Within my fourteen years of experience as an occupational therapist, I have specialized within the domain of neurorehabilitation becoming both NeuroDevelopmental Treatment (NDT) and Brain Injury Certified (CBIS). I have had the opportunity to work in many settings throughout the continuum of care including acute care, inpatient rehabilitation, skilled nursing and home health. I have had the pleasure of working with patients with a myriad of diagnoses including neurological, orthopedic and cardiac.
Specialization and intensive training within the Neurodevelopmental Treatment (NDT) approach has been pivotal for enhanced assessment and treatment of patients with neurological conditions such as traumatic brain injury and stroke. By using NDT based assessment and treatment approach, our team is able to further maximize not only motor control after neurological lesions, but also functional independence in areas such as Activity of Daily Living and Instrumental Activities of Daily Living and help patients return to work, school and their community.
Question 1-What is the NDT certification?
NDT is a systematic approach to stroke and brain injury rehabilitation that focuses on improving posture and muscle tone through proper handling and facilitation of normal movement. The main principle of NDT is to “reduce muscle spasticity and promote normal patterns of movement” (Seneviratne and Reiner, 2004, p13).
Question 2-How is this method different from conventional Occupational therapy methods?
Occupational Therapy supports health and participation in life through engagement in occupation (AOTA 2008). This correlates with the NDT approach to restore movement patterns which results in an increased participation in our patients’ occupations. The NDT approach is incorporated throughout the evaluation, constant assessment and treatment to facilitate motor control and functional movement. NDT also teaches the delayed use of adaptive equipment to “fix” the problem versus aligning, handling, and facilitating movement to give the body from freedom to re-learn movement without being constrained with a sling or any orthotic. Reviews of research about Bobath (NDT) Therapy have shown that receiving NDT or a combination of NDT and other intervention led to better performance and immediate increase in range of movement (Butler and Darrah, 2001, DeGangi, 1994).
Questions 3-What are the benefits for someone who has had either a stroke of traumatic brain injury?
NDT is not a specific technique but an overall philosophy that uses the knowledge of typical and atypical development and motor patterns, functional task analysis, motor control and motor learning to develop appropriate, individualized treatment plans including:
- Improved gross motor function, self care skills and reduced caregiver assistance (Knox and Lloyd-Evans, 2002, DeGangi, 1994)
- Increased range of movement (Butler and Darrah, 2001, DeGangi, 1994)
- Progression of supported walking demonstrated by improved stride length, range of movement, strength, step length, heel contact, velocity of walking and reduced spasticity (Desloovere et al., 2012) (Adams et al., 2000, Embray et al., 1990)
- Advanced motor progress has been shown to occur after more intense NDT is delivered in a block (Tsorlakis et al., 2004, Mayo, 1991, Trahan and Malouin, 2002)
- Improved reaching, hand opening and hand use (Jonnsdottir et al., 1997, Kluzik et al., 1990, Chakarian and Larson, 1993).
Seeing a patient that couldn’t sit at the edge of a bed walk more than 300 feet with a walker truly shows the benefits of NDT and how it can change the lives of my patients. In therapy, “therapists must give LIFE, not exercise” (Bobath, 1984).
By Kristy Bautista-Harris MS. OTR/L, CBIS, C/NDT
Kristy Bautista-Harris MS. OTR/L, CBIS, C/NDT, is Senior Occupational Therapist at HealthSouth Rehabilitation Hospital of Altamonte Springs. Kristy graduated from Barry University with a Bachelor of Health Administration degree and went on to complete a Master’s of Science in Occupational Therapy degree at Barry University in Miami. She has 14 years of experience as a Occupational Therapist. Kristy has been with HealthSouth of Altamonte Springs since the hospitals opening in October 2014. Kristy is fluent in Spanish.