Neurodevelopmental Treatment Approach in Cerebral Palsy

By Dr. Madahvi Kelapure.B.Pt.H. C/NDT (ped). Paediatric Physiotherapist

Parents of children with special needs are always faced by multitude of questions. Why is my child not able to move like other children? Why did this problem occur? Will this problem increase further? Will he be cured? When will my child start walking? What can I do as a parent to aid his development? Once the diagnosis of Cerebral Palsy is made, first and foremost recommendation to the parents is Physical therapy. Cerebral Palsy is a condition which occurs due to insult to an immature brain, where the child has difficulty to coordinate the movements of body and control his/her posture. It is important to notice that, although the lesion in brain is permanent and will not change, the consequences of the lesion do change over a period of time as the child grows. Physical therapy program is directed to make the child as independent as possible. Over years, there have been advances in the field of physical therapy for children with Cerebral Palsy. At present, Neurodevelopmental Treatment Approach is the most commonly used model of treatment for children with Cerebral Palsy. The approach is unique by the virtue that it looks at the child as a 'whole'. That means the treatment is directed not only towards physical independence, but it also targets child's emotional, social, sensory, perceptual aspects so that he or she becomes an active member of the society and can fulfil his duties like any other individual. Treatment by the approach does not stop at achieving physical improvement; but assures that the child is able to use the same to accomplish his age- appropriate roles e.g. a 4 years old child is expected to eat by self, play with toys indoors and outdoors, attend school so on and so forth... All these deeds are called as 'functional activities' and the ultimate goal of NDT is to optimize these functional activities. For convenience, this treatment is divided into three specialities. Physical therapists, Occupational therapists and Speech & Language therapists, all provide a NDT based treatment intervention. Physical therapists (PT) target the child's 'gross motor' abilities. i.e. to be able to sit, stand, walk; to be able to transfer self from floor to chair/car and vice versa so on and so forth. A program of Occupational therapy (OT) based on NDT helps to improve 'fine motor' function, i.e. the ability to use hand to hold and manipulate different objects, toys, crayon etc. OT also helps to improve quality of eye function, sensation and perception. OT also trains the child for Activities of Daily Living (ADLs) like bathing, dressing, feeding etc. Speech and Language therapists work towards quality of breathing, phonation, eating, drinking which are important for development of speech. Therapists have to undergo intensive training to become NDTA certified. How exactly these therapists work? It commences by evaluation of child's functional abilities and impairments. Interview with the parents yields a whole lot of important information about the child. Evaluation also specifies the way child is able to move, noting the wrong posture and movement patterns. NDT approach relates these posture and movement patterns to specific system impairments. E.g. if the child is walking on his toes with knees touching each other and he trips and falls often, then evaluation analyses its probable causes like, increased stiffness in leg muscles, difficulty to generate force in the muscles, difficulty to relax one muscle group while the other is active, not able to use his eyes well; so on and so forth. All these jobs are assigned to different systems in our bodies like musculoskeletal system, neuromuscular system and sensory systems. In treatment, strategies are targeted towards these systems in order to improve the postural control and movement coordination so that, at the end of treatment session, the child is able to walk in a near normal pattern without falling off frequently. The goal of treatment is often decided jointly by the parents and therapists and the child whenever he is able to take part in decision making. Goal is often the 'just right' challenge for the child. Evaluation and treatment goes hand in hand. Therapists often use manual handling during treatment to guide active movement from the child. They make use of adaptive equipments like balls, bolsters, benches etc to make the movement easy for the child. Therapist always creates a situation where the activity is made meaningful, safe and enjoyable to the child so that he feels an urge to move. Thus, treatment is a close interplay between the child and therapist.

Repetition is important for learning a new movement and the therapist gradually decreases her control so that the child is required the 'take over'. Thus the child 'owns' newly learnt movement. To achieve the set goals, it is very essential that there is a 'carry over' of the change made during treatment to the home environment. For this, guiding and training parents/ caregivers during treatment, is very important. This happens when there is a mutual communication and rapport between the therapist and mother. Also, therapist always takes into account the personal factors of the child, what are the facilitators and barriers, the cultural and family background and respects the situation and capabilities of the family. Treatment session generally lasts for an hour and the frequency is decided according to the problems of the child. A severely involved child will benefit from 5 days a week treatment sessions where as for a mildly involved child, twice a week could be sufficient. A home management program is always given to the parents, so that whatever the child does throughout the day happens in a therapeutic way. To conclude, although NDT approach cannot 'cure' your child with Cerebral Palsy, but it assures improved quality of life by optimizing function.

FAQ Find your Doctor Physiotherapy Programmes Call Us Call Us BOTOX