- NDT is a sensorimotor approach widely used by occupational therapist in the treatment of CNS disorders which result in abnormal posture and movements. This treatment modality is used for varied patients with various dysfunctions like those with neuromuscular disorders, immature CNS disorder (premature infants) and other developmental delay. NDT is used for paediatric rehabilitation point of view.NDT can be simply defined as progressing the child through his developmental stages with facilitation of normal movements and inhibition of abnormal movements. Main principles of NDT which forms basic of treatment plan are given by DR.BERTA BOBATH (1943).
- Normal development and interplay between stability and mobility.
- Effect of postural reflexes on sensory motor sensory feedback.
- Movement components and the ability to dissociate movement
- Sequential development takes place in three planes: vertical, horizontal and diagonal.
Since the baby is conceived in womb, a complex task of CNS formation begins. Even when baby is in womb, some movements, some response is given to surrounding. If these are appropriate, healthy maturation of CNS occurs. These movements are happening at reflex level. Many such reflexes are present at birth and with development keeps on integrating in CNS only to result in more mature and voluntary movements. Any block in this process at any level leads to abnormal development. So NDT focuses on specific handling techniques as well as adaptive equipments to achieve inhibition of abnormal pattern and facilitation of normal patterns. Tone normalization: These techniques are designed to normalize tone and obtain postural alignment throughout entire body and to prepare upper extremity and lower extremity for weight bearing , weight shifting and function. NDT helps child to enhance the quality of motor performance, teach new movement skills in preparation for greater performance and prevent disability resulting from abnormal motor pattern. Gross motor skills such as locomotion ( rolling, crawling, walking). Oral motor skills such as feeding techniques, speech, head and trunk control, fine motor skills such as reach, grasp, manipulation and release. All are developed and refined using NDT technique. All ADL tasks like self care( feeding, dressing , toileting, bathing, grooming, play) if carried out with NDT techniques more functional goals are achieved . Many disorder”s make use of Adaptive Devices mandatory for the child such as C.P chair, wheelchair, adaptive equipments like modified utensils, home environment etc. If NDT techniques are known to caregivers or are supervised by a known therapist progression of physical disability because of faulty environment is avoided. To understand NDT more meaningfully let us go through normal child development.
Any child develops first head control posture, the next development would be turning and rolling involving a lot of movements in order to achieve the next development stage. Then to this equilibrium component is also added. This became necessary to maintain sitting position. From sitting position the infant has to move to creeping and then creeping to quadruped and then to crawling. Then comes static standing, kneeling and finally walking, then more difficult motor patterns like standing on one leg, hopping, skipping, and running are learnt & mastered. This was just a glance through child development for gross motor activities. Many other development for a child go through such series of achievements like hand control, eye movements, speech etc which are not given amount of weightage they deserve in the development. For any therapist dealing with NDT therapist has to concentrate mainly on following issues.
- Developing the child in aspects which have been missed during development.
- Practicing age appropriate patterns which stress on mastering previous stages of development.
- To prepare for next stage of development.
While using NDT, occupational therapist treats not just one or two limbs but the whole individual, not only by inhibition of wrong movement, but also by facilitation of right movements. NDT deals differently for hypotonic & hypertonic child.
For both hypotonic & hypertonic abnormal tone affects midline orientation leading to difficulty in performing bilateral skills. Low Ms tone infants have poor ability to do eye tracking leading to visual perceptual problems resulting in difficulty for visual motor task like tying shoelaces, writing, coloring etc. Hand function like grasp, grip, and nature motor patterns for object manipulation faces difficulty. For those children with high Ms tone there are high chances of development of contractures, determinates, tightness to a extent to cause faulty postures, decreased thoracic space leading to less lung capacity for respiration inability to use upper extremity and lower extremity for any functional use. Range of motion at any joints may get compromised. Handling technique varies for each child according to his clinical pictures (tone, age, developmental stage, nutritional status, prognosis, functional involvement).
Parent education, quality home program is the key for successful rehabilitation using NDT.