The Neuro-Developmental Treatment (NDT) frame of reference is used to analyze and treat posture and movement impairments based on kinesiology and biomechanics. To identify difficulties and plan for intervention, the following concepts are to be considered in NDT, including planes of movement, alignment, range of motion, base of support, muscle strength, postural control, weight shifts, and mobility. NDT assumes that posture and movement impairments are changeable. Thus, it utilizes movement analysis to identify missing or atypical elements. By treating problems of motor coordination, neuromotor and postural control abnormalities, the ultimate goal of NDT is to optimize participation in a person’s life roles. In the evaluation using NDT, each individual is evaluated as a unique person with particular competencies and limitations. Since NDT emphasizes informal, ongoing examinations as part of treatment to evaluate the treatment strategies, there are no standardized assessment formats. As for the intervention, therapeutic handling is the primary technique of NDT, with graded application of manual forces to the client’s body through the therapist’s hand, combined with directional cues for the client to feel and learn new movement patterns. Occupational therapists are often specifically involved in the facilitation of upper extremity movements such as reaching, grasping, releasing of objects, and in-hand manipulation skills. Therapeutic handling can be also embedded in functional tasks such as self-care or play. Often these functional tasks are entrenched in NDT together with other components including cognition, perception, creativity, and self-esteem.
Frame of reference
Domain of occupation
A dynamic hands-on treatment approach
Barthel, K. A. (2010). A frame of reference for neuro-developmental treatment. In P. Kramer & J. Hinojosa (Eds.), Frames of reference for pediatric occupational therapy (3rd ed., pp. 187-233). Philadelphia: Lippincott Williams & Wilkins.
The Biomechanical frame of reference for positioning children for function is applied to individuals who are unable to maintain posture from appropriate automatic muscle activity caused by neuromuscular or musculoskeletal dysfunction. The goals of this frame of reference are (1) to enhance development of postural reactions, which can be done by reducing the demands of gravity and aligning the body, and (2) to improve functional performance by providing external support for proximal stability to improve distal function.
This frame of reference identifies functions and dysfunctions in five areas of handwriting for children, including proximal posture, components, use of writing tools, grasp, and handwriting. Good proximal control is required for functional and effective distal control of the writing tools. Either excessive postural stability or lack of postural stability during writing tasks is considered as dysfunctions. Components including ocular-motor skills, attention, and memory are considered as essential.
The dynamic system theory model of visual perception aims to facilitate practitioners in understanding the development of visual perception from a dynamic systems theory perspective. This model views vision and ocular motor abilities as a part (instead of the foundation) of the complex interaction of components of the experience of vision.
Acquiring motor skill is a process that requires practices, feedback, and involvement of the learner. This frame of reference employs several principles from learning theory. It focuses on the child’s ability, characteristics of the task, skills required, environment, and regulatory conditions. Regulatory conditions are aspects of the environment that determine movement specifics, which are described in a continuum between closed and open tasks.
The Framework of Occupational Gradation (FOG) focuses on one’s active movements with the more involved upper extremity. There are two versions of FOG, one for young children (C-FOG) and one for older children and adults (A-FOG). Both aim to provide occupational ideas in preventing learned non-use of the more involved upper extremity for clients with neurological impairment. These ideas can be incorporated into daily lives to increase use of the extremity. Appropriateness of task for each client is determined by hand dominance and perceived meaningfulness.