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Neurodevelopmental Techniques in Paediatric Rehabilitation

Original Editor -Rajshri Suryavanshi

Top Contributors - Rajshri Suryavanshi, Rucha Gadgil and Kim Jackson  

Introduction

kids playing

Neurodevelopmental techniques (NDT) play a crucial role in paediatric physiotherapy, focusing on enhancing motor control, postural alignment, and functional movement in children with neurodevelopmental disorders. These techniques are grounded in the understanding of how children develop and learn to move, aiming to facilitate optimal movement patterns through therapeutic intervention. These techniques focus on the relationship between motor skills and the underlying neurological processes that support them.

Key Principles of Neurodevelopmental Techniques

The principles are as follows:[1][2]

  1. Individualised Assessment: Each child presents unique challenges; therefore, comprehensive assessments are essential to tailor interventions. Clinicians evaluate motor skills, muscle tone, and sensory processing.[3]
  2. Facilitating Movement: Techniques such as handling and positioning are utilised to facilitate proper movement patterns. This includes providing support to encourage the child to engage in movement tasks they find challenging, allowing for the child’s exploration of movement. Active Participation Encourages active engagement from the child helps promote independence and motivation during therapy sessions[4].
  3. Normalisation of Tone: Techniques aim to adjust abnormal muscle tone, whether too high (spasticity) or too low (flaccidity), to facilitate smoother movements.[5]
  4. Promoting Functionality: The ultimate goal of NDT is to enhance functional independence. Therapy often incorporates play and daily activities to motivate children and make sessions enjoyable and relevant to the child’s life. Emphasis is placed on achieving meaningful, functional movements that support daily activities, rather than just improving isolated motor skills[6].
  5. Incorporating Sensory Input: Utilising various sensory modalities can enhance the child’s awareness of their body and environment, helping to refine motor skills.[7]
  6. Holistic Approach: NDT considers the whole child, including cognitive and physical limitations, to create individualised treatment plans.[8]
  7. Family Involvement: Engaging family members in the therapeutic process is essential. Training parents and caregivers on techniques allows for continued support and practice at home.[9]

Applications

NDT can be considered as solely Bobath approach but recent studies have considered it to be a holistic multidisciplinary model that is widely used in pediatric physical therapy [10]for children. It has shown positive effects on children with various conditions, including cerebral palsy, traumatic brain injuries, Down's Syndrome[7], Movement Dysfunction, Developmental coordination disorders,ADHD and developmental delays,[11] among others. Its focus on functional outcomes makes it a valuable method for enhancing young patients' quality of life and independence. NDT has shown very good outcomes in several conditions.[12][13]

Commonly used techniques

Neurodevelopmental techniques are used to support a variety of pediatric conditions. Here are some key techniques commonly used along with activity suggestions:

  • Bobath Approach (NDT): This method emphasises normalizing movement patterns, improving postural control, and facilitating functional movements through hands-on guidance.[14]Using hands-on guidance to assist movements. Activity: Support the child in rolling from back to stomach by gently guiding their hips and shoulders while they reach for a toy.
  • Sensory Integration Therapy: The sensory integration technique helps children process and respond to sensory information, using activities that challenge their sensory systems to improve motor planning and coordination.[15]. Activity: Create a sensory pathway with different materials (like carpet, foam, and grass) for the child to walk or crawl over, promoting exploration and movement
  • Task-Oriented Training: This approach focuses on meaningful activities that promote functional movement, allowing children to practice skills in context rather than in isolation. Activity: Engage the child in a simple obstacle course where they must navigate around objects, promoting problem-solving and motor skills.[16]
  • Rhythmic Auditory Stimulation: This method uses rhythmic sounds or music to promote movement and timing, particularly helpful in gait training.[17] Activity: Use a variety of sound-making instruments (e.g., tambourines, shakers) or recordings of everyday sounds (like animals or vehicles). Have the child identify the sounds and mimic them.
  • Constraint-Induced Movement Therapy (CIMT): In this technique, the unaffected limb is constrained to encourage the use of the affected limb, promoting motor recovery through intensive practice.[18]
  • Aquatic Therapy: Aquatic therapy utilising the properties of water, this technique provides resistance and support, allowing children to explore movement with less risk of injury.[19]
  • Strengthening and Conditioning: Tailored exercises to enhance muscle strength, endurance, and overall physical fitness, often incorporating play to keep children engaged. Activity: Use a balance board while the child stands and throws or catches a ball, enhancing balance and core engagement.[20]
  • Play-Based Therapy: Incorporating play into therapy to make movements more enjoyable and meaningful, fostering motivation and engagement in exercises[21]. Activity: Use a therapy swing to promote vestibular input while the child plays with hanging toys, enhancing sensory integration and core strength.
  • Visual and Vestibular Stimulation: Activities that enhance coordination, balance, and spatial awareness, are crucial for overall motor development.[22] Activity: Use moving objects (like a ball or a light) to encourage the child to track with their eyes. You can also use toys that require pushing or rolling.
  • Family-Centered Care: Involving family members in therapy sessions to ensure that exercises and strategies can be integrated into daily routines.[23]

These techniques can be tailored to meet individual needs, promoting optimal development and improving the quality of life for children with various conditions.

Multidisciplinary Approach with techniques

Neurodevelopmental techniques are widely used by rehabilitation professionals, including speech therapists[24] and occupational therapists, to support children with developmental challenges. Alongside the above-mentioned techniques, several other techniques are incorporated by rehab professionals in pediatric patients according to their needs. Some of the techniques are:

  • Modeling and Repetition: Therapists model desired behaviours or skills and encourage children to repeat them. For example, in speech therapy, a therapist may model correct pronunciation and encourage the child to mimic.[25]
  • Functional Activities: Engaging children in real-life activities that promote skill development. For instance, using cooking tasks in occupational therapy to practice measuring, following instructions, and enhancing fine motor skills[26].
  • Positioning Techniques: Using proper positioning to facilitate better communication and engagement. This might include adjusting seating arrangements to enhance eye contact and interaction during speech therapy.
  • Environmental Modifications: Altering the environment to support the child's development. This may include reducing distractions or using adaptive equipment to assist with tasks.[27]
  • Joint Attention Activities: Activities that encourage shared focus between the therapist and the child, such as using toys or books that require interaction, to enhance social communication skills.[28]
  • Storytelling and Narrative Therapy: Using stories to develop language skills, comprehension, and social understanding. Therapists may encourage children to create their own stories or retell familiar ones.[29]

Conclusion

Neurodevelopmental techniques in paediatric physiotherapy provide a framework for improving motor skills and functional independence in children with neurodevelopmental challenges. By focusing on individualised care, sensory integration, and active family involvement, therapists can create a supportive environment that fosters growth and development. More information can be found on:

NDTA

Motor Development Principles

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The video explains about NDT

References

  1. ↑ Veličkovíć, T.D. Basic principles of the neurodevelopmental treatment (NDT) - Bobath. Paediatria Croatica, Supplement. 2002. 46. 163-168.
  2. ↑ Zanon MA, Porfírio GJM, Riera R, Martimbianco ALC. Neurodevelopmental treatment approaches for children with cerebral palsy. Cochrane Database Syst Rev. 2018 Aug 3;2018(8):CD011937. doi: 10.1002/14651858.CD011937.pub2. PMCID: PMC6513386.
  3. ↑ Fawcett AL. Principles of assessment and outcome measurement for occupational therapists and physiotherapists: Theory, skills and application. John Wiley & Sons; 2013 Mar 15.
  4. ↑ Udhoji SP, Raghumahanti R, Kovela RK. Effectiveness of dynamic neuromuscular stabilization, neurodevelopmental techniques and proprioceptive neuromuscular facilitation on trunk and gait parameters in patients with subacute stroke: A three-arm parallel randomised clinical trial. F1000Research. 2024 Jan 8;13:29.
  5. ↑ Tekin F, Kavlak E, Cavlak U, Altug F. Effectiveness of Neuro-Developmental Treatment (Bobath Concept) on postural control and balance in Cerebral Palsied children. Journal of back and musculoskeletal rehabilitation. 2018 Jan 1;31(2):397-403.
  6. ↑ Law M, Darrah J, Pollock N, Rosenbaum P, Russell D, Walter SD, Petrenchik T, Wilson B, Wright V. Focus on function–a randomized controlled trial comparing two rehabilitation interventions for young children with cerebral palsy. BMC pediatrics. 2007 Dec;7:1-2.
  7. ↑ 7.0 7.1 Yana M, Kavlak E, Güneş M. Combined sensory integration therapy plus neurodevelopmental therapy (NT) versus NT alone for motor and attention in children with Down syndrome: a randomized controlled trial. International Journal of Developmental Disabilities. 2024 Sep 2;70(5):849-56.
  8. ↑ Mayston MJ, Saloojee GM, Foley SE. The Bobath Clinical Reasoning Framework: A systems science approach to the complexity of neurodevelopmental conditions, including cerebral palsy. Developmental Medicine & Child Neurology. 2024 May;66(5):564-72.
  9. ↑ Shiozu H, Kimura D, Iwanaga R, Kurasawa S. Participation strategies of parents of children with neurodevelopmental disorders: An exploratory study. Children. 2024 Feb 3;11(2):192.
  10. ↑ Lee KH, Park JW, Lee HJ, Nam KY, Park TJ, Kim HJ, Kwon BS. Efficacy of intensive neurodevelopmental treatment for children with developmental delay, with or without cerebral palsy. Annals of rehabilitation medicine. 2017 Feb 28;41(1):90-6.
  11. ↑ Girolami GL, Campbell SK. Efficacy of a neuro-developmental treatment program to improve motor control in infants born prematurely. Pediatric Physical Therapy. 1994 Dec 1;6(4):175-84.
  12. ↑ Howle JM. Neuro-developmental treatment approach: theoretical foundations and principles of clinical practice. NeuroDevelopmental Treatment; 2002.
  13. ↑ Ahmed MM, Al Areefy AA, Alsayegh AA. Does Neurodevelopmental Approach of Physical Therapy Have an Impact on Gross Motor and Cognitive Function of Non-obese Children with Autism Spectrum Disorder (ASD)? A Randomized Controlled Trial. Journal of Disability Research. 2025 Jan 3;4(1):20240120.
  14. ↑ Fatima U, Gondal JI, Liaqat S, Ansar A. The effect of basic physiotherapy interventions along with bobath technique in children with neuro developmental delay. International Journal of Engineering, Science and Mathematics. 2014;3(3):33-50.
  15. ↑ Wuang YP, Wang CC, Huang MH, Su CY. Prospective study of the effect of sensory integration, neurodevelopmental treatment, and perceptual–motor therapy on the sensorimotor performance in children with mild mental retardation. The American journal of occupational therapy. 2009 Jul 1;63(4):441-52.
  16. ↑ Rameckers EA, Crafford R, Ferguson G, Smits Engelsman BC. Efficacy of a task-oriented intervention for children with a dual diagnosis of specific learning disabilities and developmental coordination disorder: a pilot study. Children. 2023 Feb 21;10(3):415.
  17. ↑ Thaut M, Abiru M. Rhythmic Auditory Stimulation in Rehabilitation of Movement Disorders: A Review Of Current Research. Music Perception 1 April 2010; 27 (4): 263–269.
  18. ↑ Rahman E. Effectiveness of modified constraint induced movement therapy along with conventional physiotherapy on upper extremity function for children with hemiplegic type of cerebral palsy (Doctoral dissertation, Bangladesh Health Professions Institute, Faculty of Medicine, the University of Dhaka, Bangladesh)).
  19. ↑ Shariat A, Najafabadi MG, Dos Santos IK, Anastasio AT, Milajerdi HR, Hassanzadeh G, Nouri E. The effectiveness of aquatic therapy on motor and social skill as well as executive function in children with neurodevelopmental disorder: a systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation. 2024 May 1;105(5):1000-7.
  20. ↑ Al-Nemr A. Synergistic effect of functional strength training and cognitive intervention on gross motor function in children with cerebral palsy. Applied Neuropsychology: Child. 2024 Jul 2;13(3):246-55.
  21. ↑ Koukourikos K, Tsaloglidou A, Tzeha L, Iliadis C, Frantzana A, Katsimbeli A, Kourkouta L. An Overview of Play Therapy. Mater Sociomed. 2021 Dec;33(4):293-297. doi: 10.5455/msm.2021.33.293-297. PMID: 35210953; PMCID: PMC8812369.
  22. ↑ Uyanik, M., Kayihan, H., Bumin, G., Sener, G. (2009). Neurodevelopmental Therapy: Sensory Integration and Vestibular Stimulation Intervention in Mentally Retarded Children. In: Söderback, I. (eds) International Handbook of Occupational Therapy Interventions. Springer, New York, NY.
  23. ↑ Zanon MA, Porfírio GJM, Riera R, Martimbianco ALC. Neurodevelopmental treatment approaches for children with cerebral palsy. Cochrane Database Syst Rev. 2015 Nov 5;2015(11):CD011937.
  24. ↑ Acar G, Ejraei N, Turkdoğan D, Enver N, Öztürk G, Aktaş G. The effects of neurodevelopmental therapy on feeding and swallowing activities in children with cerebral palsy. Dysphagia. 2022 Aug;37(4):800-11.
  25. ↑ Simacek J, Dimian AF, McComas JJ. Communication intervention for young children with severe neurodevelopmental disabilities via telehealth. Journal of autism and developmental disorders. 2017 Mar;47:744-67.
  26. ↑ Sah AK, Balaji GK, Agrahara S. Effects of task-oriented activities based on neurodevelopmental therapy principles on trunk control, balance, and gross motor function in children with spastic diplegic cerebral palsy: A single-blinded randomized clinical trial. Journal of Pediatric Neurosciences. 2019 Jul 1;14(3):120-6.
  27. ↑ Østensjø S, Carlberg EB, Vøllestad NK. The use and impact of assistive devices and other environmental modifications on everyday activities and care in young children with cerebral palsy. Disability and rehabilitation. 2005 Jul 1;27(14):849-61.
  28. ↑ Jones EA, Carr EG. Joint attention in children with autism: Theory and intervention. Focus on autism and other developmental disabilities. 2004 Feb;19(1):13-26.
  29. ↑ Monteiro MJ. Narrative therapy and the autism spectrum: A model for clinicians. Human Systems. 2021 May 1;1(2-3):150-64.
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