Traditional Approach- NDT Flashcards
What was the early focus on NDT
the need to control tone through key points of control.
used developmental postures with early focus
Facilitation:
teaching a movement with use of hands
Inhibition
decreasing muscle activity through handling
What philosophy was included?
the philosophy of combining movement with function to get carry-over
use Resistance on L side to help get movement on R side
NDT has evolved over time, Less focus on developmental postures, more focus on…?
-Developmental Concepts
> Normal posture and alignment at rest,
Maintain normal alignment throughout transitions,
Use of motor learning principles as posture and movement is practiced and learned
Advocates for the constraint induced therapy (forced use)
Advocates for use of BWSTT
What is constraint induced therapy?
Tie the good arm so the pt is forced to use weak arm
Developmental Concepts involve:
Vertical Orientation
Repetition
Handling in functional situations
Movement into higher levels of activity
Developmental Concepts involve: Vertical Orientation
Reticular Formation functions better in upright position. Babies initially spend a great deal of time sleeping– quickly changes as they are handled in upright. *** upright is more motivating for adults, easier to relate to function.
Developmental Concepts involve: Repetition
each repetition should be for the purpose of improving quality (this is why children repeat activities over and over again) Repetitions are not motivational– watch carefully for deterioration of quality and then change it up.
Developmental Concepts involve: Handling in functional situations
proximal: stability or a quick response
distal: slower response
parents impose external stimuli so that children can function at a higher level. ( hands on hips so that they sit better in their seat) We will do the same with key points
Developmental Concepts involve: Movement into higher levels of activity
there is overlap. In order to perfect lower level, need to work at higher levels.
3 General Areas of Function are?
Posture
Transitional Movement Patterns
Ability to be active in postures
3 General Areas of Function: posture
Acquisition of control over a relatively stable base of support. Needs to be with proper alignment (mobility/Stability)
3 General Areas of Function: Transitional Movement Patterns
Ability to move from one position to another, example: sit→stand
Patient needs to maintain control over a changing base of support
(controlled mobility)
3 General Areas of Function: Ability to be active in postures
Will need to have tone high enough to maintain posture, but low enough to allow movement
Work toward automatic function
(skilled)
Goal for NDT
- To improve quality of movement
- Less energy cost
- More normal time frame
-Enhance quality of life
-Prevent secondary complications
»_space;Improper movement leads to orthopedic problems over time.
What are the 5 Components of Movement we need to work on during therapy
Trunk Control Midline Orientation Movement over base of support Head control on trunk Limb Function and Control on Trunk
Trunk Control
-Need mobility and stability first
-Separation of upper and lower trunk
»_space;Upper trunk= Cspine, thorax, scapula
»_space;Lower trunk- Lumbar spine, pelvis
-Movement laterally
»_space;One side of trunk shortens/ one elongates
-Rotation
-Upper vs. Lower trunk initiated movement
»_space;Upper is less challenging
Midline Orientation
Achieve midline posture; without support as able
Move in any direction AND return to upright midline orientation
Movement over Base of Support
- Weight shift should be to the involved side first
- Move in all directions, including diagonals- as required for function
Head control on trunk
May need to correct the trunk first, then look at head.
Need this for vertical alignment, breathing, and oromotor function
Good activity is prone forearm weight bearing
Limb Function
-an extension of the trunk.
-Use first for support, then for function away from the trunk, free in space.
>UE: sitting weight shifts onto an extremity OR standing modified plantigrade
>LE: work on stance before swing
-Acknowledge that patient will have “comfortable methods”
>i.E showering: hair vs. body first
Hands together , which thumb is on top
Principles of Handling:
Observation
Feel
Combine
Starting Postures
Observation= view of pt
Feel= c hands to detect tone, facilitate movement
Combine= total picture
Starting Postures= transitions and termination of movement
Principles of Handling:
Use key points of control
Open handed approach
Light contact
Move slowly
Use key points of control= proximal-quicker response; distal-slower response
Open handed approach= spread hands- light contact, use fingers to guide, facilitate muscles, scoop
Light contact= ^^^
Move slowly= ^^^don’t pull
Principles of Handling:
Preparation
Preparation….Movement…. Function
Wt. bearing precedes movement
Isometric…eccentric…. Concentric
Proximal to distal key points
Preparation
Preparation….Movement…. Function= hands grasped together, hook around knee to move foot
Wt. bearing precedes movement
Isometric…eccentric…. Concentric= hold, slowly lower, raise it back up
Proximal to distal key points
Principles of Handling:
Small to large ranges
Slow to fast
Task analysis- break down each skill, for example:
Supine to sit
Ascending a stair
Small to large ranges= bring your limbs to my hands
Slow to fast
Task analysis- break down each skill, for example:
>Supine to sit
>Ascending a stair
*assume posture first-> wt shifts, assume midline-> then put all together
Principles of Handling:
Give “feel” for the movement
Very similar to AAROM; guided movement
Allows patient to establish an internal reference of correctness
Communication
Achieve success– carry over
Give “feel” for the movement
Very similar to AAROM; guided movement
Allows patient to establish an internal reference of correctness
Communication
Achieve success– carry over
- watch eyes
