Traditional Approach- NDT

Question 1

What was the early focus on NDT

Answer 1

the need to control tone through key points of control.

used developmental postures with early focus

Question 2

Facilitation:

Answer 2

teaching a movement with use of hands

Question 3

Inhibition

Answer 3

decreasing muscle activity through handling

Question 4

What philosophy was included?

Answer 4

the philosophy of combining movement with function to get carry-over

use Resistance on L side to help get movement on R side

Question 5

NDT has evolved over time, Less focus on developmental postures, more focus on…?

Answer 5

-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

Question 6

What is constraint induced therapy?

Answer 6

Tie the good arm so the pt is forced to use weak arm

Question 7

Developmental Concepts involve:

Answer 7

Vertical Orientation
Repetition
Handling in functional situations
Movement into higher levels of activity

Question 8

Developmental Concepts involve: Vertical Orientation

Answer 8

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.

Question 9

Developmental Concepts involve: Repetition

Answer 9

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.

Question 10

Developmental Concepts involve: Handling in functional situations

Answer 10

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

Question 11

Developmental Concepts involve: Movement into higher levels of activity

Answer 11

there is overlap. In order to perfect lower level, need to work at higher levels.

Question 12

3 General Areas of Function are?

Answer 12

Posture
Transitional Movement Patterns
Ability to be active in postures

Question 13

3 General Areas of Function: posture

Answer 13

Acquisition of control over a relatively stable base of support. Needs to be with proper alignment (mobility/Stability)

Question 14

3 General Areas of Function: Transitional Movement Patterns

Answer 14

Ability to move from one position to another, example: sit→stand
Patient needs to maintain control over a changing base of support

(controlled mobility)

Question 15

3 General Areas of Function: Ability to be active in postures

Answer 15

Will need to have tone high enough to maintain posture, but low enough to allow movement
Work toward automatic function

(skilled)

Question 16

Goal for NDT

Answer 16

• To improve quality of movement
• Less energy cost
• More normal time frame

-Enhance quality of life
-Prevent secondary complications
&raquo_space;Improper movement leads to orthopedic problems over time.

Question 17

What are the 5 Components of Movement we need to work on during therapy

Answer 17

Trunk Control
Midline Orientation
Movement over base of support
Head control on trunk
Limb Function and Control on Trunk

Question 18

Trunk Control

Answer 18

-Need mobility and stability first
-Separation of upper and lower trunk
&raquo_space;Upper trunk= Cspine, thorax, scapula
&raquo_space;Lower trunk- Lumbar spine, pelvis
-Movement laterally
&raquo_space;One side of trunk shortens/ one elongates
-Rotation
-Upper vs. Lower trunk initiated movement
&raquo_space;Upper is less challenging

Question 19

Midline Orientation

Answer 19

Achieve midline posture; without support as able

Move in any direction AND return to upright midline orientation

Question 20

Movement over Base of Support

Answer 20

• Weight shift should be to the involved side first

- Move in all directions, including diagonals- as required for function

Question 21

Head control on trunk

Answer 21

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

Question 22

Limb Function

Answer 22

-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

Question 23

Principles of Handling:

Observation

Feel

Combine

Starting Postures

Answer 23

Observation= view of pt

Feel= c hands to detect tone, facilitate movement

Combine= total picture

Starting Postures= transitions and termination of movement

Question 24

Principles of Handling:

Use key points of control

Open handed approach

Light contact

Move slowly

Answer 24

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

Question 25

Principles of Handling:

Preparation

Preparation….Movement…. Function

Wt. bearing precedes movement

Isometric…eccentric…. Concentric

Proximal to distal key points

Answer 25

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

Question 26

Principles of Handling:

Small to large ranges

Slow to fast

Task analysis- break down each skill, for example:
Supine to sit
Ascending a stair

Answer 26

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

Question 27

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

Answer 27

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