Articles that support NDT core values and are of relevance to NDT clinicians

Leech KA, Roemmich RT, Gordon J, Reisman DS, Cherry-Allent KM. Updates in Motor Learning: Implications for Physical Therapist Practice and Education. Physical Therapy. 2022; 102(1)://doi.org/10.1093/ptj/pzab250 E I

Abstract

Over the past 3 decades, the volume of human motor learning research has grown enormously. As such, the understanding of motor learning (ie, sustained change in motor behavior) has evolved. It has been learned that there are multiple mechanisms through which motor learning occurs, each with distinctive features. These mechanisms include use-dependent, instructive, reinforcement, and sensorimotor adaptation-based motor learning. It is now understood that these different motor learning mechanisms contribute in parallel or in isolation to drive desired changes in movement, and each mechanism is thought to be governed by distinct neural substrates. This expanded understanding of motor learning mechanisms has important implications for physical therapy. It has the potential to facilitate the development of new, more precise treatment approaches that physical therapists can leverage to improve human movement. This Perspective describes scientific advancements related to human motor learning mechanisms and discusses the practical implications of this work for physical therapist practice and education.

The discussion from the journal club reenforced on how Neurodevelopmental Treatment (NDT) weaves motor learning science into clinical practice.

In NDT, evidence-informed care drives our clinical reasoning — we just discussed how NDT incorporates these motor learning pathways:

• Use-dependent motor learning: NDT treatment sessions focus on 1 or 2 more efficient movements to provide enough practice so that future repetitions become more like the practiced movement.
• Instructive motor learning: NDT therapists use clear cues and feedback to guide the learner toward more efficient movement strategies.
• Reinforcement motor learning: NDT therapists develop activities that provide that “just right” challenge, allowing the learner to explore efficient movement and experience success.
• Sensorimotor adaptation-based motor learning: NDT therapists adjust the sensory input, environment, and/or task demands so a more efficient movement becomes more flexible and resilient.

NDT treatment sessions become active problem-solving labs where clients practice, adapt, and own their movement — building skills that carry over into real life at home, work, and in the community. We are grateful for colleagues who dig into the science so we can deliver more intentional, evidence-aligned care.

Articles of Interest

Krishna S, Narayan A, Karnad SD, Alsulaimani M. Relationship Between Postural Control, Quality of Upper Limb Skills, and Functional Independence in Children with Cerebral Palsy: A Cross-Sectional Study. Phys Occup Ther Pediatr. 2026 Jan 22:1-14. doi: 10.1080/01942638.2026.2614584. Epub ahead of print. PMID: 41571315.

Abstract

Aim: To evaluate the relationship between postural control, quality of upper limb skills, and functional independence in children with cerebral palsy (CP).

Methods: This cross-sectional study included 36 children (aged 3-8 years; GMFCS I-V and MACS I-V) with CP. Postural control was assessed using the Early Clinical Assessment of Balance (ECAB), upper limb (UL) skills by Quality of Upper Extremity Skills Test (QUEST), and functional independence through Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT, DA domain). Spearman's correlation and multiple linear regression were used for analysis (α = 0.05).

Results: Strong positive correlations were found between ECAB and QUEST (ρ = 0.823, p < 0.001), ECAB and PEDI-CAT (ρ = 0.781, p < 0.01), and QUEST and PEDI-CAT (ρ = 0.872, p < 0.001). Regression models explained 69.3% of the variance in PEDI-CAT and 73.6% in QUEST scores. Multiple linear regression was significant only for the MACS to predict the functional independence (PEDI-CAT) and upper limb skills (QUEST).

Conclusion: Postural control significantly correlates with both the UL skills and functional independence in children with CP.

Steinbusch CVM, Defesche A, van der Leij B, Rameckers EAA, Knijnenburg ACS, Vermeulen JRJ, Janssen-Potten YJM. The Effect of Bimanual Intensive Functional Training on Somatosensory Hand Function in Children with Unilateral Spastic Cerebral Palsy: An Observational Study. J Clin Med. 2023 Feb 17;12(4):1595. doi: 10.3390/jcm12041595. PMID: 36836129; PMCID: PMC9960591.

Abstract

(1) Background: Next to motor impairments, children with unilateral spastic cerebral palsy (CP) often experience sensory impairments. Intensive bimanual training is well known for improving motor abilities, though its effect on sensory impairments is less known. (2) Objective: To investigate whether bimanual intensive functional therapy without using enriched sensory materials improves somatosensory hand function. (3) Methods: A total of twenty-four participants with CP (12-17 years of age) received 80-90 h of intensive functional training aimed at improving bimanual performance in daily life. Somatosensory hand function was measured before training, directly after training, and at six months follow-up. Outcome measures were: proprioception, measured by thumb and wrist position tasks and thumb localization tasks; vibration sensation; tactile perception; and stereognosis. (4) Results: Next to improving on their individual treatment goals, after training, participants also showed significant improvements in the perception of thumb and wrist position, vibration sensation, tactile perception, and stereognosis of the more affected hand. Improvements were retained at six months follow-up. Conversely, proprioception measured by the thumb localization tasks did not improve after training. (5) Conclusions: Intensive functional bimanual training without environmental tactile enrichment may improve the somatosensory function of the more affected hand in children with unilateral spastic CP.

Jack SM, Phoenix M. Qualitative health research in the fields of developmental medicine and child neurology. Dev Med Child Neurol. 2022 Jul;64(7):830-839. doi: 10.1111/dmcn.15182. Epub 2022 Feb 13. PMID: 35156198.

Abstract

This invited review introduces the principles of qualitative health research (QHR) to the fields of developmental medicine and child neurology to facilitate the conduct of applied qualitative research. It provides practical guidance on how to write a study purpose statement aligned with the foci of QHR and then articulate an overarching research question using the Emphasis-Purposeful sample-Phenomenon of interest-Context framework. Guidance for health researchers on how to select a study design that aligns with the practice, education, or policy goals of applied QHR is provided. This is followed by strategies to guide decision-making with respect to purposeful sampling, selecting data collection methods, and identifying the most appropriate analytic approach to code and synthesize the data. Findings from QHR studies can be used conceptually or instrumentally to provide new insights or inform decisions within the discipline of developmental medicine and child neurology. While qualitive findings are increasingly valued in the field, designing studies that demonstrate methodological congruence is one strategy to improve the overall quality and trustworthiness of discipline specific QHR.

Kolaski K, Romeiser Logan L, Goss KD, Butler C. Quality appraisal of systematic reviews of interventions for children with cerebral palsy reveals critically low confidence. Dev Med Child Neurol. 2021 Nov;63(11):1316-1326. doi: 10.1111/dmcn.14949. Epub 2021 Jun 6. PMID: 34091900.

Abstract

Aim: To evaluate the methodological quality of recent systematic reviews of interventions for children with cerebral palsy in order to determine the level of confidence in the reviews' conclusions.

Method: A comprehensive search of 22 databases identified eligible systematic reviews with and without meta-analysis published worldwide from 2015 to 2019. We independently extracted data and used A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2) to appraise methodological quality.

Results: Eighty-three systematic reviews met strict eligibility criteria. Most were from Europe and Latin America and reported on rehabilitative interventions. AMSTAR-2 appraisal found critically low confidence in 88% (n=73) because of multiple and varied deficiencies. Only 7% (n=6) had no AMSTAR-2 critical domain deficiency. The number of systematic reviews increased fivefold from 2015 to 2019; however, quality did not improve over time.

Interpretation: Most of these systematic reviews are considered unreliable according to AMSTAR-2. Current recommendations for treating children with CP based on these flawed systematic reviews need re-evaluation. Findings are comparable to reports from other areas of medicine, despite the general perception that systematic reviews are high-level evidence. The required use of current widely accepted guidance for conducting and reporting systematic reviews by authors, peer reviewers, and editors is critical to ensure reliable, unbiased, and transparent systematic reviews. What this paper adds Confidence was critically low in the conclusions of 88% of systematic reviews about interventions for children with cerebral palsy (CP). Quality issues in the sample were not limited to systematic reviews of non-randomized trials, or to those about certain populations of CP or interventions. The inclusion of meta-analysis did not improve the level of confidence in these systematic reviews. Numbers of systematic reviews on this topic increased over the 5 search years but their methodological quality did not improve.

Rodby-Bousquet E, Alriksson-Schmidt A, Jarl J. Prevalence of pain and interference with daily activities and sleep in adults with cerebral palsy. Dev Med Child Neurol. 2021 Jan;63(1):60-67. doi: 10.1111/dmcn.14678. Epub 2020 Sep 19. PMID: 32951227; PMCID: PMC7756851.

Abstract

Aim: To analyse the prevalence of pain, pain sites, pain severity, and pain interfering with work or daily activities and sleep in adults with cerebral palsy (CP).

Method: This was a cross-sectional study based on data from 1591 adults (16-76y, median age 25y; 879 males, 712 females; Communication Function Classification System [CFCS] levels I-V) in the Swedish Cerebral Palsy Follow-up Program. Pain severity was rated for several body sites and pain interference with activities/work and sleep was also evaluated. Logistic regression was used to estimate the odds ratios (ORs) of the factors associated with the prevalence of pain and pain interfering with activities/work or sleep.

Results: Pain was reported in 1059 of 1591 adults; a higher proportion self-reported pain (69.9%) compared to proxy-reported pain (62.4%). More adults classified in CFCS level I (72.5%) reported pain compared to those in CFCS levels II to V (56.5-64.9%). Adults with severe/very severe pain had a sixfold risk of pain interfering with activity/work (OR=6.68; 95% CI 4.99-8.96) and sleep (OR=6.60; 95% CI 4.84-8.98).

Interpretation: Two-thirds of adults with CP experienced pain, which is likely to be underreported in individuals who do not communicate efficiently or rely on proxy reports. Pain strongly interfered with activities and sleep; thus, it must be assessed and treated more effectively.

FOOD FOR THOUGHT:

This article from Sweden looked at the prevalence of pain report for adults with cerebral palsy (CP). Sixty seven percent of the respondents reported pain. The adults with CP in this study reported pain that often negatively impacted their ability for activity/work and sleep. Interestingly, pain was reported more by self-report versus for those adults who rely on proxy reports, leading the authors to ponder if pain is under reported for those adults who do not communicate efficiently. As providers, how might we help to alleviate the incidence of pain for adults with CP?