Brief introduction to NDT By Kinjal Shah (intern from SGMPC)
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Brief introduction to NDT
By Kinjal Shah (intern from SGMPC)
AIM OF TREATMENT
• Aim of the treatment for cerebral palsy/with disabilities due to brain damage is to prepare and guide them towards their greatest possible independence and to prepare them for as a a normal adolescences and adult lives as can be achieved by Bobath in 1984.
• The concept of neuro-developmental treatment (NDT) has been evolved empirically by Mrs. Bertha Bobath from 1942 onwards.
• By careful clinical observation of adult hemiplegia and of children with cerebral palsy, she studied their reactions to being handled.
• Dr.Karel Bobath, her husband & a neurologist, tried to find the theoretical explanations. By Kong 1991.
• NDT is a holistic approach dealing with the quality of patterns of coordination & not only the problems of individual muscle function.
• It involves the whole person, not only sensory-motor problems but also problems of development ,perceptual-cognitive impairment, emotional, social & functional problems of daily living (Bobath 1990).
A Brain lesion interferes with the development of normal postural
control in relation to gravity.
1. Instead of normal postural tone, we find abnormal tone: too high (spsticity), too low (hypotonicity) or fluctuating (athetosis).
2. Instead of normal reciprocal interaction, we find excessive co-ordination, or sudden inhibition of antagonists resulting in the lack of ability to make a graduated movement.
3. Instead of normal automatic movement patterns of righting, equilibrium,& protective reactions, we find a few static and stereotyped postural patterns of tonic reflexes.
• The abnormal sensory-motor development interferes with child’s whole development i.e. sensory, perceptual, cognitive, psychological.
• Associated sensory &/or perceptual deficits can be primary due to brain lesion but frequently they are secondary to the physical disability, which prevents child
• Associated sensory &/or perceptual deficits can be primary due to brain lesion but frequently they are secondary to the physical disability, which prevents child
from exploring himself the environment.
• He does not develop the same concept of his body. as does a normal child.
• Abnormal sensorymotor experiences will result in an abnormal body awareness & abnormal body image (Bobath 1984; Kong 1986; Quinton 1986).
• It is impossible to superimposed normal movement patterns on abnormal ones, the abnormal patterns need to be suppressed (inhibited).
• The importance of sensory motor experience- we do not learn a movement but a “sensation of movement”.
• By moving the proximal part of body it is possible to influence and to change the movement s of distal parts (Bobath 1942).
Parents participation is important
• Guiding & training the parents in home management is of the greatest importance.( finnie 1986, bobath 1997).
Inhibition combined with stimulation & facilitation
• After preparing & obtaining a more normal postural tone the patient needs to learn move in many different combinations of more normal movement patterns.
• Mrs. Bobath looked for possibilities of a how to transmit to the patient in order to enable them to experience normal sensation of functional movements they had either lost or never developed.
• Only by feeling a near normal movements with minimal effort can the patient learn how to perform it.
• The therapist’s task is to make this possible.
• Bobath recognized that during normal development, in the beginning there is influence of tonic reflexes which later disappear & are supported by the development of righting reactions.
• These are later overlapped & integrated into balance reactions & voluntary movements (Kong 1991).
Reflex inhibitory control
• Inhibition is the process of intervention that reduces dysfuntinal muscle tone. It breaks up the abnormal excessive flexion or extension(Bobath 1984; Quinton 1986;Boehme 1988).
Inhibition combined with stimulation & facilitation
• After preparing & obtaining a more normal postural tone the patient needs to learn move in many different combinations of more normal movement patterns.
• Mrs. Bobath looked for possibilities of a how to transmit to the patient in order to enable them to experience normal sensation of functional movements they had either lost or never developed.
• Only by feeling a near normal movements with minimal effort can the patient learn how to perform it.
• The therapist’s task is to make this possible.
• Bobath recognized that during normal development, in the beginning there is influence of tonic reflexes which later disappear & are supported by the development of righting reactions.
• These are later overlapped & integrated into balance reactions & voluntary movements (Kong 1991).
SUPINE
• Baby’s position: the baby lies in supine on the floor.
• Therapist position: Long sitting on the floor with baby between her legs.
GOALS
• Activation of eye muscles.
• Visual tracking.
• Activation of head turning with rotation.
• Activation of head, trunk & neck flexors.
• Elongation of spinal extensors.
• UE reaching.
• In supine we can also give,
• Hands to arms.
• Hands o mouth & face.
• Hand to hand.
• Hands to head.
• Tactile exploration with hands.
• Visual body exploration with eyes.
SUPINE ROLLING
HANDS TO FEET ROLLING.
• Baby’s position: the baby lies on the mat.
• Therapist position: heel sit in front of baby in a position to move with baby.
GOALS
• Elongation of spinal extensors.
• Activation of trunk flexors.
• Hip flexion with knee extension.
• Sensory feedback of side lying to facilitate lateral righting reactions.
Supine to sit
• Baby’s position: lies on the floor.
• Therapist position: heel sit on the floor in front of baby.
GOALS
• Rotation of trunk & pelvis over hip.
• UE weight bearing.
• Lateral righting reactions.
• Oblique abdominal activation.
Prone on lap
• Baby’s position: baby lies on lap in prone.
• Therapist position: long sitting on floor.
• GOALS
• Elongation of rectus abdominus muscle.
• Elongation of hip flexors.
• Neck, trunk, and hip extension.
• Head lifting..sensory stimulation.
Prone lateral weight shifts
• Baby’s position: lies in prone on your lap,with both arms flexed over your legs.
• Therapist position: long sit on the floor.
goals
• Elongation of rectus abdominus.• Elongation of hip flexors.• Head lifting & turning from side to side.• Sensory stimulation through the visual,
tactile, proprioceptive and vestibular system.
• Lateral righting reaction.• Lower extremities dissociation.
Prone on ball
• Baby’s position: lies prone on ball with the ribs and pelvis well supported by ball. Baby’s arms are in shoulder flexion over ball.
• Therapist position: place your self behind the baby in a position to move forward with baby.
GOALS
• Head & trunk extension.
• Symmetrical hip & knee extension.
• Forward protective extension of upper extremities.
• UE weight bearing.
• Vestibular & proprioceptive stimulation.
On ball we can give weight bearing on forearm also weight bearing on extended arms.
Lateral righting reaction
• Baby’s position: baby lies in prone over the ribs and pelvis well supported. Arms in shoulder flexion over the ball.
• Therapist position: kneel beside ball.
GOALS
• Lateral righting reaction of head & trunk.
• Elongation of the weight bearing side.
• Abduction & protective extension of the free extremities.
Prone to sitting on floor
• Baby’s position: the baby lies in prone or in fore arm weight bearing.
• Therapist position: kneel beside the baby.
GOALS
• Movement around the body axis.
• Trunk rotation.
• UE weight bearing & weight shifting.
• Pelvic femoral mobility.
• Somatosensory input into the base of support for subsequent postural preparation & reaction in sitting.
PRONE TO RUNNER’S STRETCH POSITION
• Baby’s position: baby lies prone or in weight bearing on the mat with the hips extended.
• Therapist position: kneel beside the baby.
GOALS
• Head lifting & righting on the saggital plane.
• UE, extended arm weight bearing.• Elongation of the trunk muscles on the
weight bearing side.• Lateral flexion of spine & lateral righting of
head, trunk, & pelvis on the unweighted side.
• Lower extremity dissociation, including increased range of motion at the hips & knees.
• Marked dissociation of LE dissociation prevents the pelvis from moving on saggital plane thus preventing it from moving into an anterior or posterior pelvic tilt. Therfore movements around the pelvis & LS occur on the frontal & transverse plane.
• Marked dissociation of LE dissociation prevents the pelvis from moving on saggital plane thus preventing it from moving into an anterior or posterior pelvic tilt. Therefore movements around the pelvis & LS occur on the frontal & transverse plane.
Sitting to quadruped to kneeling
• Baby’s position: the baby is in long sitting on floor.
• Therapist position: sit behind or beside the baby.
GOALS
• Trunk rotation.
• UE sideward protective extension.
• UE weight bearing & weight shifting.
• Hip & knee flexion followed by hip extension with knee flexion.
• Elongation of quadriceps.
• Activation of gluteus maximus.
• Activation of gluteus maximus.
• Trunk extension on extended hips.
Prone to standing
• Baby’s position: the baby lies in prone or in forearm weight bearing on the floor with hips extended.
• Therapist position: kneel beside the baby.
GOALS
• Lateral weight shifts with elongation of the weight bearing side in prone to sidelying & kneeling to half kneeling.
• Lateral righting of the unweighted side in prone to side lying & kneeling to half kneeling.
• UE weight bearing & weight shifting.
• Lower extremity dissociation with hip & knee flexion on one side, & with hip & knee extension on the other side.
• Hip extension with knee flexion.
• Elongation of quadriceps & hip flexors.
• Activation of the hip extensor & hip abductors.
• Trunk extension on extended hips.
• Dissociation of lower extremities under the trunk.
• Transitions between ankle planter flexion & dorsi flexion.
• Elongation of the ankle dorsiflexor muscle.
Prone on bolster
• Baby’s position: baby sit beside the bolster.
• Therapist position: kneel or heel sit behind the baby.
GOALS
• Trunk rotation with symmetrical shoulder flexion.
• Hip extension with activation of gluteus maximus.
• Symmetrical trunk extension.
• UE weight bearing & weight shifting for increased proprioception & stability.
• Active shoulder flexion with elbow, wrist & finger extension.
• Elongation of wrist & finger flexors.
Symmetrical stance: weight shifts to the lateral borders of the feet.
• Baby’s position: the baby stands in front of you.
• Therapist position: sit or kneel behind the baby with your hands on the baby’s femur.
• Baby’s position: the baby stands side ways to you. The baby’s hands are free at sides.
• Therapist position: sitting on a mobile stool.
Thank you……
Thank you……
references
• Baby treatment based on NDT principles. By Lois bly.
• www. Google.com.
Symmetrical stance: weight shifts to the lateral borders of the feet.
• Baby’s position: the baby stands in front of you.
• Therapist position: sit or kneel behind the baby with your hands on the baby’s femur.
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