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.