NDT Mary Rose Franjoine PT, DPT, MS, PCS Margo Prim Haynes PT, DPT, MA, PCS.

NDT

Mary Rose Franjoine PT, DPT, MS, PCS

Margo Prim Haynes PT, DPT, MA, PCS

2009 2

2009 3

Reading and Resources

Required Reading: • Neuro-Developmental Treatment Approach Theoretical

Foundations and Principles of Clinical Practice– Chapter 1

Assignment:• To be completed prior to lecture: Study Guide Learning

Activity: Learning Activity 1.1.1(pp 1-2)

2009 4

NDT is….

• A comprehensive approach for management of patients with neuromuscular based movement disorders.

• Functional and task oriented

• Problem solving

• Grounded in current scientific theory

2009 5

NDT …• Enhances function;

improving the individuals quality of life

• Treats individual as a Whole person

2009 6

NDT …

• Family centered

• Team approach

http://www.familyconnectionsc.org/gallery

2009 7

NDT Intervention Process…

• Begins with a comprehensive assessment of the individuals– Abilities– Needs, Wants, …..

–Dreams!

2009 8

NDT Intervention Process…• Includes observation analysis and

identification of effective and ineffective postures and movements

2009 9

NDT Intervention Process…

• Progressing to identification and prioritization of primary and secondary impairments critical for intervention

• Continues with development of functional outcomes– Long term – Short term– Session

2009 10

NDT Intervention Process…

• Progresses to identification of treatment strategies to enhance function

• Considers the task & environment in relationship to person

• Concludes with implementation of the intervention & ongoing analysis

2009 11

NDT is…

• A “Hands On” approach

• It includes the use of: – Inhibition techniques– Facilitation

techniques

2009 12

NDT is…

• Therapeutic handling is used to guide and shape movement, enhancing function

• Therapeutic handling is used interdentally

2009 13

NDT Therapist…

• Utilize typical development as a framework for treatment

2009 14

NDT Therapist…

• Consider the multisystem effects of aging across the lifespan

• Strives to optimize function while acknowledging the existence of central nervous system damage

2009 15

NDT Treatment Sessions should be…

• Active

• Dynamic

• Fun

• Functional

2009 16

NDT is a Living Approach• The NDT approach has been

enhanced by advances in neural science, movement science, motor learning and motor control.

• The NDT Approach will continue to evolve as our knowledge and understanding of neuromuscular-based movement disorders and neuromotor control advances.

2009 17

Karl and Berta Bobath

2009 18

Mrs. Bobath once said, it is a “living, breathing and changing” approach, and she challenged us all to grow and advance with the approach!

Current Theoretical Base for NDT

Mary Rose Franjoine, PT, DPT, PCS

Margo Prim Haynes, MA,PT

2009

2009 20

Models of Motor Control

• Reflex

• Hierarchical Model

• Program Model

• Systems Models of Motor Control

• Neural Group Selection

2009 21

Reflex

• Peripheral Mode of Operation • Complex skills remerge through

chaining

2009 22

Reflex

Assumptions Underlying Motor Control for Neurologic Rehabilitation Chapter 4

2009 23

Hierarchical Model

• Central Mode of Operation

• Skill refined through a maturation process

Assumptions Underlying Motor Control for Neurologic Rehabilitation Chapter 4

2009 24

Hierarchical Model

Assumptions Underlying Motor Control for Neurologic Rehabilitation Chapter 4

2009 25

Program Model

• Peripheral and Central Mode of Operation

• Storage of Complex Motor Programs

• CPG

2009 26

Systems Models

• Function emerges from the interaction of multiple systems

• Coordinative Structures (Synergies)

• Degrees of Freedom

2009 27

Systems Models

Assumptions Underlying Motor Control for Neurologic Rehabilitation Chapter 4

2009 28

Dynamical Systems Theory

• Self Organization

• Rate-limiting factor

• Transition States (Chaos)

2009 29

Neural Group Selection Theory

• Contemporary Theory

• Blends our knowledge of neuro embryology and development of neuro anatomy

• Plasticity

2009 30

Neural Group Selection Theory• Primary Neuronal Repertoires

– Neonatal Optical Righting– Neonatal Kicking– Rooting

• Secondary Repertories “Neural Groups”– Synergies and preferred patterns of movement

• Neural Maps– Synergistic combinations activate for task

performance

2009 31

How Theories Work for NDT?

• Philosophy of NDT embraces Function for enhancing Quality of Life

• NDT always considers the environment and the task.

• NDT is a clinical Approach

2009 32

Additional References

• Horak, F.B. Assumptions underlying motor control for neurological Rehabilitation. In M. Lister (Ed), Contemporary management of motor control problems. Alexandria, VA: American Physical Therapy Association.

• Hadders-Algra, The neuronal group selection theory: Promising principles for understanding and treating developmental motor disorders. Developmental Medicine and Child Neurology, 2000;24; 20 (10):707-715.

NDT

Mary Rose Franjoine PT, DPT, MS, PCS

Margo Prim Haynes PT, DPT, MA, PCS