Neurodevelopment al Approach

Prepared by Name: Ahmad Zaidin Bin Othman Matrix No.: 2009872506

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Neuro = brain function

Definiti on

Development = development of components of movement required for motor control

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Its method is based on hands-on from assessing to treatment of individuals with disturbance of function, movement and postural control due to lesion to the CNS
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Primarily used on CP child and adult CVA

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It is used by both the Occupational Therapist and 4/22/12 Physiotherapist.

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Histor y -It was introduced during the 1940 by the

Bobaths, Karel Bobath a physician and Berta Bobath, a gymnast cum physical therapist.
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It was first developed to improve motor behavior in individuals with CP, while decreasing secondary contractures such as deformity. The theories of Bobath technique is that by giving typical movement patterns to child with 4/22/12 their CP brain would
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Assumpti Foundation skill should be remediated on first.

Normal movement is learned through experiencing what normal movement feels like. Postural control or stability is essential for movement. Normal movement requires normal muscle tone.
4/22/12 Central programs in the brain can be

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Traditional Bobath Neglect the concept of traditional Concept compensatory training.

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Neglect the affected side of hemiplegic in functional role. Passive stretching and exercise only address problem of abnormal tone and co-ordination. Neglect the Brunnstrom technique.
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Bobath Concepts Normal and abnormal motor patterns

and muscular synergies are group of muscles that respond together to create total flexion or extension of limb.
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Postural reflexes and reactions is involuntary, stereotyped responses to a stimulus related to the position of the head or body to gravity. Muscle tone is the slight degree of contraction that muscle maintain when 4/22/12 inactive.

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Normal moveme nt

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Retrain normal movement responses on the patients hemiplegic side. Avoid activities and exercises that increase abnormal tone or movement. Use treatment activities and exercises that encourage or 4/22/12 strengthen normal movement

Principl es

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4) Help patient use existing motor control on hemiplegic side for occupational performance. 5) Develop compensations and adaptations that encourage use of the affected side and decrease development of abnormal movements and asymmetrical postures.
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Evaluation
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Muscle tone Postural reflexes and reaction Motor patterns and synergies
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Done through:
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Observation Handling Interview patient

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1) Muscle Observation: Tone

Whether patient demonstrates abnormal tone Handling: 1) Placing Response:

patient will actively assists during passive movement when movement control is present. If therapist stop the movement briefly 4/22/12

2) Associated Reaction: involuntary, nonfunctional changes in limb position and muscles. also occurs during yawn or sneezes. for hemiplegic patient, their hemiplegic arm is in a flexed position when the patient walks It is linked to postural control, 4/22/12 once balance is regained it will

Important in maintaining posture, balance and equilibrium, and positioning.

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2) Postural Reaction

Position the body against gravity.

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Keep the body mass over 4/22/12 base of support.

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Difficulty shifting weight

Difficulty maintaining control against gravity

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Activating equilibrium responses Asymmetrical posture

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3) Motor Patterns and Synergies

Abnormal condition, motor patterns and synergies present in greater or lesser amounts than expected.
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For hemiplegic patient, motor patterns are poor because synergistic muscle are weak to contribute the movement.
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They need to pay full attention and effort to produce movement on affected side.
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- Normal movement can be achieved when: - normal muscle tone is present - normal postural reaction and reflexes are present - normal motor patterns and synergies.
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4) Functional Performance

Example of normal movement are: - Walking 4/22/12 - Carrying object

Loss ability to coordinate both side of body.

Loss ability to perform gross motor activity

Difficult performing functional task

Dependence in doing self-care, vocational, or recreation activities

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Treatment To determine abnormal patterns such as Goals posture, and hypertone, asymmetrical
weak synergistic movements. (INHIBITION technique) To decide normal movements components such as coordinated movement at the involved and two side of the body. (FACILITATION technique) To improve functional use of involved side to decrease compensation and adaptive equipment.
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Inhibition Technique Used to decrease spasticity

Function of inhibition technique: - To correct alignment - To lengthen or shorten muscle - Decrease abnormal muscle4/22/12 tone
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Technique used in Inhibition:

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Reflex-inhibiting patterns (RIP) Scapula mobilization Trunk rotation Weight bearing Lengthen muscles and realign joint
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Reflex-inhibiting patterns (RIP): Flexor spasticity in the arm is located in the shoulder elevators and internal rotators and elbow, wrist, and finger flexors.
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It is inhibited with RIP that includes, shoulder girdle depression and shoulder external rotation, elbow and wrist extension, and open hand.
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Lengthen Muscles and Realign Joint: Therapist places hemiplegic arm in extended position that maintain passive length in flexor muscle of the arm and hold position while facilitating normal movement response.
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The arm will not resist moving into RIP if there is no or little spasticity.
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4/22/12 Precaution should be taken when

Scapula mobilization: Used to reposition the scapula. -Lengthen tight muscle around shoulder girdle.
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Trunk Rotation: Rotational movement of spine to decrease spasticity.

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Weight Bearing: Used to elongate soft tissue structures and minimize flexion or extension synergies in 4/22/12
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Facilitation Technique
It is used to:
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Provide sensation of normal movement on hemiplegic side Train normal movement pattern. Activate normal postural response and trunk control. Teach ways to incorporate involved side into functional task and 4/22/12

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-The therapist use light contact with correct key point of control and manually assist the patients movement pattern. -This will minimize the learning of abnormal movement by allowing patient practice normal 4/22/12

Weight-Bearing: Patient is taught to activate muscle in trunk by moving body weight over stable arm .

This will produce changes in the position of hemiplegic arm, actively lengthening and shortening muscles.

It begins with first, teaching patient to accept weight on the hemiplegic arm with forearms on a table.

Extended elbow weight bearing is more difficult because it requires control of the elbow and wrist joints as well as control of the trunk and shoulder girdle.

Extended elbow weight bearing are done with the

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Selective Arm Movements: Used to: i) Give patient sensation of normal movement ii) teach normal patterns of initiation and sequencing iii) reeducate and strengthen normal movement for function.
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Move the patients arm in normal pattern. Patient is encouraged to assist with the movement.
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Key Point of Control physical The key point is place of

contact between therapist part of body and clients body. Proximal key point: - Located closer to source of problem usually the head, trunk or large joint. -Used to influence posture and movement in all three planes, especially during difficult movement. (in acute or 4/22/12 flaccid stage)

Distal Key Point: - Located away from source of problem such as the hand and foot. - It is used to allow client to engage in activities with minimal control of therapist.
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Compensation -Used to: Training

Incorporate involved arm into activity. Increase or maintain trunk symmetry.

Prevent spasticity and abnormal coordination at affected side

-When patient cannot move hemiplegic side, clasped-hand grip are used.
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Clasped-Hand Grip: Maintain hemiplegic forearm in midposition

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Wrist in extension

Move the arm forward with elbow extension

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Avoiding pattern of flexor spasticity

Patient who have difficulty may grasp 4/22/12 the ulnar side of the hemiplegic wrist
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Motor learning theorist has critized that handling technique in NDT is too passive and lacking in opportunities for independent practice.
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Limitatio n

B. Bobath emphasis on movement quality has resulted a perception where, patients should not be encouraged to move independently until they are able to use normal patterns of muscle activation.
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This limit the patients functional recovery. 4/22/12

Referen Crepeau, E. B., Cohn, E. S., & Schell, B. A. (2003). ce Willard & Spackman's Occupational Therapy.
Pennsylvania: Lippincott Williams & Wilkins. Kielhofner, G. (2004). Conceptual Foundations of Occupational Therapy 3rd Edition. Philadelphia: F. A. Davis Company. Pendleton, H. M., & Schultz-Krohn, W. (2006). PEDRETTI"S OCCUPATIONAL THERAPY: Practice Skills for Physical Dysfunction 6th Edition. Missouri: MOSBY ELSEVIER. Reed, L. R., & Sanderson, S. N. (1999). Concepts of Occupational Therapy Fourth Edition. Maryland: 4/22/12 Lippincott Williams & Wilkins.

Thank You! Question and Answer Session

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