week 3 Motor Learning and Neurodevelopment Treatment Approach (NDT)

principles of movement, positioning, handling and facilitation

Motor learning theory

acquisition of new motor skills, the improvement of existing and long term retention through practice

contains the cognitive, associative, and autonomous stage

Cognitive stage in the Motor Learning Theory

• movements are slow, inconsistent and inefficient

• learners focus on aspects of movement and require mental effort

• goal is to understand the task, develop strategies and problem solve.

Associative stage in the Motor Learning Theory

• movement are fluid, reliable, efficient and with fewer errors

• learner perform parts of movement automatically but still need focus

• goal is to refine movements, improve consistency and reduce errors. 

Autonomous stage in the Motor Learning Theory

• movements are accurate, consistent and efficient

• decrease cognitive effort, may multi task

• maintain skill and adapt to new situations/generalize

Dynamic systems theory

interaction between organism (and their ability), task (requirement) and enviroment contribute to motor development.

Neurodevelopment Treatment Approach NDT

• a FOR

• The Bobath Concept (question how does posture and movement impact function)

• framework for understanding how movement is learned and adapted

Evolution of NDT

first inspired by Reflex higherarchial model then moved to Dynamic systems model 

Reflex Higherarchical Model

First model to contribute to the evolution of NDT

Motor control is a strict hierarchy

movement is triggered by a series of reflexes AND is a response to sensory stim

fails to explain voluntary movement

Dynamic Systems Model

Model that NDT is currently inspired by 

• a complex interaction between multiple subsystems

• movement is guided by functional goals 

• explains multifaceted nature of motor control 

Core principles of NDT

• brain had plasticity (ability to change)

• children needs to feel typical movement patterns using positioning, facilitation and handling techniques

• learning movements patterns should occur in natural enviroment 

• remediation of foundational skills will make normal skills acquisition possible

• cannot impose normal movement w abnormal muscle tone

• children should learn/experience normal movement pattern during meaningful activities

• targeting postural control through key pts of control 

Proximal points of control

shoulders, hip, trunk, pelvis

distal points of control

hands, feet, head

Passive elongation of muscle, reflex inhibiting pattersn, positioning and weight shifts can be used to…

inhibit hypertonia (the increase of muscle tone/stiffness)

joint compression, traction, manuel resitiance and weight shifts can be used to…

increase hypotonia 

axial control can be achieved through

elongation, weight shifts, passice pelvis tilt, and truck rotation

automatic reaction can be achieve through

inhibitng reflexes and use of normal movement patterns

weight shifts can occur through

dissociation of synergistic patterns and inhibiting reflexes 

Muscle tone

muscle readiness for passive strength, tested passively

NDT assessment objectives understand an individuals….

muscle tone

functional abilities/limitations

analysis of movement patterns and compensatory movement

absent components of movement

impact of movement on participation in occupational roles.

decreased BOS

increases truck control

increased BOS

decrease truck control

The NDT assessment looks to understand a child’s…

• functional skills

• quality of movement

• structural limitations and deformities 

Handling Technique 

NDT intervention strategy that can be preparatory or used to facilitate typical movement patterns. When done correctly, changes in sensory input is achieved. 

As a part of NDT intervention strategies, abnormal movement patterns can be changed through..

altering sensory input (which changes motor output)

hand placement

directs, organizes, and facilitates initiation , activation of muscles and response to muscles

therapeutic touch

requires a respect and knowledge of the child’s sensory systems and how they process tactile, proprioceptive and kinesthetic input 

Ways to increase tone…

intermittent joint compression ( to provide proprioceptive input)

vibration 

resistance (through gravity or heavy work) 

weight bearing in small ranges 

tapping 

Decreasing tone

muscle elongation

muscle activation within new length 

trunk rotation 

dissociation 

weight bearing.shifting in large ranges 

fine manual vibration 

traction 

Developmental transition Sequence

Supine → side lying/roll → prone → side sit → quadruped → short kneel → tall kneel → 1 point kneel → stand