1. Neurodevelopmental Therapy Concept & Principles
Robyn Smith
Department of Physiotherapy
UFS
2012

2. What is NDT? NDT = Neurodevelopmental Therapy
Also referred to as Bobath concept
Approach to the management of children with pathology of the central nervous system

3. Background Developed in 1940’s United Kingdom
Dr. Karel Bobath (neurologist) and his wife Berta (physiotherapist)
“The aim of treatment for children with disabilities due to brain damage is to prepare them and guide them towards their greatest possible independence and to prepare them for as normal adolescence and adult lives as can be achieved”
Bobath, 1984

4. Background
“living concept” an approach that continues to evolve even today
Based on current neuro- and movement sciences
Evidence-based
The most widely used form of neurodevelopmental therapy

5. Principles: What does NDT advocate:
Problem solving
Holistic → sensory –motor issues, also developmental, cognitive, perceptual, emotional and functional problems
Interdisciplinary
Interactive – parent and child involved
Goal directed (Function and participation key)
Early intervention recommended
Advocates use ICF as tool

6. Basic departure point Understanding of :
developmental process of motor control (sequencing)
components of normal movement
Components which constitute a functional task
Good facilitation and handling skills

7. How does work? Neurological deficit or damage
Disturbances in normal muscle tone →
Disturbances in postural muscle tone (ability to develop antigravity control disturbed)
Developmental problems – not attain milestones
Abnormal sensory motor
experience
Persisting or worsening
movement patterns

8. Systems involvement in case neurological damage:
Neural elements:
Muscles
Nerves
Non neural elements:
Muscle contractility
Biomechanical issues

9. How is it done? What does therapist aim to do during treatment?
Trained therapist use specialised handling techniques to:
Modify /influence patterns abnormal tone
Preparation e.g. mobilisation
Facilitate/ stimulate more normal movement patterns using key point control
Automatic reactions (righting and equilibrium reactions- head and trunk control against gravity)

10. How is it done? What does therapist aim to do during treatment?
Develop postural control/adjustments as background for voluntary movement
Provide more normal sensory- motor experience
Strengthen and open synaptic pathways and make use of neural plasticity
Help the a child with neurological dysfunction to optimise their functional abilities

11. How is it done? What does therapist aim to do?
Practice and repetition
Carryover and parent participation
Regular and quality physiotherapy intervention

12. NDT therefore provides the therapist with flexible treatment guidelines they can use to select individualised treatment strategies for their client
“It is not a recipe” each child is different need to be able to use the principles in the context of each individual patient.

13. Facts on the evidence of effectiveness of NDT
Are numerous s studies and evidence reviews but there is some difficulty in demonstrating the effectiveness of the approach
Evidence of efficacy is relatively low to support use above other therapy modalities

14. Facts on the evidence of effectiveness of NDT
Hard to compare outcomes as they depend on the type of cerebral palsy and the severity of the brain lesion
Numerous problems with study methodology: few randomised controlled clinical trials, small sample size and variation of standardised outcome measures
Poor description of the exact techniques and therapy intervention given and the duration thereof

15. Current opinion based on research then.....
Studies on effectiveness of NDT have been inconclusive
NDT has not been shown to be more effective than any other therapy approach

16. What to NDT therapists and parents say....
Based on the changes in the activity level and participation abilities of the child both parents and therapists feel that NDT is an effective approach
Approach taught at most universities at a pre-at undergraduate level
Most common meuropaediatric
postgraduate course as well

17. What do the detractors of the approach say ....
Therapy approach too “hands on” often not allowing the child to do things independantly
Labour intensive
Costly over time
Lack of evidence to support its use

18. Should NDT be used in conjunction with other therapy approaches
Based on the available research: YES

19. Physiotherapists toolbox:
Rarely is NDT therapy used in isolation
Most therapists use an eclectic approach to their therapy.
NDT forms the core of their therapy but often used other approached or adjunct to make the therapy more child and family specific and effective

20. The physiotherapists toolbox
The physiotherapists “toolbox” an eclectic approach (Mayston, M. 2007, p 69)
Training functional
Tasks for optimal
Performance
i.e. repetition &
home activities
Maintain muscle
length
Tone influencing,
myofascial release,
orthotics &
stretching
Specific training
for neuroplasticity
e.g. CIT
Treadmill
NDT
Train postural
reactions
task specific
goal directed
The physiotherapists toolbox
Child with
Neurological
impairment
CVS &
general
Fitness activites
Muscle
strengthening
Functional,
resistance,
weight bearing
Sensory
perception and
cognitive
function
Social &
behavioural
aspects
Encourage
participation
Hippotherapy
Virtual reality
&compression
suit therapy

21. References Images courtesy of Google
Brown, E NDT course notes (unpublished)
Brown, E NDT early intervention course notes unpublished)
Bobath Centre website
Barber, C.E A guide to physiotherapy in cerebral palsy. In Paediatrics and child Health. 18(9) September 2008 pp
Poutney, T Cerebral Palsy in Physiotherapy for children pp 97-98
Ratliffe, K.T Neurological and muscular disorders of childhood in Clinical Pediatric Physiotherapy. A guide for the Physical Therapy Team. pp

22. References
Styer-Acevado, J The infant with Cerebral Palsy in Pediatric Physical Therapy. Tecklin, J.S. (eds). 4th ed. pp
Sheperd, R.B. Cerebral Palsy in Physiotherapy in Paediatrics. 3rd ed. pp
Velikovi, T.D. Basic principles of neurodevelopmental treatment