NEURO-DEVELOPMENTAL TREATMENT
CORE PRINCIPLES
Neuro-Developmental Treatment (NDT) is a multi-faceted, interactive practice model used by occupational therapists, physical therapists and speech-language pathologists for patients with neurological diagnoses across their lifespans. It focuses on dynamic patient engagement, continuous evaluation and modification based on comprehensive movement analysis. NDT aims for long-term, positive neuroplastic changes and functional independence for fuller participation in life; and incorporates advanced handling strategies and evidence-informed practices that exceed standard therapy methods. NDT distinguishes itself from traditional therapy approaches through an integrated method that draws from patient strengths while combining functional and impairment-specific interventions.
The core principles of NDT encompass:
PATIENT-CENTERED EXAMINATION, EVALUATION AND INTERVENTION
Key Features
Practitioners apply the International Classification of Functioning, Disability and Health (ICF) enablement model when conducting dynamic evaluation and intervention.
Details
We conduct a comprehensive examination of participation, activities, body structures and functions and their interactions, including contextual and environmental influences, as the means to enhance motor control and meaningful task performance. Patients are actively engaged within the constructs of a task and the environment, and we continuously evaluate and modify strategies to integrate functional capabilities and limitations, fostering positive neuroplasticity for function.
IN-DEPTH ANALYSIS OF MOVEMENT WITHIN THE CONTEXT OF FUNCTION
Key Features
Practitioners perform comprehensive observation and analysis of movement, focusing on motor control, postural control and environmental facilitators and barriers, all of which help guide targeted intervention.
Details
We examine posture, base of support and anticipatory adjustments while continuously analyzing movement during task performance. Skilled handling allows us to understand patient movement strategies by focusing on the interactions among body segments and systems to enhance functional outcomes.
PATIENT-GENERATED GOALS DRIVE THE INTERVENTION PROCESS
Key Features
Practitioners actively engage patients to enhance motivation and congruity, ensuring the success of interventions and the achievement of personalized goals.
Details
We develop and modify interventions driven by specific, meaningful patient and family/caregiver goals to enhance future functionality. The focus is on optimizing efficiency and minimizing cognitive burden while ensuring active patient responsiveness throughout the therapeutic process.
DESIGN AND IMPLEMENT A PLAN OF CARE
Key Features
Practitioners carefully evaluate examination findings and implement clinical decision-making and reasoning to design and execute a plan of care. The functionally based session plan sequences strategies to appropriately challenge the patient and build skills.
Details
We create and implement each patient’s plan of care by synthesizing multiple variables from ongoing evaluation. Strategies are developed that are unique to and within the context of the patient’s desired outcome and available resources. Utilizing a dynamic therapeutic environment, functional goals and impairments are concurrently addressed. The therapeutic challenge is adapted and progresses within the session based on patient response and feedback.
THERAPEUTIC HANDLING TO ENHANCE FUNCTIONAL OUTCOMES
Key Features
Practitioners use hands-on strategies to discern, guide and facilitate optimal movement and to promote positive neuroplastic changes.
Details
Using intentional, skilled and dynamic handling strategies, we strive for functional independence and participation. This therapeutic handling allows us to assess and respond to patient-initiated movements; to provide precise, targeted input; and to improve motor control, postural control and movement efficiency. Intervention is guided by handling to limit negative neuroplastic changes and to provide a solid foundation for future skill development.
MINIMIZE LONG-TERM IMPLICATIONS OF COMPENSATION
Key Features
Practitioners focus on reducing the need for compensatory strategies by promoting optimal movement to enhance participation and limit the influence of underlying impairments.
Details
We facilitate alignment and efficient movement while inhibiting atypical strategies. Our focus is on minimizing long-term impairments by addressing malalignments and reducing compensatory movements to prevent future functional deficits.
PROMOTE SKILL ACQUISITION AND RETENTION
Key Features
Practitioners support carryover and independence in activities and participation salient to the individual.
Details
We foster independence during and between sessions by continuously adjusting to the patient’s evolving needs. This is accomplished through tailored task expectations, modification of environmental variables, skilled grading and withdrawal of therapeutic handling. Principles of motor learning are embedded within intervention, focusing on practice, intrinsic feedback and patient-generated error detection. Comprehensive education, recommendations for continued progress including patient-specific home programs and appropriate use of equipment, and active caregiver involvement all reinforce therapeutic gains to support long-term functional outcomes.
EVIDENCE-INFORMED CARE DRIVES CLINICAL REASONING
Key Features
Practitioners use peer-reviewed research in conjunction with clinician expertise and patient preference to inform practice.
Details
We apply an in-depth understanding of the literature from diverse fields of study to support the clinical decision-making and reasoning process.
NDT Core Principles Task Force
Karen Brunton, PT, C/NDT, Chris Cayo, OTR/L, C/NDT, Monica Diamond, PT, MS, NCS, Mary Rose Franjoine, PT, DPT, MS, PCS , C/NDT, Cathy Hazzard, PT, C/NDT, Vinita Jobes, OTD, LOT, C/NDT, Therese McDermott, CScD, CCC-SLP,C/NDT, Jodi Renard, PT, DPT, CBIS, C/NDT, Liz Ridgway, OTR/L, OTD, C/NDT, Teresa Siebold, PT, C/NDT, Carol Terilli, PT, DPT, C/NDT