NDT is a technique to facilitate the movements which are not present in the Cerebral Palsy children.
Facilitation is a process in which therapist hand gives a direction to the child’s body how to move. In this technique therapist holds the complete control of child’s body weight and the movement. Therapist gives a direction to the body to shifts its COG (Center of Gravity). As the COG shifted to some direction the control over the balance in the child is lost. Therapist should teach the child how to gain control again, by shifting weight to another side. This whole procedure is the part of NDT.
Facilitation is a process in which therapist hand gives a direction to the child’s body how to move. In this technique therapist holds the complete control of child’s body weight and the movement. Therapist gives a direction to the body to shifts its COG (Center of Gravity). As the COG shifted to some direction the control over the balance in the child is lost. Therapist should teach the child how to gain control again, by shifting weight to another side. This whole procedure is the part of NDT.
Equipments used in the NDT are Ball, Bolster, or Table/Bench.
Equipments are to challenge the body weight, to help accommodation the structural deformities of the child. These facilitation techniques are used improve the postural control of the child by challenging the posture.
BOLSTER/ROOSTER: is devices which is used to for prone, sitting and sit to stand facilitating techniques. It should be firm, provides a mobile surface that is easy to control because it rolls predictably front to back when child lies prone or sit on it.
BALL: is the most challenging device for the facilitation techniques. It is not firm because it can move in any direction and the base of support is very less.
There are two type of cerebral palsy according to the tone, Hypertonic and Hypotonic. Facilitation is given according to the tone of child. Hypertonic child is given facilitation techniques to decrease its tone and to improve its posture. Hypotonic is given different facilitation to increase the tone and posture.
First of all we should check the child’s stage and milestones before taking in the NDT.
Neck holding is the first step which should come in the child if it is absent then just facilitate neck extensors to extend the neck. On bolster put child in prone then ask him to hold the neck in extension by facilitating trapezius muscle or taking the shoulders in retraction. On ball put child in creep/crawl positions then the same facilitation done. Facilitation on the spine can also be done to make spine in extension and neck in hold position.
Quadruped position is the next position attends by the child. In this weight bearing on all four limbs is essential. So the power on all four limb must be good. This posture is attended on the ball. We can make it more challenging by rolling the ball so that the COG of the child’s body shifts and the opposite muscles work to prevent a fall.
Pelvic control facilitation techniques can be done on the ball and bolster both. On the bolster we can make child sit and the roll the bolster to shift COG and facilitate muscles to prevent any fall. Like this we can make child sit on the ball and can move ball too to shift the base of support and facilitate muscles. On ball different positions can be attended like cross sitting, kneeling, sitting by legs open wide on ball, sitting and hands are extended and sitting with hand in overhead position. Rankly decrease base of support and increase pelvic control. In all these positions we can facilitate pelvic muscles by rolling ball, shifting base to either side, ask child to reach an object to either side, make base less supportive by tilting ball on opposite side. All these make the muscles work and repetition of this strengthen the muscles.
Neck holding is the first step which should come in the child if it is absent then just facilitate neck extensors to extend the neck. On bolster put child in prone then ask him to hold the neck in extension by facilitating trapezius muscle or taking the shoulders in retraction. On ball put child in creep/crawl positions then the same facilitation done. Facilitation on the spine can also be done to make spine in extension and neck in hold position.
Quadruped position is the next position attends by the child. In this weight bearing on all four limbs is essential. So the power on all four limb must be good. This posture is attended on the ball. We can make it more challenging by rolling the ball so that the COG of the child’s body shifts and the opposite muscles work to prevent a fall.
Pelvic control facilitation techniques can be done on the ball and bolster both. On the bolster we can make child sit and the roll the bolster to shift COG and facilitate muscles to prevent any fall. Like this we can make child sit on the ball and can move ball too to shift the base of support and facilitate muscles. On ball different positions can be attended like cross sitting, kneeling, sitting by legs open wide on ball, sitting and hands are extended and sitting with hand in overhead position. Rankly decrease base of support and increase pelvic control. In all these positions we can facilitate pelvic muscles by rolling ball, shifting base to either side, ask child to reach an object to either side, make base less supportive by tilting ball on opposite side. All these make the muscles work and repetition of this strengthen the muscles.
The main purpose of the NDT is to improve balance with less support. Facilitation technique is more effective then passive movements. Resistive exercises are difficult in cerebral palsy child because they are not so cooperative and not following commands. So the most effective technique is NDT in the cerebral palsy.
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