Neurofacilitation of Developmental Reaction (NFDR) Approach

NFDR is a treatment approach used for children with neurodevelopmental delay that aims to normalize muscle tone and reflexes, thereby improving motor development and functioning. There are two phases to NFDR intervention: 1) preparatory and variability phase, and 2) modulation phase.

The first phase begins with interventions designed to prepare the body for later stages. Treatments in this stage normalize muscle tone, movements of the body and restore better posture overall. The variability component challenges postural control/stability further by varying the conditions which previously provided support (e.g. support surface). The therapist maneuvers the body of the child to increase stability, normalize tone and reinforce normal motor behavior.

The modulation phase aims to expose the child to movement experiences for different durations and conditions (e.g. position in space, changes in movement, level of muscular effort required etc.) to modulate muscle tone and primitive reflex behaviors. The therapist applies different techniques to regulate how the child’s body reacts (e.g. neuro-facilitatory contact points, vestibular, proprioceptive and kinesthetic inputs, etc).

NFDR is an approach/technique that prepares muscles to undergo tonal changes that enhance motor development and functional performance for children with neurodevelopmental delay.

No.

There is very limited research to support the effectiveness of NFDR for cerebral palsy(CP). One small study compared NFDR to neurodevelopmental treatment (NDT) and found that NFDR was more effective in improving early motor behavior (gross motor function and spasticity) for young children (6months- 2 years old), while NDT was more effective in modifying primitive reflexes.

Not much information is available in the literature regarding the specific details of how NFDR is administered. As with any intervention, you can expect an assessment before the start of treatment where muscle tone, reflexes, gross motor function and posture are evaluated. These measurements could be repeated at certain points during a treatment period and at the end. NFDR is a hands on approach like other neurodevelopmental interventions  Sessions are likely one to one with a skilled therapist who will use different activities, movements and positioning to work on goals. Other early motor interventions (such as NDT) may use similar techniques.

Typically, early motor interventions are delivered by pediatric occupational therapists and physiotherapists.

There is little information in the literature outlining the NFDR approach. One study describes a 3 month intervention protocol period. Sessions were provided 3 times per week for 40 minutes.

None are known.

Only one recent study has shown that NFDR is more effective in improving gross motor function and spasticity than a comparison intervention (NDT) in children with spastic CP. More research is required to determine who can most benefit from this approach and to develop clinical guidelines for its use.

Information on this website is provided for informational purposes only and is not a substitute for professional medical advice.

One fair quality RCT (Batra et al., 2012) compared the effects of Neurofacilitation of Developmental Reaction (NFDR) approach on gross motor function in children with CP (mild/moderate spasticity). This fair quality RCT randomized participants to receive either NFDR or neurodevelopmental therapy (NDT). Gross motor function was evaluated using the Gross Motor Function Measure (GMFM: Components I-V, Total dimension score) at post-treatment (3 months). A significant between-group difference was found in all measures, favoring NFDR vs. NDT.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that NFDR is more effective than a comparison intervention (NDT) in improving gross motor function in children with CP (mild/moderate spasticity).

One fair quality RCT (Batra et al., 2012) compared the effects of Neurofacilitation of Developmental Reaction (NFDR) approach on primitive reflexes in children with CP (mild/moderate spasticity). This fair quality RCT randomized participants to receive either NFDR or neurodevelopmental therapy (NDT). Primitive reflexes were evaluated using the Primitive Reflex Status and Primitive Reflex Intensity Grading score at post-treatment (3 months). No significant between-group differences were found.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that NFDR is not more effective than a comparison intervention (NDT) in improving primitive reflexes in children with CP (mild/moderate spasticity).

One fair quality RCT (Batra et al., 2012) compared the effects of Neurofacilitation of Developmental Reaction (NFDR) on spasticity in children with CP (mild/moderate spasticity). This fair quality RCT randomized participants to receive either NFDR or neurodevelopmental therapy (NDT). Spasticity was evaluated using the Modified Ashworth Scale (MAS: right/left shoulder, elbow, forearm, wrist, hip, knee, ankle) at post-treatment (3 months). Significant between-group differences were found for left/right shoulder, right elbow, right forearm, left/right wrist, right hip, right knee and right ankle, favoring NFDR vs. NDT.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that NFDR is more effective than a comparison intervention (NDT) in improving spasticity in children with CP (mild/moderate spasticity).