Neurodevelopmental Treatment (NDT) Bobath Approach PDF

NEURO-DEVELOPMENTAL TREATMENT (NDT) PTY 224 Lec. 2.1 BOBATH APPROACH By: Dragana Djuric  NDT ( BOBATH) ▪Neurodevelopmental treatment (NDT) is a hands-on treatment approach used by physical therapists, occupational therapists and speech-language therapist ▪NDT-trained thera...

NEURO-DEVELOPMENTAL TREATMENT (NDT) PTY 224 Lec. 2.1 BOBATH APPROACH By: Dragana Djuric  NDT ( BOBATH) ▪Neurodevelopmental treatment (NDT) is a hands-on treatment approach used by physical therapists, occupational therapists and speech-language therapist ▪NDT-trained therapists work collaboratively with patients, their families and caregivers and other members of the rehabilitation team ▪NDT name is commonly used in North Amerika and Bobath approach in Europe ▪An international association was established in 1983. ▪Since 1996, it is known as International Bobath Instructor Training Association (IBITA) NDT APPROACH IN NEUROLOGY Use for neurological patient who has difficulty controlling movement as: ▪ Cerebral palsy and traumatic brain injury in pediatric population ▪ Stroke ▪ Head injury BOBATH (NDT) THERAPIST ▪ Basic course ▪ 2 Advanced courses ( long process) ▪ Instructor training Bobath Centre (London) ▪ In pediatric patient accent is on Early intervention services & consultations ▪ 2 weeks of intensive block of therapy ▪Bobath concept aims to improve gross motor function and postural control by facilitating muscle activity through key points of control assisted by the therapist. BOBATH CONCEPT HISTORY ▪Berta Bobath –physiotherapist ▪Karel Bobath a psychiatrist/neuropsychiatrist ▪They developed this approach for effective management of neuro-motor dysfunctions in the late 1940 ▪ Theory :'hierarchical/reflex model‘- higher level cortical centre, while lower centres controlled more primitive reflexes. ▪They find that CP as having difficulty with postural control and movement against gravity ▪NDT interventions aimed to stop abnormal postures and movements by holding the child in fixed postures that were supposed to inhibit reflexes. ▪Before Bobath approach braces, passive stretching, and surgery were only management BOBATH APPROACH ▪ Over the past 8 decades, many concepts have remained unchanged in the writings while others have undergone evolution because of new scientific knowledge which lead to update concept of NDT. NDT DEFINITION ▪NDT is a holistic and interdisciplinary clinical practice model informed by current and evolving research that emphasizes individualized therapeutic handling based on movement analysis for rehabilitation of individuals with neurological pathophysiology. NDT WHAT IS NDT TOADAY? ▪It is an interactive problem-solving approach that focuses on continuing reassessment with attention to individual goals, developing working hypotheses, treatment plans. ▪ The therapist uses the ICF model in a problem-solving approach ▪Objective measures to evaluate interventions. ▪ It is a goal-orientated and task-specific approach, aiming to organise the internal (proprioceptive) and external (exteroceptive) environment of the nervous system for efficient functioning of the individual. ▪It is an interactive process between patients and therapists CEREBRAL PALSY- POSTURAL CONTROL ▪The normal postural reflex mechanisms consist of righting and equilibrium reactions, reciprocal innervation and coordination patterns. ▪The release of abnormal tone and tonic reflexes seen in CP interfered with the development of righting and equilibrium reactions. NDT ▪ An in-depth knowledge of the human movement system and motor control ▪ Principles of motor learning ▪ Understanding of typical and atypical development ▪ Expertise in analyzing ✓ Postural control ✓ Movement ✓ Activity, and participation (ICF) PRINCIPLES OF MOTOR LEARNING ▪Repetition ▪Progression ▪Influence of sensory information NDT ▪Integration of postural control and task performance ▪Selective movement control for the production of coordinated sequences of movements. ▪Sensory inputs to motor control and motor learning has always been a vital focus of the Bobath concept. ▪Bobath concept demands training in different real-life situations rather than just practicing in the therapy department. ▪Individuals are encouraging for active participations during treatment sessions ▪Functional training SENSORY STIMULATION OUTLINE OF NDT APPROACH Individualized Functional Patient: Life role, supports systems, home environment, patient's goals ICF: Outcomes Pathologies, abilities, limitations Optimize use of systems (sensory, musculoskeletal) and available movement Motor Control patterns/synergies Target the Involved Side Progressive, increased demand and functional use Closed vs. open environment, simple vs. complex, part vs. whole, practice and feedback/knowledge of results Motor Learning Coordination with rehab team, parents/caregivers, and support staff to allow PRINCIPLES OF TREATMENT ▪Plan treatment to prepare the child for functional activity ▪Incorporate child’s own activity in the treatment ▪Use Reflex-inhibiting pattern (RIP) for spastic form of CP. A position that is used to inhibit spasticity by lengthening shortened muscles to reduce spasticity, ▪Give the child sensory experience of more normal movement and postures ▪Facilitate wide ranges of movement in tonus inhibiting pattern (TIP) ▪Facilitate automatic righting, equilibrium and protective reactions NDT INCLUDES NEUROPLASTICITY AS A BASIS HOW THE BRAIN CAN CHANGE AND REORGANIZE ITSELF AND ITS PROCESSES BASED ON PRACTICE AND EXPERIENCE ▪Facilitation of normal postural alignment and movement patterns ▪Accent should be placed on the involved side during developmental and functional activities sensory feedback (manual contact, visual integration, somatosensory reinforcement) is essential to recovering function ▪Treatment includes looking at the whole person and specific functional needs; recovery vs. compensation.  KEY ELEMENT TO APPLYING NDT Cannot impose normal movement on maligned joints Alignment Inhibition, Facilitation, Key points Handling Assisting patients in achieving the Placing appropriate posture ALIGNMENT ▪Base of support - wide, narrow, staggered, asymmetrical ▪Body segment alignment - synergies, compensatory head and trunk position ▪Muscle activation - pattern and timing of movement during functional activities ▪Weight shift - in all planes NDP PRACTICAL APPLICATION ▪Treatment incorporates facilitation and inhibition using key points of control ▪Abnormal tone is always inhibited ▪Normal response are always repeated ▪FACILITATION- is a mean by which movement is made easy, made possible ▪INHIBITION- involves decreasing the use of pathological movements and the effects of tonal dysfunctions on movement ▪Facilitation and inhibition may be used simultaneously and may be applied throughout the session NDT ▪ Focuses on the abilities of the client to carry out efficient postural responses and movement pattern while avoiding abnormal movement pattern ( with therapist help) ▪Principles of NDT encourage ▪Use both side of body ▪Bearing weight on affected side ▪Managing muscle tone MOTOR LEARNING ▪ Motor learning is improved with accurate instruction and feedback. This includes both verbal and nonverbal instruction and feedback, including handling and physical prompting. NDT BASED ON THEORY OF MOTOR LEARNING Handling can play an important role in motor learning, especially during the early phases of learning.  Hands-on guidance is a naturally occurring, motor teaching strategy that influences motor learning and is particularly useful when eliciting specific behavior or when limiting the scope of error in performance aids motor learning.  Physical or verbal guidance during the task can be an effective method for limiting movement errors during the performance of a task and assists the learner through the postural adjustments and movements needed for task completion. NDT Repetition through practice is an important component in motor learning. Activities that are task specific and that the client repeats, both in an NDT therapeutic session and in functional ways in other settings, have a better chance of becoming part of the client’s movement repertoire.  Practicing novel skills, with increasing degrees of challenge, is important to motor learning. NDT- TREATMENT EFFECTIVENESS ▪Therapists must be able to observe normal from abnormal alignment and movement patterns ▪ Therapists must be able to make the functional activities meaningful to the patient ▪ Task specific therapists must be able to select the optimal practice method, feedback, and environment for maximum function and independence ▪Therapists must have stable footwear, good flexibility in lumbar spine and lower extremities for optimal body mechanics during mat activities EVIDENCE- THE LACK OF AN EVIDENCE BASE ▪Effectiveness of NDT and underline the need for intensive application of the treatment. ▪Girolami and Campbell reported on the efficacy of NDT treatment for infants born prematurely and found improved motor control. ▪Critics Novak et al(2013) 1. regarding contracture, high-quality RCTs showed that casting was a superior treatment to NDT. 2. regarding tone reduction, the highest quality evidence suggested that NDT was ineffective for this indication and other evidence shows BTX exists as a highly effective alternative. 3. NDT is time-consuming and expensive for families, and, what is more, a high- quality RCT shows that substantially better functional motor gains are achieved from motor learning than from NDT at equal doses. 4. Novak (2020) NDT is nor effective treatment  EVIDENCED- BASED PRACTICE 14 New Bobath Concept REFERENCES ▪Michielsen , M, Vaughan-Graham J, Holland A, Magri A, Suzuki M (2017): The Bobath concept – A model to illustrate clinical practice. Disability and Rehabilitation Dec 17:1-13. ▪Michielsen M, Vaughan-Graham J, Holland A, Magri A, Suzuki M. (2019). Responding to Comments – The Bobath concept – a model to illustrate clinical practice. Disability and Rehabilitation 41(17):2109-2110. doi: 10.1080/09638288.2019.1606946. Epub 2019 May 9. ▪Raine, S. (2006). Defining the Bobath concept using the Delphi technique. Physiotherapy Research International, 11, 4-13. ▪Raine, S. (2007). The current theoretical assumptions of the Bobath concept as determined by the members of BBTA. Physiotherapy Theory and Practice, 23(3), 137-152. ▪Vaughan-Graham, J., Eustace, C., Brock, K., Swain, E. & Irwin-Carruthers, S. (2009). The Bobath concept in contemporary clinical practice. (Grand Rounds)(Report). Topics in Stroke Rehabilitation, 16(1), 57-68. REFERENCES ▪ https://www.bobath.org.uk/courses ▪https://ibita.org/ ▪https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483668/