Here we present a widely used neurophysiotherapeutic approch - NDT, exploring its current principles and throwing a glance at the historical development and why it is being so widely practice. does it really have that evidance base? Find more as you click on. Give a like if I helped you learn or clear concepts. Thankyou. Love you all. Lets learn more.

1. NDT

2. HISTORY
• Till 1900s the CP patients were
managed only by surgery and orthotics.
• The Bobaths put together the
philosophy of the bobath approach that
increased the scope of physiotherapy in
mx CP.
• Based on the reflex hierarchical theory
of motor control.
• NDT interventions aimed to inhibiting
abnormal postures and tone by holding
the child in reflex inhibiting postures,
but it was not found to be very
effective.

3. Current Principles
• The patients with CNS dysfunction have problems with
control of stability and mobility because of impaired
feedback and feed forward systems.
• Abnormal tone and abnormal movement should be inhibited,
whereas the normal tone and normal movement should be
facilitated.
• Once the patient learns the typical movement patterns he
will be able to make functional gains as he moves more
efficiently.

4. • For assessment the therapist should have knowledge of the
typical development and typical movement patterns. Therapist
should observe and analyze and find the missing components of
the movement.
• Create client‐ centered goals as NDT is a holistic multidisciplinary
problem solving approach.
• The therapy starts with preparatory work- stretching spastic
muscles, ROM excs, wt. bearing.
• NDT is an hands on approach in which key points of control are
used to facilitate normal alignment and movement while the
patient actively performs a task-oriented movement.
– Focus is on quality of movement and the ability to co-ordinate
movement while maintaining an appropriate postural background.

5. • The normal alignment should be maintained using adaptive
devices when the therapist is not maintaining the alignment.
• All principles of motor learning to be followed during therapy-
– Repetition
– Feedback
– Variability of task
• The therapist should maintain a working hypothesis and
perform continuous reexaminations.

6. How it might work?
• NDT uses sensory input through the key points to re‐educate
the patient's internal reference systems so that he has more
movement choices and greater efficiency of movement.
• The main is to give a sensorimotor experience because the
learning comes from movement perception.
• Feed forward is developed as the child practices the skill or
task with the therapist's guidance.
• Therapist provides less guidance and assistance as the infant
takes over and anticipates postural and motor requirements.

7. A systematic review of interventions for children with
cerebral palsy: state of the evidence
Aim:
Describe systematically the best available intervention
evidence for children with CP.
DISCUSSION:
• 1 RCT showed favorable outcomes with higher-intensity
NDT. (2/weeklyx16weeks)
• Weak evidence suggest NDT improves function. As the
methodological quality of the studies were very low and only
studies with a high risk of bias found a favorable benefit from
NDT.
Novak et. Al (2013), . Developmental Medicine & Child Neurology, 55(10), 885-910.v

8. • NDT(a bottom-up approach),have little carryover into
functional activities.
• NDT principles have now included additional evidence-based
treatment approaches under the NDT banner (e.g. motor
learning and the philosophy of family-centred practice), and it
is difficult to filter what features of the treatment are actually
working.

9. CONCLUSION
• There is lack of efficacy evidence for large proportions of the
interventions in use within standard care for people with CP.
• The most evidence based approaches that improve the
activities level: bimanual training, CIMT, context-focused
therapy, goal-directed training, home programmes, and
occupational therapy after BOTOX.

10. EVIDENCE

11. TAKE HOME MESSAGE
• NDT is based on
– Facilitation of typical movements
– Inhibition of compensatory motor behavior
– an multidisciplinary management strategy
– Sensorimotor experience
– Qualitative approach
• Always use a holistic approach of
management.