The document discusses the evolution and application of Neuro-Developmental Treatment (NDT) for children with cerebral palsy, highlighting its historical roots, principles of therapy, and current evidence regarding its efficacy. While NDT aims to facilitate typical movement patterns and improve motor function through a hands-on, multidisciplinary approach, evidence suggests that its effectiveness is limited and often lacks robust methodological quality. Alternative evidence-based interventions, such as bimanual training and goal-directed therapy, have shown greater success in enhancing activity levels for children with cerebral palsy.

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.