Ch 18

Neurological Developmental Treatment (NDT) Overview

• Focus on a neurodevelopmental approach (NDT).
• Objectives:
  • Understand the importance of positioning.
  • Describe various positions and transitional movements.
  • Explore characteristics of motor development.
  • Understand principles of NDT.

Key Definitions

• Positioning:

  • Refers to a child's ability to maintain postural control while participating in daily activities.
  • Postural control develops as infants strengthen necessary muscles to stabilize and maintain upright positions (sitting and standing).

• Therapeutic Handling:

  • Involves dynamic techniques to guide children's movements.
  • Aims to influence muscle tone and promote postural stability.

Transitional Movements in Motor Development

• Transitional Movements:

  • Movements in and out of different positions (e.g., transitioning from supine to standing).
  • Physiologic Flexion at Birth:
  • Passive stretch to extensors of the trunk.
  • First voluntary movement is neck extension, facilitating head lifting.

• Development of Head Control:

  • Achieved as infants gain muscle strength and co-activate cervical flexors and extensors.

• Log Rolling:

  • Initial unintentional rolling from prone to supine during weight shifting.
  • Whole body rolls as a unit without segmental movement.

• Prone on Elbows Position:

  • Requires co-activation of thoracic, lumbar, and hip flexors to maintain stability while propped on elbows.

• Role of Flexors and Extensors:

  • Different functions but work together to control movements and prevent abrupt movements.

General Considerations for Motor Skills

• Progression of Motor Skills Development:

  • Necessary for engagement in daily living activities.
  • Key components: skeletal alignment, typical development, perception and body awareness, postural control, and balance.

• Postural Mechanisms:

  • Involve muscle tone, postural control, stability, writing responses, and equilibrium reactions.

• Equilibrium Maintenance:

  • Essential for stability; writing responses help regain balance.

• Protective Extension Reactions:

  • Support safety by using arms to absorb impact rather than the head or vital organs.

Importance of Positioning as a Therapeutic Tool

• Promoting Comfort & Proper Positioning:

  • Necessary for function; uncomfortable positions can worsen a situation.
  • Aim for alignment and symmetry; prioritizing proximal stability aids distal mobility.

• Positions Supporting Development:

  • Prone Position:

  • Enhances neck and trunk extension while promoting muscle strength in the upper body.

  • Side Lying Position:

  • Comforting for sleep/play; may require external support for stability in children with control issues.

  • Co-activation of head and trunk flexors/extensors is critical.

• Sitting:

  • Good balance of neck/trunk flexors needed for upright sitting; W sitting is not recommended beyond one year.
  • Sitting Variations:
    • Long Sitting: Legs extend forward.
    • Ring Sitting: Bottoms of feet face each other.
    • Tailor Sitting: Legs crossed.

Wheelchair Considerations

• Wheelchair Use:

  • Essential for mobility and exploration; input from OTs, PTs, physicians, and family crucial for individualized wheelchair features.

• Posture in Wheelchairs:

  • Ensure knees/hips at 90 degrees or greater flexion; support needed for trunk stability.

• Types of Wheelchairs:

  • Manual vs. Electric:
  • Manual wheelchairs can be tiring but encourage upper body strength.
  • Electric provides easier mobility but risks dependency.

Child Interaction with Environment

• Infant Mobility:

  • Rolling and crawling are primary modes of exploration; integral for learning and sensory experiences.

• Adaptive Equipment:

  • Suggestions may include adapted tricycles, scooters, or motorized vehicles for mobility assistance.

Various Body Positions and Their Developmental Significance

• Quadruped Position:

  • Knees on floor, arms extended; involves substantial head/neck stability and abdominal strength.

• Kneeling Positions:

  • Tall Kneeling: Secure base with both legs; promotes trunk equilibrium during play.
  • Half Kneeling: Intermediate position before standing; requires trunk stability and control.

• Standing Position:

  • Full weight bearing through lower extremities fosters bone growth, muscular development, and circulation; prerequisite skill for walking.

• Adapted Standers in Pediatric Care:

  • Necessary for ensuring proper development; may not always be received positively by children.

Neurodevelopmental Treatment (NDT) Details

• NDT Origin and Purpose:

  • Developed by Carol and Bertha Bovath; a problem-solving approach for those with functional limitations (primarily children with cerebral palsy).

• Key Principles of NDT:

  • Refined movement through repetition; improved neural pathways enable efficient movement.

• Handling Techniques in NDT:

  • Focus on key points of control: hips, shoulders, trunk, pelvis, hands, feet, head.

• Inhibition vs. Facilitation:

  • Inhibition: Reducing hypertonicity.
  • Facilitation: Encouraging hypotonicy.

• Guided Therapy:

  • Individualized focus on functional outcomes; quality and reproducibility of movements are emphasized; integrating active engagement can promote new neural pathways.

Current Evidence and Applications of NDT

• Need for Rigorous Clinical Studies:

  • Emphasize evidence-based support for NDT techniques in clinics and their effectiveness.

• Therapeutic Handling and Participation:

  • Encourage children to learn functional movements by physically engaging them; promoting autonomy in daily tasks (e.g., dressing, feeding).

• Ethical Considerations:

  • Balance necessary interventions against the child’s wellbeing; discuss extremes of discomfort with caregivers and health professionals.

Conclusion

• Encouragement for Further Learning:
  • Suggested readings and review of case studies to reinforce concepts introduced in the chapter.
  • Students urged to reach out with questions as needed.