Neurodevelopmental Treatment

Frame of Reference
Kunle-Ligali Precious Ayomide
MRH/2018/050
Table of Contents

• Introduction
• History
• Principles
• Evaluation
• Intervention
• Key Elements
Introduction

• The Neuro-Developmental Treatment (NDT) frame of

reference is a dynamic hands-on treatment approach
guiding occupational therapists globally in their assessment
and intervention of clients who experience posture and
movement impairments.
• It’s key objectives are to improve the quality of movement
and help clients relearn normal movements. NDT is client-
centered and it seeks to minimize impairments and prevent
secondary disabilities.
History

• NDT was developed as the “Bobath approach” by Berta &

Karel Bobath in the 1940s. With her history as an instructor
in gymnastics who was trained in the analysis of normal
movement & muscle tone & Dr Karel’s experience as a
psychiatrist & neurophysiologist, they formed the Bobath
concept of using different therapeutic techniques to show
that abnormal muscle tone can be altered in hemiplegic
patients & children with cerebral palsy.
History cont.

• The bobath approach worked with neurological damage

such as a stroke, brain injury or cerebral palsy and
emphasised that through working on patterns of normal
movement, individuals will eventually through continual
rehabilitation be able to increase their variety of movement.
Bobath’s clinical experimentation found that abnormal
degrees of posture can be influenced and modified through
specialised techniques of handling. Thus allowing for
postural alignment and control.
Principles

• Part of the NDT philosophy is a belief in recovery, in the

client's potential. This belief was coupled with a belief in the
influence that normal movement could have on a person's
quality of life. The NDT approach is now widely described as
a problem-solving method for restoring movement and
participation for individuals with UMN lesions, specifically
cerebral palsy and hemiplegia
Principles Cont’
• The approach is aimed at restoration of function through identifying and
correcting underlying impairments that interfere with movement and
participation in everyday activities.
• The emphasis is on regaining normal movement and postural control, and
quality of movement in general.
• Compensations are discouraged but can be introduced if incorporating the
hemiplegic side as much as possible can be achieved ; avoiding repetition
of abnormal movement patterns with the hemiplegic side, many of which
lead to orthopedic impairments over time; and neutral/symmetric
alignment during activities, which reinforces the other two.
Principles Cont’
• Neuroplasticity: Based on the dynamic systems theory of motor
control such as the plasticity of the CNS; brain’s ability to
reorganize and adapt in response to new experiences and learning.
• Treatment is adapted to the needs of the specific individual/child.
• Parent participation, education and guidance is actively
encouraged
• It is a multidisciplinary approach, involving physiotherapists,
occupational therapists and speech and language therapists
Evaluation

• An occupational therapist using the NDT approach begins

with an occupational history interview. Grounded in the
occupational profile and the client's goals, the therapist
would then observe the client's performance in various
occupations. Based on NDT, this observation would include
assessment not only of the client's level of assistance and
the amount of movement present, but also of the quality of
his or her movement and postural control.
Evaluation cont.
• The client's ability to maintain postural alignment required for the
occupation.
• The “normal” or typical motor performance skills required for the tasks or
activities that will be addressed. NDT-trained therapists analyze
movement in terms of the whole body and the stability & mobility
relationships between body segment
• The client's alignment and movement while performing basic motor skills
necessary in everyday activity such as reaching, sit-to-stand, and
transferring, as well as while performing occupational goals.
• Underlying impairments that are contributing to movement dysfunction.
Interventions

• Preparatory Phase: The therapist's careful analysis of the

movement components required for the task or occupational
goal.
• Set-up of the environment to promote active participation
on the part of the client as well as attention to the client's
starting alignment for activity.
• Mobilization to give the client access to the range of motion
required for the task.
Interventions Cont’

• Therapeutic handling is the primary technique of NDT, with

graded application of manual forces to the client’s body
through the therapist’s hand, combined with directional
cues for the client to feel and learn new movement patterns.
Occupational therapists are often specifically involved in the
facilitation of upper extremity movements such as reaching,
grasping, releasing of objects, and in-hand manipulation
skills. Therapeutic handling can be also embedded in
functional tasks such as self-care or play.
Interventions Cont’
• Along with verbal cues, demonstration, and structure of the
environment, facilitation of motor skills is done with handling. In
handling, the therapist uses his or her body in contact with the
client's to promote more efficient movement and avoid unwanted
motor responses or alignments. Specifically, therapists use
handling to add to the sensorimotor information that the client
experiences during the performance of task, to make the client
more aware of his or her body and incorporate the hemiplegic
side, and to assist with the coordination and timing of movement
patterns.
Interventions Cont’
• Facilitation: A therapeutic handling strategy that makes a posture or movement
easier or more likely to occur.

• Inhibition: restrict client’s atypical postures and movements that prevent the
development of more selective motor patterns and efficient performance.
•
• Repetition is very important for motor learning.

• A single treatment session progresses from activities in which the patent is

most capable to more challenging ones.
Interventions Cont’

• Another intervention is constraint induced movement theory

which focuses on restraining the more functional limb,
increasing activity with affected limb. Allowing individuals to
complete occupational activities independently, due to
increased strength in the affected limb. This method was
highly valued in a research paper assessing occupational
intervention outcomes in paediatric settings.
KEY ELEMENTS TO NDT APPLICATION
• Alignment: cannot impose normal movement on maligned joints
• Handling: Inhibition, facilitation, key points of control.
• Alignment check points: Use of 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.
Philosophy and Occupational Therapy

• Holistic
• Patient centredness.
• Works with patient to increase functioning
• Problem solving
• Focuses on occupational activity to increase skills.
References
• Heidi McHugh Pendleton et Winifred Schultz-Krohn (2018) pg 1429-
1438 chapter 31 sect 3, 8TH EDITION, Pedretti's Occupational
Therapy
• https://otworldandme.wordpress.com/2020/06/12/the-neurodevelo
pmental-approach-frame-of-reference-for-idiots/
• https://ottheory.com/therapy-model/neuro-developmental-treatmen
t-frame-reference
• Barthel, K. A. (2010). A frame of reference for neuro-developmental
treatment. In P. Kramer & J. Hinojosa (Eds.), Frames of reference
for pediatric occupational therapy (3rd ed., pp. 187-233).
Philadelphia: Lippincott Williams & Wilkins.