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NDT was dev by who? When?
Bobath 1950s-70s
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5 categories of changes after a strke
- motor
- sensory
- visual
- pereptual (agnosia, apraxia, body image problems, etc)
- language disorders (aphasia)
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3 key players inNDT today
- Lois Bly
- Judith Bierman
- Reggi Boehme
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Bobath's original assumptions - 3 things required for vol function
- 1- normal postural tone of moderate intensity (high enough to resist gravity, low eough to give way to movement)
- 2 - normal recprocal interacion of muscles --including fixation of prox muscles to allow distal mobility, LE asymmetrical flex/ext to allow gait, graded control of ag/antagonists
- 3 - righting and equilibrium responses
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diff btwn righting and equilibrium responses
- righting = getting eyes to horiz plane
- equilib = reactions to keep you stable when center of gravity is displaced
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protective extension
- sticking out a limb to stop you from falling
- used when equilib reactions fail
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Bobath 3 stages and goals for each one
- flacidity -- get tone
- spasticity -- inhibit tone and get functional movements
- relative recovery -- get diversity of controlled movement
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4 ways NDT interacts w models of mtorcontrol (hierarchica,dynamic sytems theory, generalized motor program thery, neuronal group selection theory)
- NDT should be ...
- function oriented
- task specific -- using practice, repetition, PT feedback, knowledge of results, knowlded of performance
- fostering economical, functional synergies as movement options
- problem-solving by pts
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associated reactions
- tonic postural reactios in muscles deprived of voluntary control - sort of like a reflex, but more like overlow - flexing one arm helps flex the other, or TNR influencing mvmnt
- can be slow to develop but then last longer than the initial stim
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nromal poural reflex mechanism = central postural control system ... what is it
- anti-gravity, dynamic control of postural adjusments/postural sets -- this is prior to movement, and postural reactions -- during and after movement
- it's part of normal motor dev
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10 pt summary of Bobath/NDT
- 1. postural control and movement coordination are the big problems
- 2. these can be improved by directly addressing the problems in task-specific contexts
- 3. these issues affect the pt's body and place in life and society
- 4. the framework for the theory is based in a working knowledge of typical adaptive motor dev and how it changes across the lifespan
- 5. NDTers change mvmnt strategies to improve qol for pts
- 6. sensory is involved both for feedback and for feedforward (informing pt on where/how to move)
- 7. pt needs to actively partcipate while PT heps thru manual guidance
- 8. NDTers use mvmnt analysis to id missing or atypical elements that link functional limitations to system impairments
- 9. ONGOING EVALUATION
- 10. goal - to optimize function
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shunting
changing state of a distal muscle by stimming prox - can inhibit excitatory outflow to the spastic muscles and simultaneously facil ACTIVE mvmnt in highly integrated, complex mvmnts... make shoulder relax before fingers can extend
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primary goals of Bobath (basic stuff)
- inhibit poor, non-functional patterns of mvement
- tain more complex, functional patterns posture and movement
- ensure the pt is being an active learner
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a few things to remember under the NDT emphasis
- secondary impairments can come from disuese or poor use, so pt needs motor training for safe mvmnt
- on affected side diff limb segments may be at diff stages of recovery - some parts spastic, some flaccid
- on unaffected side - mayb have motor impairments or movement disorders after a stroke
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positioning to counter flexor synergy
- supine, pillow to elevate affected pelvis and reduce ER
- put leg in neutral, not IR
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positioning to counter ext synergy
supine, light abd, small pillow under knee
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