Flashcards in Module 3 Deck (33):
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What is neuro-developmental treatment?
A manual therapy treatment philosophy directed at restoring and improving functional motor control in the human neuromuscular system.
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What NDT governed by?
The problem solving sequence, key points of control, and working within an appropriate environmental construct.
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What is the problem solving sequence?
Ask for movement
Facilitate movement
Passive movement assessment
Mobilize and/or stretch
Integrate movement
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What are the key points of control?
Proximal: on moving part or muscle that moves part
Distal: away from part or muscle that moves parts.
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When was NDT developed?
1940's
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Who developed NDT?
Karel Bobath and Berta Bobath
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What is the NDT functional progression?
Bed mobility
Transfers
Gait
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What are the nine bed mobility movements?
Hooklying
Bridging
Bridge and scoot
Supine to sitting towards weaker side
Supine to sitting towards stronger side
Upright sitting
Hip hiking
Scooting forward
Scooting backwards
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What is the process for hooklying?
Ask patient to bend knees. If unable, provide least amount of facilitation required.
Determine motor control before releasing patient's lower extremity.
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What is the process for bridging?
Patient hooklying.
Ask patient to push bottom up using feet and arms. If unable, provide least amount of facilitation required.
Apply long-axis traction caudally throu distal femur with pressure down into patient's foot; proximal hand under pelvis lifting up.
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What is the process for bridge and scoot?
Patient hooklying.
Ask patient to scoot towards or away from clinician.
Once bottom clears mat, facilitate scooting by internally or externally rotating the ipsilateral distal femur and manually directing patient's pelvis.
Ask patient to lift head off pillow while helping to scoot upper torso.
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What is the process for supine to sitting towards weaker side?
Patient hooklying.
Ask patient to move UE 30 degrees away from body and log roll onto weaker side.
Ask patient to move LE's off mat and push with arm to sit up. Clinician must be on weaker side.
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What is the process for supine to sitting towards stronger side?
Patient hooklying.
Ask patient to move UE 30 degrees across body and log roll onto stronger side.
Ask patient to move LE's off mat and push with arm to sit up.
Clinician must be on weaker side.
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What is the process for upright sitting?
Patient sitting with hands on mat.
Ask patient to position feet under knees and sit up tall.
Place one hand on L/S and lift anterior and superior while other hand stabilizes upper trunk by gently pushing superior and posterior under clavicles.
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What are the positions of the forefeet, patella, hands, trunk midline and head during upright sitting?
Forefeet under patella
Patellas inline with acetabulum
Hands on mat slightly externally rotated
Trunk midline with no leaning in Sagittal or frontal plane
Head looking forward
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What is the process for hip hiking?
Patient in upright sitting position. Patient may position arm slightly further away from body.
Ask patient to lift one hip off mat.
Place finger pads on quadratus lumborum and lift medial and superior.
One hand may be required to stabilize upper trunk by placing anterior hand on contralateral shoulder.
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What is the process for scooting forward?
Patient in upright sitting position with arms slightly away from body.
Ask patient to lift one hip off mat and scoot that hip forward.
Hike hip and draw femur forward by adducting it with hand or leg.
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What is the process for scooting backwards?
Patient in upright position.
Ask patient to scoot backward.
Stabilize weaker tibia.
Place hands on mid-back and guide patient forward until weight transfers onto their feet.
Draw patient further forward until patient's bottom comes off mat.
Shift forward to increase tibial contact and guide patient backwards.
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What is the process for transfers?
Patient in upright sitting position at edge of mat.
Ask patient to turn heels towards chair and transfer into chair. Stabilize weaker tibia.
Place hands on mid-back and guide patient forward until weight transfers onto their feet.
Draw patient further forward until patient's bottom comes off mat and move patient in direction of chair.
Patient's COG must remain over their BOS during transfer.
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What is the process for sit to stand?
Patient in upright sitting position at edge of mat.
Ask patient to stand up.
Place posterior thigh underneath patient's thighs; anterior knee on patient's involved superior tibia.
Posterior UE obliquely on patient's upper and lower trunk and anterior hand under patient's clavicle.
Guide patient forward until weight transfers onto their feet then cue patient to stand with posterior thigh.
Dynamically stabilize patient's weaker knee with anterior knee while guiding trunk in anterior and superior direction.
Facilitate hip extension with posterior elbow.
Patient's COG must remain over their BOS during transfer.
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What is the process for stand to sit?
Patient in standing position at edge of mat and ask patient to sit down.
Place weaker knee between clinicians knees; posterior UE obliquely on patient's upper and lower trunk and anterior hand under patient's clavicles.
Ask patient to briefly look back at sitting surface. Knees bend first followed by hips and patient reaches back for sitting surfaces. Patient's COG must remain over BOS.
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When should a gait belt by applied?
While sitting or supine
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How should a gait belt be worn?
Buckle in posterior
Snug but not too tight
Clinician typically stands postero-lateral
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What are two other names for forearm crutches?
Lofstrand or Canadian crutches.
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How is the lofstrand crutch applied in sitting position?
Estimate appropriate height of assistant device based on patient height and secure locks. If height is incorrect have patient sit and make adjustments. Allow patient 20-30 degrees elbow flexion and cuff should cover proximal third of patient's forearms.
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How is the lofstrand crutches applied in supine position?
Measure from anterior axillary fold to a point 8in. Lateral from lateral border of heel. Allow patient 20-30 degrees of elbow flexion and cuff should cover proximal third of patient's forearms. Secure all locks.
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What are the different types of canes?
Single-point, small and large-based quads
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How do you apply a cane in a sitting position?
Estimate height of assitive device based on patient height and secure locks. The top of the cane handle should be in line with greater trochanter. The handle must point posteriorly and flat edge of quad cane must be toward patient.
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How do you apply cane in supine position?
Measure from greater trochanter to a point 6 in. lateral to distal-lateral foot. Allow patient 20-30 degrees of elbow flexion. The top of the cane handle should be in line with greater trochanter. The handle must point posteriorly and flat edge of the quad cane towards patient. Secure all looks.
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What are the differ types of walkers?
Pick-up, 2 or 4 wheel rolling, hemi
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How do you apply a walker in sitting position?
Estimate height based on patient's height. The topnofnthe hemiwalker handle should be in line with greater trochanter. The flat edge of hemiwalker must be towards patient.
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How do you apply a walker in a supine position?
Measure from greater trochanter to a point 6 inches lateral to distal lateral foot.
Allow patient 20-30 degrees of elbow flexion. The top of the hemiwalker should be in line with the trochanter with the flat edge towards the patient.
Secure all locks.
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