NDT approach
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| Treatment approach is to re–learn normal mvmnts by utilizing techniques such as positioning, weight bearing, rotation of trunk and encouraging the use of both sides of the body. | NDT approach
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| Associated mvmnts & associated reactions, key points of control & reflex inhibiting patterns are used in this treatment approach | NDT
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| Abnormally high tone is reduced or | INHIBITED
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| Abnormally low tone is increased or | FACILITATED
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| Reduction of abnormal patterns of movement must be accomplished before normal, selective isolated movements can occur. Normal movement is ______________ in the presence of abnormal tone | IMPOSSIBLE
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| •Weight bearing over the affected side •Trunk rotation •Scapular protraction •Forward positioning of pelvis/anterior pelvic tilt •Facilitation of slow, controlled movements •Proper positioning •Incorporating the UE into activities | NDT techniques to normalize muscle tone
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| over the hemiplegic side is the most effective way to help regulate or normalize tone and is one of the most common techniques seen in the clinic | WEIGHT BEARING
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| This activates trunk musculature and aids in trunk stability, which will enhance UE movement and is another way of normalizing tone and facilitating normal movement | TRUNK ROTATION
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| This benefits patients who display a flexor synergy of the UE. Following the rule of working proximal to distal, the scapula should be guided into forward protraction before the patient attempts to raise the hemiplegic arm or open the hand | SCAPULAR PROTRACTION
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| This is the preferred sitting position for patients with hemiplegia. This position provides proper alignment of the pelvis, shoulder, and head | ANTERIOR PELVIC TILT
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| Quick movements increase tone and tend to trigger an associated reaction, thus resulting in a flexor synergy of the UE; they should be AVOIDED! Patients with high tone should be instructed to perform activities slowly and in a controlled manner. | Slow, controlled movements should be facilitated in patients with high tone
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| On the hemi side, w/ patient’s back positioned parallel to the EOB; head placed on a pillow, avoiding extreme flexion; shoulder fully protracted w/atleast 90 degrees of shoulder flexion; forearm supinated and elbow flexed; and hand placed under the pillow | NDT Preferred position for:
Lying in bed
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| Patient placing both feet flat on the floor, the hips near 90 degrees of flexion, the knees and ankles at less than 90 degrees of flexion, and the trunk extended. The head should be in midline and the affected arm fully supported when working at table | NDT Preferred position for:
Sitting
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| Weight should be equally distributed on both LE’s, the trunk symmetrical, and the head in midline | NDT Preferred position for:
Standing
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| Is important in promoting functional use of the involved UE. The involved UP can be incorporated via weight-bearing, bilateral activities, or guided use | Incorporating the UE into activity
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| The patient should sit in a chair with a firm back when dressing. The chair provides stability and can improve balance. The same sequence should be followed to enhance learning | How patient should sit when dressing
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| 1.Pos shirt across pt. knees w/armhole visible & sleeve between knees 2.Patient bends forward at hips, placing affected hand in sleeve 3.Arm drops into sleeve 4.Bring color to neck 5.Sit up; dress non hemi side 6.Button shirt bottom to top | Donning Shirt
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| 1.Clasp hands, & cross affected leg over non hemi leg 2.Release hands. 4.Clasp hands to uncross leg 5.Place non hemi foot in pant leg. Pt.must weight bear on hemi side 6.Pull pant to knees 7.Hold onto waistband, pt.stands w/COTA help 8.Zip & snap | Donning underclothes and pants
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| 1.Clasp hands and cross legs 2.Put sock and shoe on hemiplegic foot 3.Cross non hemiplegic leg; put on sock and shoe | Donning socks and shoes
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