NDT & handling - Bobaths: info & techniques

Neurodevelopmental Treatment (1950s)

Neurological & developmental framework for treatment of cerebral palsy & movement disorders

• Theoretical Foundation: Normalization of movement

NDT Intervention

Use of handling & movement facilitation techniques in activity

• ROM + Managing muscle tone + Postural alignment 

• Postural Control: weightshifting, rotation, balance of flexion & extension, equilibrium responses 

• Functional use of synergies + Execution of movement sequences

Handling & Facilitation Techniques

Graded/tactile sensory input provided by OT’s hands at key points of control on child’s body to facilitate typical movement

EX 1

• Rotary movement/turning being facilitated

• OT has child w/ CP on lap, child leans against her torso to limit degrees of freedom

• OT breaks up synergistic patterns of lower extremities wanting to ADDuct/internally rotate/flex by inserting knee between child’s legs & gives support from back just above hips. 

EX 2

OT’s hands on hips as child leans forward to ball

EX 3

Child upright, OT facilitates above hips and at torso so child can maintain an effective upright posture easily

Function-Dysfunction Continua

• Original Pathology → Tone, atypical synergies, primitive reflexes

• Compensations → Fixing, limit degrees of freedom, tone changes, motor programs

• Short-term Implications → Contractures, inefficient postural control 

• Long-term implications → Deformities/Disability

____ are key as they are the biggest joints

Hips & pelvis

• Shoulders also facilitate