Therapy Talk: What is NDT?

What’s with the ironing board???

If you are a patient, friend or family member at Aim2Walk you may have seen me around the clinic, toting an ironing board under my arm.  I am actually not trying to teach our patients to iron my shirts for me.  I bring out the ironing board when I am using the NDT approach of therapy with stroke or traumatic brain injured patients.  Matt and I are both NDT Certified therapists, and we incorporate this technique into our treatment sessions with our clients.  I thought I would use this opportunity to introduce you tothe NDT approach!

What is NDT Approach?
Neuro- Developmental Treatment is a therapy approach for patients with a neurological condition.  It is a hands-on, problem solving approach where the therapist uses his or her hands to provide guidance and optimize function.  NDT Certified therapists work together with patients, families, caregivers and other healthcare professionals to develop individualized comprehensive treatment programs based on NDT theory and philosophy.

What is the NDT Philosophy?
Before I started my NDT training, I had a hard time finding out what the NDT approach was.  Was it the same as Bobath therapy? What made it different? How would it fit in with what I already knew about physiotherapy? The answer, I found out, was that the NDT approach grew out of the work of Karl and Berta Bobath, but has continued to evolve and change with the addition of new research, theories and models in physiotherapy practice.  Current NDT practice blends the ideas of the Bobaths with knowledge gained in the field of Movement Science, which was the basis of my neurological physiotherapy training.

What Does the NDT Therapist Do?
As an NDT therapist, my job is to be always watching analyzing my patient’s posture and movement.  During an assessment or treatment session I will ask myself 3 basic questions.
What am I seeing?
What does my patient’s movement look like?  Does it look like a normal movement? Are they “cheating”?  Which body parts are moving and which ones aren’t?
Why is that happening?
Why does my patient move that way? Is it because of weakness? Is it because of stiffness? Is it because of pain or discomfort? Is it because they cannot control their movement?
How can I change this in treatment?
How can I use my hands to guide my patient’s movement? How can I reduce the “cheating” that I see? How can I change the activity to encourage my patient to relearn this skill?

How does ‘Therapeutic Handling’ make the difference?
As an NDT therapist, I rely on my touch both to get information from my patient’s body and as a way to guide the body into improved movement and postures.  In this way, I use my hands as both an assessment tool and a treatment tool.
Assessment tool:
I use my hands to feel the way my patient achieves the postures and movements required for activities.  Through my hands I can get information about how the body is lined up, where the weight is being carried, balance, coordination, muscle tension, and motion.  This information helps me to understand why the patient moves the way they do.
Treatment Tool:
As a treatment tool, my hands are used to encourage some movement and postures and discourage others while learning a new skill.  This is done through the combination of:
Facilitation: I can use my touch to give guidance or direction that makes it easier for my patient to move.
Inhibition: I can use my touch to prevent or reduce incorrect postures or movement “cheats”.
Motor Learning:  I use my knowledge of how skills are learned and relearned and combine it with facilitation and inhibition to maximize my patients learning potential. 

As an NDT therapist, I feel that my hands are important tool in helping my patients achieve their therapy goals.  If you are interested in learning more about the NDT Approach you can visit the Neuro-Developmental Treatment Association website at

Reference: Howle JM (ed). Neuro-Developmental Treatment Approach: Theoretical Foundation and Principles of Clinical Practice.  NDTA, 1540 S. Coast Hwy., Suite 203, Laguna Beach, CA 92651. Copyright 2002 (

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