you can get a fair idea WHAT key points of control are and how can be they used to control a patient.... though it is demonstrated on children, it can be used with adults also, if beneficial.

1. KEY POINTS OF CONTROL
IN CEREBRAL PALSY
PRESENTER: SARA SHEIKH
3RD YEAR, 6TH SEMESTER
OCCUPATIONAL THERAPY

2. NEURODEVELOPMENTAL
TREATMENT (NDT)
The concept is based on two fundamental principles
about the nature of the CNS dysfunction:
1. The arrest, or retardation of normal movement is
caused by the interference with normal brain
maturation resulting from brain lesion
2. The resultant release of abnormal, or immature,
postural reflex activity causes the observed
abnormal patterns of posture and movement.

3. Intervention strategies and techniques for NDT
consist of:
• facilitation
• inhibition
• key points of control.

4. WHAT ARE KEY POINTS OF
CONTROL?
The way the child is touched during therapy has
a powerful effect, so it must be ensured that
this effect is positive. It helps to know that
through just one point at one time, the child’s
posture and movement pattern can be changed.
These points are called Key Points of Control.
Through these, the child can be stimulated as
well as his spasticity inhibited and normal
postures and movements facilitated.

5. TYPES OF KEY POINTS
Key points are of two types: Pr oximal and Distal
PROXIMAL KEY POINTS: DISTAL KEY POINTS:
They are located closer to the Distal key points work only if the
source of problem and child has some postural control
facilitate more activity distally. proximally and are located away
from the source of problem.

6. PROXIMAL KEY POINTS:
HEAD,
SHOULDER GIRDLE,
TRUNK,
PELVIS

7. HEAD
POSITION: FACILITATES:
Raising the head in prone, Extension in the rest of the
sitting and standing body (if no STNR influence
present)

8. SHOULDER GIRDLE
POSITION: FACILITATES:
Applying moderate pressure at Stabilises shoulder girdle,
the shoulders while sitting. trunk and hips.

9. TRUNK
POSITION FACILITATES
Hold trunk firmly while sitting Promotes trunk and pelvic
or standing stability and head control

10. PELVIC GIRDLE
POSITION FACILITATES
Push hip forwards, standing Stabilises pelvis and legs to
with support. achieve a better standing.
Hold pelvis while sitting. Better sitting balance and
posture.

11. DISTAL KEY POINTS:
ARMS/ELBOWS,
HANDS,
KNEES/LEGS,
FEET

12. ELBOWS/ARMS
POSITION: FACILITATES:
Adduction of extended arms Stabilises shoulder girdle;
Better head control in
pulling to sit and vice versa.

13. HAND (BASE OF THUMB)
POSITION: FACILITATES:
Abduction of thumb with Opening of the fingers.
supination and wrist
extension.

14. KNEES/LEGS
POSITION FACILITATES
Grasp legs or knees while Better standing balance will be
standing achieved.

15. FEET
POSITION: FACILITATES:
Pulling feet slightly upwards Extension of pelvic girdle and
while in prone spine: weight bearing on
elbows.

16. Overlap in effects of Proximal and Distal
key points can occur, so the therapist can
change or combine them as the child
moves.

17. SOME COMBINATIONS OF
KEY POINTS

18. HEAD AND ARMS
POSITION: FACILITATES:
Head raised with horizontally Extension of upper spine,
abducted arms. opening of fingers and
abduction of legs.

19. PELVIS AND SHOULDER GIRDLE
POSITION FACILITATES
Apply moderate pressure Trunk stability and head
simultaneously at pelvic and control will be maintained
shoulder girdles while throughout the movements.
pulling to sit

20. SOME USEFUL TIPS
• Keep your hands firmly on the child. Light
movement and touch cannot be used to control or
guide.
• Be careful about positioning with children having
asthma, lung infections, stomach or kidney
problems.
• Be careful about the choice of key point. It would
be useless if you try to “pull-to-sit” a child by
grabbing his hands when his shoulders/neck
muscles are weak.