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 NDT Approach

Individualized Functional Outcomes	Patient: Life role, supports systems, home environment, patient's goals ICF: Pathologies, abilities, limitations
Motor Control	Optimize use of systems (sensory, musculoskeletal) and available movement patterns/synergies
Target the Involved Side	Progressive, increased demand and functional use
Motor Learning	Closed vs. open environment, simple vs. complex, part vs. whole, practice and feedback/knowledge of results
Team-Approach	Coordination with rehab team, parents/caregivers, and support staff to allow for continual practice and consistent use of facilitation strategies

 

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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Alignment	Cannot impose normal movement on malaligned joints
Handling	Inhibition, Facilitation, Key points
Placing	Assisting patients in 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 efficient posture from which to move (typically upright) Reorient to midline (head/trunk) Neutral alignment of body segments	Observe starting posture and make comparisons to normal Review the evaluation and POC for PT assessment of primary impairments (e.g. decreased ROM, strength, sensation, control) Select a movement-based functional intervention which progresses patient toward mobility goals	Use hands on key points of control to facilitate normal posture/movement and inhibit abnormal posture/movement May includes manual stretching if PT has determined ROM/muscle length interferes with function

 

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Example of NDT Techniques

 

 

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