Neuro Developmental Treatment (NDT) Techniques
History
Developed by Berta Bobath, PT and Karel Bobath, MD for functional recover
Main patient populations include: adult CVA/hemiplegia, and Cerebral Palsy
Theoretical Framework
NDT as a neuromuscular and functional reeducation technique now includes
neuroplasticity as a basis how the brain can change and reorganize itself and its
processes based on practice and experience
facilitation of normal postural alignment and movement patterns
demand should be placed on the involved side during developmental and functional
activities
sensory feedback (manual contact, visual integration, somatosensory reinforcement)
is essential to recovering function
treatment includes looking at the whole person and specific functional needs;
recovery vs. compensation
Outline of N
Patient: Life role, supports systems, home environment, patie
Individualized Functional Outcomes
ICF: Pathologies, abilities, limitations
Motor Control Optimize use of systems (sensory, musculoskeletal) and avail
Target the Involved Side Progressive, increased demand and functional use
Closed vs. open environment, simple vs. complex, part vs. wh
Motor Learning
Team-Approach Coordination with rehab team, parents/caregivers, and suppor
Essentials for Treatment Effectiveness
therapists must be able to observe and distinguish normal from abnormal alignment
and movement patterns
therapists must be able to make the functional retraining activities meaningful to the
patient; task specific
therapists must be able to select the optimal practice method, feedback, and
environment for maximum function and independence
therapists must have stable footwear, good flexibility in lumbar spine and lower
extremities for optimal body mechanics during mat activities.
Key elements to Applying NDT
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Cannot impose normal
Alignment movement on malaligned
joints
Inhibition, Facilitation, Key
Handling
points
Assisting patients in
Placing
achieving the appropriate
Alignment Check points - PTs and PTAs use manual contact to establish, align and assist
the patient with these key elements
Base of support - wide, narrow, staggered, asymmetrical
Body segment alignment - synergies, compensatory head and trunk position
Muscle activation - pattern and timing of movement during functional activities
Weight shift - in all planes
Functional Check points - PTs and PTAs will modify manual cues and feedback to the
demands of the task and the ability of the patient. Examples of functional check points
include:
1. Gravity
2. Levers
3. Time
4. Distance
5. Speed
6. Environment
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NDT Intervention Framework
Starting Posture Missing Components Manual Cues
Begin and
assess the most Observe starting posture Use hands on key
efficient posture and make comparisons to
from which to points of control to
normal facilitate normal
move (typically
upright) Review the evaluation and posture/movement
POC for PT assessment of and inhibit abnormal
Reorient to primary impairments (e.g. posture/movement
midline decreased ROM, strength, May includes manual
(head/trunk) sensation, control) stretching if PT has
Neutral Select a movement-based determined
alignment of functional intervention ROM/muscle length
body segments which progresses patient interferes with
toward mobility goals function
