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Neurodevelopmental Treatment (NDT)
Evidence reviewed as of before
01-01-2021 Author(s): Ogourtsova, T. (PhD OT); Steven, E. (MSc App OT); Iliopoulos, G. (MSc App OT); & Majnemer, A. (PhD, OT, FCAHS)Share this
intervention:
NDT
Introduction
Neurodevelopmental Treatment (NDT) is a therapeutic approach used by occupational therapists, physiotherapists and speech language pathologists for the rehabilitation of people of all ages with cerebral palsy (CP), stroke, TBI and other related disorders.
Accessed on June 28, 2022 from http://associatedtherapies.com/neurodevelopmental-treatment/
Originally called the Bobath approach, NDT first focused on improving gross motor functioning and postural control by facilitating muscle activity through key points of control assisted by the therapist. Currently, NDT has expanded to reflect developments in the understanding of movement and movement dysfunction (including an understanding of typical and atypical development). NDT-trained therapists use this knowledge to analyze activity and participation throughout the lifespan. They use dynamic and reciprocal therapeutic handling techniques to guide the movement of the whole body while clients participate in functional activities.
NDT evaluation and treatments take a client-centered and problem-solving approach (as opposed to standardized methods). They emphasize participation in daily activities that are relevant to the individual and their family. Overall, NDT attempts to improve the quality of life of patients with neurological lesions by optimizing their level of activity and participation.
NDT is a therapeutic intervention that is used by occupational therapists, physiotherapists and speech language pathologists to treat disorders of function, movement and postural control for individuals with damage to their central nervous system (e.g. CP, stroke, and TBI).
NDT involves a hands-on, reciprocal and dynamic interaction between the therapist and client. The therapist positions/supports their client at certain areas of the body (typically the head, shoulder and pelvis) to guide the movement of the whole body. This helps to improve how the body moves and is positioned during a certain task.
NDT is a non-standardized treatment, and therefore requires the therapist to observe, analyze and interpret how a client is completing an activity before determining an individualized treatment plan. NDT addresses task-specific postures and movements. The therapist works closely with the client and their family to identify what activities are important in their daily life and in the future. NDT aims to improve the quality of life of patients with neurological conditions by improving their ability to participate in meaningful activities.
NDT is used for children with CP (or other clienteles with neurological pathophysiology) who have functional limitations. This treatment approach is used to improve a person’s ability to participate in daily activities by addressing dysfunction in posture and movement.
NDT is one of the most common interventions to treat children with CP, however the literature does not consistently support that NDT can promote functional improvement. This is likely because NDT protocols are hard to evaluate: they are not delivered in a standardized manner, expertise can vary amongst professionals, and NDT is often combined with other therapy techniques.
Two studies were reviewed for the purposes of this project. The first compared NDT to home exercises (included stretching and active/passive movement activities). It found that NDT was more effective at improving gross motor function in young children (2- 6 years old with diplegic CP). Another study compared NDT to a similar neurodevelopmental treatment approach (NFDR) in children 6 months to 2 years of age with mild-moderate spasticity. NDT was found to be less effective at improving gross motor function and spasticity, and not more effective at improving primitive reflexes.
Sessions will begin with observations and evaluation (standardized and non-standardized) where the therapist will interact with your child while asking them to perform different movements or functional tasks. The therapist will analyze any strengths and limitations in function (e.g. postures and movements) as well as get to know how your child is participating in daily activities. The therapist will collaboratively set goals with you and your child.
Treatment sessions involve close interaction between your child and therapist, where different preparatory work may be required (e.g. muscle elongation) and different positioning/handling techniques will be used while your child is completing a task. These handling techniques provide feedback to your child’s sensorimotor system, which may enable him or her to relearn movement choices and discourage inefficient or compensatory techniques.
As the child progresses, the therapist guidance and assistance fades so that the child can perform actions independently. Family members may also receive education in NDT principles, which often include written programs to carry out at home.
Typically, occupational therapists, physiotherapists and speech language pathologists who have completed an advanced training (100 hours) in the principles of NDT, in-depth analysis and hands-on treatment techniques from a professional association (e.g. NDTA). In addition, to maintain a NDT certification, a minimum of 20 hours of continuing education is required every 3 years.
The treatment length and frequency of sessions is determined by the therapist and is based on the individual needs and goals of the client. An example of an intensive NDT program is 45 minutes twice a week plus a 30 minute-a-day home program. A non-intensive program example could be 45 minutes per week or no less than one session per month.
More research is needed with consistent NDT protocols, age of clientele, type of CP and professional expertise in order to determine if NDT is more effective than other interventions. The studies reviewed suggest that NDT is more effective in improving gross motor function when compared to home exercises but less effective when compared to NFDR.
NDT continues to be a common treatment option for children with CP. It has little known adverse effects and is often incorporated into other treatment approaches by therapists.
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) investigated the effects of neurodevelopmental therapy (NDT) on gross motor function in children with CP (mild/moderate spasticity). This fair quality RCT randomized participants to receive either NDT or neurofacilitation of developmental reaction (NFDR) approach. 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 NDT is less effective than a comparison intervention (NFDR) in improving gross motor function in children with CP (mild/moderate spasticity).
One fair quality RCT (Batra et al., 2012) investigated the effects of neurodevelopmental therapy (NDT) on primitive reflexes in children with CP (mild/moderate spasticity). This fair quality RCT randomized participants to receive either NDT or neurofacilitation of developmental reaction (NFDR) approach. 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 NDT is not more effective than a comparison intervention (NFDR) in improving primitive reflexes in children with CP (mild/moderate spasticity).
One fair quality RCT (Batra et al., 2012) investigated the effects of neurodevelopmental therapy (NDT) on spasticity in children with CP (mild/moderate spasticity). This fair quality RCT randomized participants to receive either NDT or neurofacilitation of developmental reaction (NFDR) approach. 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 NDT is less effective than a comparison intervention (NFDR) in improving spasticityin children with CP (mild/moderate spasticity).
One fair quality RCT (Labaf et al., 2015) investigated the effects of neurodevelopmental therapy (NDT) on gross motor function among children with diplegic CP. In this fair quality RCT, children were randomized to receive NDT or home exercises. Gross motor function was assessed using the Gross Motor Function Measure – 88 (GMFM-88: Lying and rolling; Siting; Kneeling and crawling; Standing; Walking, running and jumping) at post-treatment (3 months). Significant between-group differences were found in 4 out of 5 dimensions (Lying & rolling, Sitting, Kneeling and crawling, Standing), favoring NDT vs. home exercises.
Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that NDT is more effective than a comparison intervention (home exercises) in improving gross motor function in children with diplegic CP.
References
Batra, M., Sharma, V. P., Batra, V., Malik, G. K., & Pandey, R. M. (2012). Neurofacilitation of Developmental Reaction (NFDR) approach: a practice framework for integration / modification of early motor behavior (Primitive Reflexes) in Cerebral Palsy. Indian journal of pediatrics, 79(5), 659–663. https://doi.org/10.1007/s12098-011-0545-3
Labaf, S., Shamsoddini, A., Hollisaz, M. T., Sobhani, V., & Shakibaee, A. (2015). Effects of neurodevelopmental therapy on gross motor function in children with cerebral palsy. Iranian journal of child neurology, 9(2), 36. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515339/
A group of lifelong disorders affecting a person’s movement, coordination, and muscle tone and which are the result of damage to the brain before, during, or shortly after birth.
Describing behavior, activity or a brain process that combines sensory and motor function. Sensorimotor skills involve the process of receiving sensory messages (sensory input) and producing a response (motor output).
