment strategies often include preparation and
simulation of critical foundational elements (task
components) as well as practice of the whole task.
5. NDT intervention includes planning and solving motor
problems.
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 6. Repetition is an important component in motor
learning.
7.Create an environment that is conducive to
cooperative participation and support of the clients
efforts.
8.Knowledge of the development of posture and
movement components is use in designing treatment
strategies.
9.A single treatment session progresses from
activities in which the client is most capable to
activities that are more challenging.
10.NDT intervention methods include modifying the
task, or the environment, and take into account the
current level of the clients performance and capacity
for function.
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 11.Individual treatment sessions are designed to
evaluate the effectiveness of treatment with the
session.
12. Families receive information regarding the clients
problems and management of those problems, as they
are able to understand and assimilate the information.
13. In an NDT approach, suggestions to the family are
as practical as possible.
14. NDT recommends an interdisciplinary model of
service.
15.Coordinate with the goals and activities of all other
medical, therapeutic, social, and educational
disciplines to ensure a life-span approach to solving
the clients problems.

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Thekey points(proximal or distal) are the places of
physical contact between the therapists parts of the
body or therapy equipment and clients body.
(Boehme, 1988)
Proximal key points:
Located closer to the
source of the problem,
usually at the head,
trunk, or large joints
Used to influence
posture and movement
in all three planes
(sagittal, frontal, and
transverse), especially
during difficult moments

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 Distal key points:
Located away from
the source of the
problem, usually at
the upper and lower
extremities level
Used to allow the
client to engage in
activities with
minimal control of
the therapist
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Technique
Facilitation Inhibition

Traction
and light joint
Tapping and intermittent compression
compression to provide It is used in combination
proprioceptive and tactile with facilitation
stimulation
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Weight bearing and
Adaptive equipment and
weight shifting
orthothic devices:
promote:

Allows more independent

movement
Decreases the possibility
of deformities and
contractures
Can be used by parents
Postural alignment and other professionals to
Childs movements reinforce the therapy
Proximal stability
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Play in NDT:
Motivates and engages the child
Provides appropriate stimuli for development
of normal movement patterns
Fulfills therapeutic goals
Facilitates the handling techniques
Facilitates the use of the gained movements
in other activities
Allows observation of childs spontaneous and
automatic postures and movements

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References:
Boehme, R. (1988).Improving upper body control. An approach to assessment
and treatment of tonal dysfunction.Tucson, AZ: Therapy Skill Builder.
Brown, G. T., & Burns, S. A. (2001). The efficacy of neurodevelopmental
treatment in paediatrics: A systematic Review.British Journal of Occupational
Therapy, 64(5), 235- 244.
Butler, C. &Darrah, J. (2001). Effects of neurodevelopmental treatment (NDT) for
cerebral palsy: an AACPDM evidence report.Developmental Medicine and Child
Neurology, 43,778-790.
Howle, J.M. (2004).Neuro-develompmental treatment approach. Theoretical
foundations and principles of clinical practice.Laguna Beach, CA: NDTA.
Ottenbacher, K. J., Biocca, Z., DeCremer, G., Jedpvec. K. B., & Johnson, M. B.
(1986). Quantitative analysis of the effectiveness of paediatric therapy:
emphases on the neurodevelopmental treatment approach.Physical Therapy,
66, 1095-1101.
Schoen, S. & Anderson, J. (1993). Neurodevelopmental treatment frame of
reference (pp. 74- 86; pp. 49- 69). In P. Kramer & J. Hinojosa (Eds.)Frames of
Reference for Pediatric Occupational Therapy. Baltimore, MD: Williams & Wilkins.

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 Thank You

All
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