Philosophy - Neuro-Developmental Therapy Programs

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The Therapy
Neuro-Developmental Therapy Programs applies the principles of normal development to the treatment of children and adults with a brain injury. It recognises that normal brain growth follows a structured pattern, a step-by-step process by which higher brain areas progressively develop from the levels below. Children usually crawl before they walk, and wherever possible the same should apply to someone with a brain injury.

The process of normal development "wires up" and organises the brain, stimulating into action neurons that are dormant or non-specific at the time of birth - exactly what needs to happen for a therapy program to be successful. Given the importance of normal development to the overall growth of the brain, one of the first questions that needs to be asked when devising a therapy program is: "How does this function normally develop?".  For instance, when teaching an immobile child to move, the stages of normal development have to be identified and utilised wherever possible. Attention needs to be directed towards the lower movement stages such as tummy crawling and hands and knees crawling, before an attempt is made to develop  more sophisticated movement patterns.

These treatment techniques have to be applied with correct frequency, intensity and duration - at a level that is determined by the child's age, and the severity and nature of the brain injury.  They should not be used in isolation, since with a problem as complex as brain injury there is never just one answer. But a developmental approach such as that used by Neuro-Developmental Therapy Programs provides the important nucleus around which the therapy program can be based.

Foundations of Development
“The basic architecture of the brain is constructed through an ongoing process  that  begins  before  birth  and  continues  into  adulthood.  Like the construction of a home, the building process begins with laying the foundation, framing the rooms, and wiring the electrical system in a predictable sequence and it continues with the incorporation of distinctive features that reflect increasing individuality over time.” National Scientific Council Center on the Developing Child at Harvard University.

Post-birth brain development begins with sensory input, the constant stimulation of the brain via the five senses. What follows is just as important - the constant practice and repetition of the newly developing skills. In the ideal situation, a marvelous symphony of reception and motion is performed over and over and over again, and slowly but surely the human brain becomes more organised and capable.

"Brain circuits that process basic information are wired earlier than those that process more complex information.  Higher level circuits build on lower level circuits, and adaptation at higher levels is more difficult if lower level circuits were not wired properly. Parallel to the construction of brain circuits, increasingly complex skills build on the more basic, foundational capabilities that precede them. Stated in simple terms, circuits build on circuits and skill begets skill". National Scientific Council Center on the Developing Child at Harvard University.

The contents of each therapy program is dependent on the  current developmental status. The milestone chart reveals the problem areas, and this is where the therapy program will focus. A lot of attention is placed on the foundation levels for each function, and the milestone chart will often reveal weaknesses in these areas. For example, a child who is having difficulty learning to walk may in fact have problems with some of the developmental levels that are required for walking to take place. Things such as balance, body awareness, coordination, completion of lower functions such as crawling, rolling, good sitting control, etc. These areas are critical for good walking, therefore the therapy program may initially work on establishing and strengthening these lower levels.

Likewise, a child who is struggling with speech may have deficiencies in some of the lower developmental levels, so attention may need to be directed towards establishing a good range of sounds, encouraging more frequent attempts at verbal communication, and reinforcing the current sound or word vocabulary. Sensory intergration often plays an important role in the therapy program. If there is evidence of tactile, spatial, balance and body awareness deficiencies, activities that focus on these areas would be the main focus of the initial therapy program.

Floor Time
“The floor is the gymnasium of the child” - Maria Montessori, famous child educator and founder of the Montessori Method.

In normal development, the first stage in the process of learning to walk occurs a long time before the baby is able to support her weight on her legs. The time a baby spends on the floor is critical to the eventual development of walking.  Rolling, tummy crawling and hands and knees crawling all help develop the foundations required for walking - balance and body sense, coordination, and muscle strength and control.

Floor time is equally important for a brain injured child. Before an effort is made to teach the child to stand, a lot of time needs to be spent on teaching the various floor movements such as rolling, tummy crawling and hands and knees crawling, and then allowing maximum time for these activities to be performed.

In 2008, Pathways Awareness, a US child development organisation, surveyed 409 therapists belonging  to the Neuro-Developmental Treatment Association (NDTA) or the American Physical Therapy Association (APTA), who work regularly with children and who averaged more than 20 years of experience. The results showed that two-thirds of the therapists reported that, in the past several years, they had observed an increase in early motor delays in babies under six months of age. When asked to explain this increase in motor delays, all of the therapists felt that decreased floor time was one of the main contributing factors.
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