NEURODEVELOPMENTAL TREATMENT NDT IN PAEDIATRICS

1. NEURODEVELOPMENTAL TREATMENT (NDT) IN PAEDIATRICS VICTORIA PROODAY MANUELA OCRAINSCHI ALDA MELO OCT 1172Y April 05, 2005

2. Agenda Defining NDT Origins and key concepts of theoretical approach Assessment and intervention Evidence of efficacy Strengths and limitations Recommendations for clinical practice

3. NDT Advanced hands-on approach to the examination and treatment of individuals with disturbances of function, movement and postural control due to a lesion of the central nervous system (CNS) Used primarily with children who have cerebral palsy (CP) and adults with cerebral vascular accidents (CVA) Practiced by OT, PT, SLP who completed advanced training in NDT

4. Origins of Theoretical Approach NDT, first known as �The Bobath approach� was originated and developed by Berta Bobath, physiotherapist, and Dr. Karel Bobath in the late 1940s Name Bobath is still used in many countries, NDT is the name commonly used in North America Developed from observations, practical applications and desire to find better solutions for client�s problems NDT- name given by NDTANDT- name given by NDTA

5. Theoretical Approach (cont�d) In 1940s dominant therapeutic approach focused on changing function at the muscular level, but Bobath hypothesized that the disorder of coordination of posture and movement is what prevented functional performance Bobath introduced the revolutionary idea that a therapist could have an impact on client�s functional movement by influencing the CNS through carefully guiding the motor output through handling

6. Theoretical Approach (cont�d) NDT evolution 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

7. Theoretical Approach (cont�d)�Living concept�

8. The basic philosophy underlying all the NDT assumptions is that lesions in CNS produce problems in the coordination of posture and movement combined with atypical qualities of muscle tone that contribute directly to functional limitations These functional limitations are changeable when the intervention strategies target specific system impairments in activities and contexts that are meaningful in the life of the person. Theoretical Approach (cont�d)

9. 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 person�s function, place in the family and community, independence and overall quality of life 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 Intervention strategies involve the individual�s active initiation and participation, often combined with therapist�s manual guidance and direct handling NDT intervention utilizes movement analyzes to 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 NDT Assumptions

10. Key Concepts �