NDT In Action

An NDT-based session will have a session goal that is a mini-version of a short-term goal. The sequence of the session is to elongate and align body structures and then activate movement patterns for a functional skill. The idea is that in order to achieve a functional goal, such as crawling, walking or jumping, certain movement patterns need to be coordinated. Muscles and coordinated movement can occur best when the body is properly aligned. The mini-goal is broken down into movement patterns that have to occur for that action to occur.

NDT therapists study typical development in depth. They look for deviations from typical movement patterns as well as the presence or lack of variability in movement patterns. In order to understand why a child cannot pull to stand you must understand the components of this skill. The child must be able to shift their weight, which requires lengthening of one side of the trunk and shortening the other side. The pelvis has to pull back in order to free up the leg to lift up. Then the body has to weight shift forward and push up to standing.

Here’s an example of what a session can look like:

• The child’s ribcage mobility is addressed first with hands-on techniques.
• The child participates in an activity on the exercise ball to increase pelvic mobility and connection between upper body and lower body.
• The child participates in reaching activities while sitting on an angled bolster with ankles, knees and hips at 90 degree angles. The therapist facilitates elongation of the trunk on the side that is weight-bearing.
• The child plays in a half-kneel position with facilitation of a neutral posture. The therapist also uses a hands-on technique to increase hip extension ROM.
• Pull to stand is facilitated from kneel to half kneel to stand in order for the child to reach a desired toy up above. This movement is practiced with variation while providing opportunities to play with different movement patterns to achieve pull to stand.
• Instruction to parent in strategies to practice at home.

Therapists who use an NDT approach will often use other tools to assist in the achievement of goals. For example, after improved alignment the therapist may use kinesiotape or theratogs to help maintain it. Electrical stimulation can be used to facilitate activation of muscles. Myofascial release, total motion release and other manual therapies can be used to achieve elongation. Partial weight-bearing treadmill training can provide gait practice after the body has improved alignment. NDT can be used as an overall framework to analyze movement patterns and help to design intervention strategies.