Neurodevelopmental Theory & Motor Control

Study Notes

The text discusses motor control therapies based on principles of normal neurological development, focusing on the reflex-hierarchical or neuromaturational sequence
Traditional motor control approaches are commonly used as a background for task-oriented occupational therapy frameworks.

Developed by Bobath in 1990
Second most common frame of reference in the U.S.
Aims to restore skilled voluntary movement in both children and adults with developmental or acquired neurological conditions, such as cerebral palsy and hemiplegia
Considered a preparatory or problem-solving approach.

Focuses on restoring voluntary movement, independent of occupational relevance (reductionism).
Uses a bottom-up approach.
Draws inspiration from neurology, medicine, physical therapy, and human development.

Emphasizes the importance of normal growth and development, including motor milestones and reflex hierarchies: attitudinal, righting, and protective reflexes.

Movement control develops from head to foot (cephalocaudal), trunk to limbs (proximal to distal), and from large to small (gross to fine).
Infants gradually gain control over primitive reflexes.
Clients internalize the sensation of movement during recovery, with stability preceding mobility.
Stability is achieved through co-contraction of complementary muscle groups.
Mobility allows for environment engagement.
After brain injury, abnormal movement and tone must be inhibited before normal movement and sensation can be restored.
Abnormal movement and tone can include flaccidity, spasticity, and splinter skills.

Treatment should be functionally oriented and incorporated into activities of daily living (ADL).
Evaluation and treatment is an ongoing problem-solving process.
Client and family needs should be respected and addressed throughout the treatment process.
NDT treatment is based on knowledge of normal movement, posture, tone, biomechanics, and sensorimotor processes, such as praxis.
Generalization of treatment should be actively sought by training the client and family in everyday activities.
NDT is a holistic approach, utilizing an interdisciplinary team.
NDT is an individualized approach.

Functional motor control: The capacity to perform voluntary skilled movements necessary for everyday life.
Dysfunction: Inability to control movements, characterized by:
- Lack of postural control
- Abnormal tone
- Generalized spasticity
- Poor inhibition of nonfunctional movements
- Sensory disturbances.

Functional movement capacities and limitations are assessed and documented through observation and handling.
Evaluation involves collaborative goal-setting among the client, family, and therapist.

For stroke clients, NDT traditionally discourages compensation.
Occupations are used as both means (for practicing movement) and ends (for accomplishing desired tasks).
For individuals with developmental disabilities, intervention includes:
- Handling
- Inhibition and facilitation to encourage normal movement.