A thorough examination and evaluation is the basis for treatment. The examination begins with the identification of an individual’s abilities and limitations. The NDT approach considers the individual as a whole and recognizes that every expression of the person—psychological, emotional, cognitive, perceptual, and physical—has value and contributes to the overall level of function. This examination focuses on identifying functions and their limitations. Evaluation analyzes and prioritizes the effectiveness of posture and movement and hypothesizes which systems affect function. Examination and evaluation lead to the establishment of treatment goals and the development of treatment strategies commensurate with the individual’s current needs, while aiming for the long-term outcome of achieving the best possible inclusion in society across the life span.

The NDT clinician's understanding of typical movement and how it changes across the life span provides a critical framework for treatment planning. In addition, the clinician must anticipate the progression of atypical postures and movements and understand how they develop from limited neuronal repertoires, the individual’s unique movement experiences, and the attempt to compensate with stereotyped movement strategies. The clinician plans treatment in partnership with the client and meaningful persons in the individual’s life. Implementation of treatment depends on the examination and evaluation outcomes, the client’s competencies and integrity, and the limitations of the multiple internal systems and external resources. The clinician constantly guides and modifies treatment according to the individual’s response to the selected strategies.

Therapeutic handling is integral to the NDT approach. It is an essential tool in both examination and treatment. Therapeutic handling allows the therapist to (a) feel the client’s response to changes in posture or movement, (b) facilitate postural control and movement synergies that broaden the client’s options for selecting successful actions, (c) provide boundaries for movements that distract from the goal, and (d) inhibit or constrain those motor patterns that, if practiced, lead to secondary deformities, further disability, or decreased participation in society.

The clinician selects an appropriate model of service and delivery of intervention that will fit the client’s lifestyle, then helps to integrate the activities developed in treatment into the client’s daily life to broaden the contexts for active carryover, which is essential for motor learning, requires practice by the client throughout the day, independently or with caregivers.

As a result of NDT intervention, the individual will use the new or regained posture or movement strategies to carry out life skills more efficiently. These strategies will minimize secondary impairments that can create additional functional limitations or disability

The NDT approach continues to be enriched as new information, new theories, and new models consistent with available clinical evidence emerge in the movement sciences. In addition, as the characteristics of the populations with CNS pathophysiology change, the approach will continue to evolve to meet their needs.

Excerpt from "Neuro-Developmental Treatment Approach: Theoretical Foundations and Principles of Clinical Practice" by Janet M Howle (in collaboration with the NDTA Theory Committee Copyright 2002.)

An Early Motor Delay occurs when a child isn't able to meet critical physical milestones in the first months and years of life, which can later affect a child's ability to learn basic skills such as chewing, grasping, crawling, standing and walking. Tummy time - supervised awake time babies spend on their stomachs - can help prevent Early Motor Delays. The survey was conducted by Pathways Awareness, a national not-for-profit that educates parents and medical professionals about the benefits of early intervention for children who show development delays. With assistance from the Neuro-Developmental Treatment Association (NDTA) and the Pediatric Section of the American Physical Therapy Association (APTA), more than 400 occupational, speech and physical therapists who regularly work with pediatric clients and who average more than 20 years of experience participated in the survey.

"This survey quantifies the observations that my colleagues and I have been discussing for years," said Gay Girolami, physical therapist and member of the Pathways Awareness Medical Round Table. "We noticed that not only were we seeing more children coming to therapy with Early Motor Delays, but that these delays were clearly related to the fact that they were spending too much time on their backs. The next step is to educate parents and medical professionals about the easy ways they can introduce tummy time to newborns."

Backsleeping, "Container" Lifestyle May Contribute

The vast majority of babies now sleep on their backs to prevent Sudden Infant Death Syndrome (SIDS). Back-sleeping, coupled with more awake time in "containers" like car seats, bouncers and strollers, add up to so much back time that babies aren't able to develop their neck and back muscles, contributing to the increase in Early Motor Delays.

Each year more than 400,000 children in the U.S. are at risk for an Early Motor Delay, and actual incidences are one in 40, a 150 percent increase from 25 years ago, a rate even higher than incidences of other accelerating conditions like autism.(1) While previous studies have linked lack of tummy time to Early Motor Delays,(2) the survey by Pathways does not definitively identify lack of tummy time as the cause of the increase in Early Motor Delays. Rather, the survey quantifies experienced observations by qualified professionals, which may serve as a hypothesis for a future scientifically controlled study on the rate of increase and causes of Early Motor Delays. In addition to back-sleeping and lack of tummy time, the increase may also be caused by factors such as a higher survival rate of preterm babies, increased numbers of twins and triplets (who may be crowded in the uterus) and increased survival of children with cardiac, neurological and genetic disorders.

Survey Methodology and Results

The Web-based survey was conducted between February and May 2008 by Pathways Awareness. Respondents were 409 highly qualified physical and occupational therapists who belong to APTA or NDTA, who work with pediatric clients on a regular basis and who average more than 20 years of experience. All results reported are significant at the 95 percent confidence level.

-- Two-thirds of therapists (66 percent) reported that they had observed an increase in Early Motor Delays in babies under six months in the past several years.

-- Of therapists noting an increase in Early Motor Delays, the vast majority named lack of tummy time while awake as the number-one reason for the increase in Early Motor Delays (84 percent), followed by the increase in premature births (59 percent) and back sleeping (54 percent).

-- Nearly two-thirds (61 percent) of all respondents thought that Early Motor Delays could be caused or exacerbated by back sleeping, and 77 percent had observed Early Motor Delay cases that could be attributed to babies spending extensive time on their backs while they were awake (in car seats, bouncers, etc.)

-- Therapists observed that most parents have little or no understanding of tummy time (70 percent).

-- The majority of therapists who observed an increase in Early Motor Delays noticed this phenomenon starting within the past six years: most observed an increase starting 4-6 years ago (44 percent) followed by 0-3 years ago (34 percent).

What Parents Can Do

If parents have concerns about their child's development, visuals, including a growth and development chart and more information about developmental warning signs, are also available on the Pathways Web site, www.pathwaysawareness.org and by calling Pathways' "parent answered" help line, 1-800-955-CHILD (2445). The development chart has been endorsed by the American Academy of Pediatrics and the National Association of Pediatric Nurse Practitioners.

About Pathways Awareness

About the Neuro-Developmental Treatment Association (NDTA™)

About the American Physical Therapy Association

(1) Statistics compiled by the Pathways Awareness Medical Round Table from a variety of sources, including the March of Dimes, Pediatrics Annual Summary of Vital Statistics, and the Centers for Disease Control and Prevention

(2) Influence of supine sleep positioning on early motor milestone acquisition. Dev Med Child Neurol. 2005; 47(6):370-6; discussion 364 (ISSN: 0012-1622)

Survey data and graphics available

SOURCE: Pathways Awareness
for Pathways Awareness
Erika Gimbel, (312) 670-1200
egimbel@hydeparkgroup.com

Copyright Business Wire 2008

Our Mission:

Neuro-Developmental Treatment (NDT) is an advanced therapeutic approach practiced by experienced Occupational Therapists, Physical Therapists, and Speech - Language Pathologists.

This hands-on approach is used in working with people who have central nervous system insults that create difficulties in controlling movement.

Therapists using NDT treatment have completed advanced training in NDT and work closely with individuals with neurological challenges (e.g. cerebral palsy, stroke, head injury), helping them to become as independent as possible. NDT-trained therapists work collaboratively with individuals, family, caregivers and physicians to develop comprehensive treatment programs based on the principles of human neurology and physiology. Individuals who have minimal to severe motor difficulties can benefit from the NDT approach.

The NDTA™ furthers the development of this unique approach by offering continuing education to the membership, providing educational services to the community, supporting clinical research and promoting client and family advocacy.

The official language for all NDTA™ publications is English.