Neuro developmental treatment

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Aims and Objectives:

The main aim is to find out if neurodevelopmental treatment ( NDT) is more effective on the Gross Motor Function Classification System ( GMFM) than other therapies specifically Adeli Suit or functional therapy in children with cerebral palsy.

This issue can be addressed through the creation of whether there is enough evidence from the literature detailed examination of all available databases and serious evaluation of the evidence available using the appropriate tools for critical assessment.

Research Question:

To find out if the neurodevelopmental treatment (NDT) is comparable to other therapy treatment in improving Gross Motor Function Classification System (GMFM) in children aged 0-18 year by measuring the improvement outcomes using Gross Motor Function Measure (GMFM) tools.





Children with cerebral Palsy


Treatment (NDT)

Other therapies specifically

Adeli suit

improving Gross Motor Function Classification System( GMFM)


Definition and Epidemiology

What is a Cerebral palsy?

"Cerebral palsy is commonly used name for a group of conditions characterized by motor dysfunction due to non- progressive brain damage early in life" (Scrutton, D., Damiano, D., & Mayston, M. 2004).

Also cerebral palsy (CP) defines "a group of permanent disorders of the development of movement and posture, causing activity limitations, which are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, and behavior, by epilepsy, and by secondary musculoskeletal problems". It is estimated that the prevalence among the general population is 2/1000. Moreover there are restrictions on the activity requiring individual rehabilitation throughout their lives. (Anttila et al. 2008)

The importance of neurodevelopmental treatment – Bobath

The most well known traditional technique used for the purpose of contracting irregular patterns of movement and position and enhance the natural processes in order to obtain the maximum functional independence, is the approach Bobath, known as the NDT. On the basis of the theory of reaction hierarchy, NDT aims to normalize muscle strength, and prevent the primitive and unnatural, and reactions facilitate the movement of natural causes. Bobath theory has evolved over the past 50 years, and now based on an approach to control systems in motor with neuroplasticity as the first mechanism for neurological recovery, a development which has been well accepted and embraced by those of us who believe in this method. However, there is no clear scientific evidence to prove the existence of more than NDT over other methods. A review on the effectiveness of NDT did not give an advantage to the alternatives which were compared with responses to change the motor's abnormality, and slow or prevent contractures, or facilitating more normal motor progress or functional motor activities, and more intense in the outcome of NDT greater benefit. Moderate evidence of effectiveness was established for treatment prehensile hand, and NDT or NDT twice a week on the state of development. (Papavasiliou 2009)

Motor disorders are complicated in children with cerebral palsy. Primary shortages include the following: abnormalities muscle strength, is affected by the situation, and the position and movement, impaired balance and coordination, and low power; selective loss of control motor. Minor problems muscle, bone and muscle contractures and bone deformities. The development of these gradually in response to deficits in primary education and produce more motor dysfunction, and the need for orthopedic Surgery. (Papavasiliou 2009)

Physiotherapy for children with cerebral palsy and often presented as a constant process from the time of risk or pathology identification. It was administered short session of intensive physical therapy to children suffering from cerebral palsy, with a focus on the acquisition of motor skills measured by the total of motors and function of a measure (GMFM). Intensive physiotherapy led to a significant improvement in the acquisition of skills compared with the amounts of ordinary physiotherapy. This feature has fallen more than 6 months later when therapy returned to the usual intensity of treatment. Increase the frequency of treatment over a period of 6 months has been clamoring for children and their families. In a pilot study of intensive physiotherapy in a short period of very young children, it was found an improvement in motor performance, measured by GMFM, which was retained in the subsequent non-treatment. For a period of 4 weeks of treatment were not well tolerated by children. (Bar-Haim et al. 2006).

Measurement Tools

GMFM - 66

GMFM tool is used to assess and compare functional situation before and immediately after 1 month of treatment, and again about 9 months later. And GMFM is an ordinal scale designed to assess changes in gross motor function with children in the CP in five dimensions: "(1) Lying and rolling; (2) crawling and kneeling; (3) sitting; (4) Standing; and (5) walk- jump- run"(Bar-Haim et al. 2006). The record is scored of each item on a four-point ordinal scale, as stated in the manual. All registration procedures were recorded on videotape. Tens of analysis at a later time with a total capacity of the motor destined computerscoring Program for the GMFM - 66 degrees, and are described in the another directory . (Bar-Haim et al. 2006).

Historical perspective of NDT

The first two trailblazers in the treatment of cerebral palsy were Berta and Karel Bobath, a physiotherapist and neuropsychiatrist, respectively. In the early 1940s, they began to develop an approach, which emerged from the clinical observations of Berta Bobath. Moreover, it was understood at the outset in the context of the reflex, hierarchical, and theories of maturity of n neurology at that period. Through writing, lectures and training courses offered by them and other trained teachers, and Bobath approach - also known as the neurodevelopmental treatment '(NDT) - extend widely that NDT has heavily affected the physical, occupational, and speech therapy for children who suffer from the CP for half century.

According to Bobaths, motor problems of the CP appear primarily from the central nervous system (CNS) disorder, which conflicts with the development of postural control against natural gravity and hamper the development in normal motors. Their aim was that motor has been created and the natural evolutions posts and / or prevent contractures and deformities. Their neurodevelopment approach concentrated on the nerve growth sensorimotor elements of the muscle strength, and reactions to abnormal patterns of movement, and postural control, sensation, perception, and memory (i.e. the components of thought most likely to be impaired as a result of damage to the central nervous system). Handling techniques, which controlled different sensory stimuli, were used to curb convulsion, abnormal reactions, and movement patterns of abnormal. It was also used to facilitate the normal muscle, replies balance, and patterns of movement. Child was a relatively passive recipient of NDT treatment. Regular sequence of development was advocated as a framework to receive treatment.

As Bobaths achieved experience over the years and the additional knowledge of the neuroscience have become available, they changed their approach to, and to focus on some aspects of treatment. They described the main points of how to processing approach had developed in the last published NDT in about 1984. At the outset, it supported the establishment of children in the 'reflex, disability and attitudes. While these attitudes did reduce spasticity, and was recognized in the Bobaths time that there is no migration to the movement and function. Then they promoted 'the main points of control' when processor irregular patterns impede movement and facilitated the more natural movements of the child, while he/she was moving. At the end of the day, the Bobaths came to believe that they had focused much to facilitate the automatic righting reactions under the mistaken assumption that the child would be spontaneously translate this experience to the voluntary remedial functional movements. Hereafter, they began to appreciate that it is necessary for children to, increasingly and systematically, and control of movement, particularly of balance. The concluded Bobaths, also, that it was wrong to promote the following rigid natural sequence of development. Finally, and discussed Bobaths realization that their treatment does not automatically migrated to the activities of daily life, as they expected it that. Therefore, for the preparation of a specific methodology functions established with a view to treat children in the actual environments in which they live, play and learn.( Butler et al.2001).


To find out if NDT is as effective on (GMFM) as other PT therapies specifically Adeli Suit or functional therapy in children with a diagnosis of cerebral palsy (diagnosed by pediatrician or rehabilitation specialist). The inclusion criteria are children aged 0-18 years, with a definitive diagnosis CP, Receiving NDT. The studies had to be in a clinical setting, the years to include 1990 until recent 2009. The following databases were searched. The COCHRANE Library, MEDLINE, EMBASE,CINAHL Psychinfo and Clinical Evidence and NICE guidelines databases. The hierarchy of evidence was used. First step the research was for the systematic review then randomized control trails.

Exclusion Criteria

Inclusion Criteria

Question component

Other age groups (adult)with other medical condition.

Children aged up to 18 Years old with cerebral palsy diagnosed by pediatrician or rehabilitation specialist

The population

Other therapies.

Neurodevelopmental treatment (NDT)

Adeli suit or functional therapy


Other Outcome Not related

Improving in GMFM

The outcome

Observational or non- randomized experimental studies


Study design

Database: Ovid MEDLINE ( R)< 1950 to October 2nd week 2009

Search strategy:

  1. exp Cerebral palsy/12660
  2. exp Child /1334518
  3. exp Physical therapy ( Specialty )1399
  4. Neurodevelopmental .mp.(6574)
  5. 1and 2 and 4 (145)
  6. Limit to randomized controlled trail (13)
  7. From 6 keep 4,6,12 (3)
  8. The search narrowed down to 13 papers.

Database: EMBASE < 1980 to 2009 week 47

Search strategy:

  1. exp Cerebral palsy / 10537
  2. exp Child / 386644
  3. neurodevelopmental .mp. 6104
  4. Functional therapy .mp. (126)
  5. 1and 2 and 3 (105)
  6. 1and 2 and 4 (4)
  7. from 5 keep 29 (1)
  8. from 6 keep 2 (1)