Module 3

Question 0

What NDT governed by?

Answer 0

The problem solving sequence, key points of control, and working within an appropriate environmental construct.

Question 1

What is neuro-developmental treatment?

Answer 1

A manual therapy treatment philosophy directed at restoring and improving functional motor control in the human neuromuscular system.

Question 2

What is the problem solving sequence?

Answer 2

Ask for movement
Facilitate movement
Passive movement assessment
Mobilize and/or stretch
Integrate movement

Question 3

What are the key points of control?

Answer 3

Proximal: on moving part or muscle that moves part
Distal: away from part or muscle that moves parts.

Question 4

When was NDT developed?

Answer 4

1940’s

Question 5

Who developed NDT?

Answer 5

Karel Bobath and Berta Bobath

Question 6

What is the NDT functional progression?

Answer 6

Bed mobility
Transfers
Gait

Question 7

What are the nine bed mobility movements?

Answer 7

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

Question 8

What is the process for hooklying?

Answer 8

Ask patient to bend knees. If unable, provide least amount of facilitation required.
Determine motor control before releasing patient’s lower extremity.

Question 9

What is the process for bridging?

Answer 9

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.

Question 10

What is the process for bridge and scoot?

Answer 10

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.

Question 11

What is the process for supine to sitting towards weaker side?

Answer 11

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.

Question 12

What is the process for supine to sitting towards stronger side?

Answer 12

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.

Question 13

What is the process for upright sitting?

Answer 13

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.

Question 14

What are the positions of the forefeet, patella, hands, trunk midline and head during upright sitting?

Answer 14

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

Question 15

What is the process for hip hiking?

Answer 15

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.

Question 16

What is the process for scooting forward?

Answer 16

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.

Question 17

What is the process for scooting backwards?

Answer 17

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.

Question 18

What is the process for transfers?

Answer 18

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.

Question 19

What is the process for sit to stand?

Answer 19

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.

Question 20

What is the process for stand to sit?

Answer 20

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.

Question 21

When should a gait belt by applied?

Answer 21

While sitting or supine

Question 22

How should a gait belt be worn?

Answer 22

Buckle in posterior
Snug but not too tight
Clinician typically stands postero-lateral

Question 23

What are two other names for forearm crutches?

Answer 23

Lofstrand or Canadian crutches.

Question 24

How is the lofstrand crutch applied in sitting position?

Answer 24

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.

Question 25

How is the lofstrand crutches applied in supine position?

Answer 25

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.

Question 26

What are the different types of canes?

Answer 26

Single-point, small and large-based quads

Question 27

How do you apply a cane in a sitting position?

Answer 27

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.

Question 28

How do you apply cane in supine position?

Answer 28

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.

Question 29

What are the differ types of walkers?

Answer 29

Pick-up, 2 or 4 wheel rolling, hemi

Question 30

How do you apply a walker in sitting position?

Answer 30

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.

Question 31

How do you apply a walker in a supine position?

Answer 31

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.

Question 32

What are the components of a wheelchair?

Answer 32

Folding and unfolding wheelchair
Brakes
Arm rests
Leg rests
Anti-tilt bars