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NDT principles

Normalization of postural and limb tone, movement patterns.
Integrate both sides of body.
Ability to bear weight and weight shift through limbs.
Establish normal righting and equilibrium patterns.
Use handling techniques.
Inhibit primitive reflexes
Associated reactions should be avoided.
Postural reactions are considered the basis for control of movement.

NDT evaluation

Abnormal tonal patterns in trunk & limbs
"Placing response"- ability to hold a posture as tx releases support of limb/trunk
Assess for presence of associated reactions and the situations that evoke them
Postural control, ability to right self
Abnormal coordination patterns of limbs

NDT Intervention

*utilize key points of control,
*utilize inhibition techniques,
*utilize specific techniques to "normalize tone" (Wt bear
ability to weight shift symmetrically in various postures
integrate both sides of body while limiting assoc rxns
*Utilize bilateral mvt patterns

PNF principles

the response of the neuromuscular mechanisms can be hastened through stimulation of the proprioceptors
Techniques are superimposed on patterns of movement and posture, focusing on sensory stim from manual contacts, visual cues, and verbal commands.
Normal motor development proceeds in a cervicocaudal and proximodistal direction
Early motor behavior is dominated by reflex activity

PNF evaluation

Vital functions of respiration, swallowing are eval'd for weakness and symmetry
Movements in response to visual, auditory, and tactile stim are elicited to determine which sensory cues reinforce mvt.
Head and neck patterns observed.
Diagonal patterns of extremities
Note dominance of flexor/extensor tone, midline alignment, stability, ROM, timing and quality of mvts.

PNF Intervention

Diagonal patterns or mass mvt patterns are utilized during functional activities
Patterns of movement
Techniques used on postures and movement patterns
Relaxation techniques

PNF patterns of movement

Prone on elbows
Supine to sidelying
Sidelying to side sitting
Supine to long sitting
Prone to quadruped
Quadruped to standing

PNF techniques on postures and mvt patterns

Manual contact over agonist muscle
Quick stretching of muscle to elicit a contraction
Traction or manual separation of joint space
Approximation or manual compression of joint

PNF relaxation techniques

contract-relax- goal is to increase ROM
hold-relax- goal to increase mobility
Rhythmic rotation

D2 flexion (RUE)

Passenger seat- taking off seatbelt

D2 extension (RUE)

Passenger seat- putting on seatbelt

D1 flexion (RUE)

Drivers seat- taking off seatbelt

D1 extension (RUE)

Drivers seat- putting on seatbelt

Brunnstrom stages of motor recovery

Stage 1= flaccidity, no voluntary or reflexive activity
Stage 2= minimal voluntary movement. Spasticity begins to develop
Stage 3= marked spasticity, synergies are performed voluntarily
Stage 4= movements that begin to deviate from synergy can be accomplished on a volitional basis
Stage 5= movements which differ greatly from the basic synergies are utilized
Stage 6= spasticity is absent; isolated muscle actions are freely performed
Stage 7= normal motor function

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