Professional Documents
Culture Documents
IN 1940s Bertha Bobath and Karl Bobath started a new treatment approach for children
with Cerebral Palsy or those with Developmental delay. It was developed due to the clinical
experience of Bertha Bobath; as she found that handling patient’s body made a difference
in the distribution of stiffness and control of movement.
2. The Focus of the theory is to address & to inhibit abnormal motor pattern & facilitate
more functional patterns.
Principles of NDT:-
1) to align the body segments Eg- correction of rib cage alignment over pelvis in sitting.
1) Across the joint to facilitate wt. shift E.g.- Sit to stand by facilitation through lower
extremity (LE), hands across hip joint.
2) Over muscle Eg All fours to Quadruped hands over gluteus maximus
3) Over Proximal joint for stability Eg – sit to stand by facilitation through Pelvis
4) Over Distal joint if some component of stability exists proximally E.g.- sit to stand
by facilitation through UE.
- Body Mechanics: -Always position yourself so that you can also move along with the
client.
- Movement should be practiced in all three planes i.e. Antero-posterior, Lateral &
Diagonal.
- Alignment of the client is the most essential feature for the effectiveness of the each
technique based on NDT principles. Always align the body segments such that wt
transfer is smooth and does not aggravate any abnormal mobility between two or
more segments. Eg:- Alignment of the rib cage over the pelvis in CP child is of
utmost importance as delayed or no development of abdominal muscles leaves the
rib cage in a hanging and hyper mobile state w.r.t trunk. Therefore it is important in
all Ant-Post wt shifts that the trunk remains straight, rib cage in straight line with
the pelvis. Also LE should be in 90-90 position i.e hips make an angle of 90o w.r.t
trunk. Similarly knees & ankle should make 90o, pelvis in neutral alignment, and
head in straight line over the trunk.
- Choice of tool: - for dynamic tasks like sit to stand, or lat. Wt. shift, a vestibular ball
would give more range and mobility. Similarly the therapist should choose their own
position or tool according to that of the client. Eg- if the client is doing lateral wt.
shift on a Vestibular ball, therapist should also choose a dynamic surface for self.
- Based on these NDT principles Facilitation Techniques were developed which guide
the client through various phases like sitting, long sitting, standing etc, and through
the transitions between these phases. The ultimate aim of NDT and so of Facilitation
techniques is to help the client gain functional independence.
REMEMBER
“Facilitation is a dance with another human being who is struggling to regain motor skills or to learn new
motor skill for the first time. Honor the client and understand your impact upon the person’s present, past,
and future goals for improvement”- Lois Bly.
Sit to Stand: Anterior Weight Shift at the Hips – Facilitation from the
Upper Extremities
Goals
Client’s Position
The client sits on a mat table or stable bench with a neutrally aligned
spine. The hips and knees are flexed to 90 degrees. The feet must touch
the floor. The client’s arms are lifted, externally rotated, and flexed
above 90 degrees at the shoulders.
Therapist’s position
Depending on the client’s size, you may stand, kneel, or half kneel in
front of the client. You must be in a position that permits you to weight
shift with the client.
Place your hands under the client’s elbows. Extend the client’s elbows,
externally rotated the client’s arms, and lift them over 90 degrees at the
shoulders. Apply diagonally upward and forwards traction to the client’s
arms. The traction facilitates the client’s trunk and pelvis to extend and
move forward at the hip joints. As the client’s weight is brought up and
forward over the feet, the client rises to stand. The client’s arms are
flexed overhead to maintain the trunk extension.
Precautions
Component Goals
Graded concentric and eccentric control of knee and hip extensors when
rising to stand and lowering to sit.
Functional Goals
Sit to Stand: Anterior Weight Shift at the Hips – Facilitation from the
Pelvis
If the client has difficulty moving the pelvis forward over the femurs,
you can facilitate the movement from the client’s pelvis.
Client’s Position
The client sits on a mat table or stable bench with a neutrally aligned
spine. The hips and knees are flexed to 90 degrees, with the feet on the
floor. The client’s arms rest on your shoulders.
Therapist’s position
Kneel or half kneel in front of the client. You must be in a position that
permits weight shift and movement with the client
Place the palms of both hands laterally on the client’s pelvis with your
fingers posterior on the pelvis. Align the pelvis to neutral. Correct with
your fingers. Once the alignment is correct (ribcage straight over pelvis),
move the client’s pelvis forward over femurs. As the weight is shifted on
the feet, give a slight diagonal shift forwards and upwards. Move back
as the client stands up to provide space.
Precautions
Component Goals
Functional Goals
Sit to Stand: Anterior Weight Shift at the Hips – Facilitation from Lower
Extremities
Client’s Position
Therapist’s position
Knee or half kneel in front of the client.
Precautions :-
Component Goals
Functional Goals
Goals
Client’s Position
Therapist’s position
G- Hand - under the client’s opposite scapula, gives the wt.shift with
the heel of your hand. A- Hand - placed on top of the soon-to-be-wt.
bearing palm holding the forearm and the palm down on the mat. Give
the wt. shift from the heel of your G- hand causing the wt to transfer
entirely on the to-be wt. bearing side. Continue the wt. shift until the wt
transfers from shoulder on to the elbow then to the forearm finally to
the palm of the hand. Once this is accomplished the client will
automatically, be upright facing you with shoulder turned to your side.
If during this transition the client finds difficulty due to weak
abdominals or due to inadequate fixation of the pelvis, once the wt is
stable on the wt. bearing forearm and palm; stabilize the same side
pelvis with your A- Hand and give a diagonally downward traction. This
will help fixing the pelvis and the traction will elongate and therefore
activate the same side abdominals.
Precautions
Component Goals
Functional Goals
Goals
Long sits on the floor with neutral alignment of the spine, hips flexed, &
knees extended.
If long sitting is not feasible, then the client can Semi-long sit i.e long
sitting on the floor with slight knee flexion.
Therapist’s position
Kneel behind the client in a position that permits you to wt. shift with
the client.
When the client’s trunk pivot over the arm, the client spontaneously
transitions to quadruped. The client’s nonweight-bearing arm follows
the trunk around to a wt-bearing position.
Precautions
Do not hike the shoulders, but elongate the entire side of the trunk.
Component Goals
Functional Goals
Goals
Client’s Position
The client is quadruped, shoulders relaxed; pelvis and the rib cage
should be in same line & Pelvis should be neutrally aligned.
Therapist’s position
Half kneel beside the client in a position that permits you to weight shift
with the client
With your Guiding Hand shift client’s wt straight back, continue post wt
shift unless the client indicates that CG is stable {indicated by hand
lifting or neck extension i.e. neck righting reaction}. When the client’s
indicates righting reaction by lifting head; hands &/or trunk, carefully
use your assisting hand to guide the hip forwards into extension.
Precautions
Functional Goals
Goals
Client’s Position
Client kneels with arm on side of the soon-to-be weight bearing hip held
in full shoulder flexion and external rotation
Therapist’s position
Place assisting hand on far side of client’s rib cage (use it to guide and
stabilize trunk during weight shift, or you can also use your body to
stabilize Client hip during weight shift)
Place guiding hand over client’s elbows (use to flex and externally rotate
client’s shoulder)
To facilitate transition, to use guiding hand, to externally rotate and
apply upward traction to the client’s arm, to elongate latissimus dorsi
Elongation of lat dorsi facilitates lateral weight shift to that side, the un-
weighted leg responds by moving forward into half kneeling
Precautions
Apply traction upwards, not outwards else the client will fall side ways
Client must have some active control of hips for the weight shift
Component Goals
Functional Goals
Goals
- To facilitate balance reactions for various weight shifts that the client
may experience in half kneeling
- To activate and elongate the lower extremity and trunk muscles
Client’s Position
Half kneel in front of you with shoulders flexed and externally rotated.
Leg should be in line with pelvis not abducted, one hip extended and
the other flexed, forward foot flat and back foot plantar-flexed
Therapist’s position
To facilitate rising to stand, hold the client’s arms near the elbows, and
flex and externally rotate the client’s shoulders. Traction the client’s
arms diagonally forward and up so that the client’s weight is transferred
to the forward leg. Continue to flex the client’s shoulders forward and
up until the client’s weight is stable on the forward foot. Rise
simultaneously with the client, using a diagonally backward weight
shift. This guides the client forward and up. You and the client both end
in a step-stance position.
Component Goals
Functional Goals
Goals
Client’s Position
In front of you with shoulders flexed to 90 degrees and externally
rotated, and elbows extended
Therapist’s position
Behind client, both hands on client’s humeri, nearer over the elbows
E.g. Walking with right leg ahead – as a client’s weight shifts to left leg,
right leg steps forward. As the client’s right leg moves forwards,
carefully apply forward traction to left arm to abduct the scapula and
rotate the left side of trunk forward. At the same time, guide right side
of client’s (C) trunk and right scapula rightly backward with your hand
and approximate the humeris into scapula. This traction of one arm and
approximation of other produces counter rotation between upper and
lower trunk. As the client steps forwards, repeat the same technique for
the other side.
Precautions
Component Goals
Functional Goals