Key aspects of implementation

Assessment

The International Classification of Function (ICF)(WHO 2001) provides a basis for assessment of the individual's ability to perform functional activities and participate in life situations, and for analysing the underlying impairments which may result in dysfunction1.

The individual is evaluated in terms of total function within all appropriate environments and the assessment is individualised to address specific bio-psycho-social needs.

The aim of the assessment is to identify and analyse problems with functional activities and participation in daily life situations, as well as to analyse movement components and underlying impairments.

Goal of intervention

1 World Health Organisation (2001) International Classification of Functioning, Disability, and Health (ICF)GenevaWHO

The goal of intervention is to optimise overall function (activities and participation.)

Goal setting and intervention are interactive processes requiring the involvement of the individual and, where appropriate, his caregivers.

Analytical problem solving is used to set up a treatment plan, in consultation with the individual1.

1 NDTA Inc. (1998) NDT - Theoretical overview

Intervention strategies

Intervention seeks solutions for motor behaviour which interferes with successful performance of an activity. Treatment strategies address underlying impairments, task-specific components of posture and movement, the functional activity itself and its integration into participation in relevant situations in daily life. Cognitive, emotional and behavioural factors are addressed in order to enable the individual to engage in task-related problem solving.

The therapist tries to optimise postural and movement strategies in order to re-establish effective task performance. Specific handling techniques and facilitation of normal movement patterns are amongst the many strategies used to achieve functional goals1, and are modified and withdrawn as independant control is acquired. The task and the environment may be structured to facilitate succesful performance by directing the individual's attention to and awareness of the task as well as by reducing the physical demands of the task. Effective intervention involves a total management strategy across 24 hours per day, and preventative and promotive measures have to be included.

Assessment and treatment are ongoing, with continuous evaluation of the response of the individual and with adjustment of goals and of the treatment plan. Changes in function are monitored and outcome is measured. Throughout, the therapist ensures that cognisance is taken of research findings in the field of neurological rehabilitation and that, following critical evaluation of published material, the approach to intervention is evidence-based.

1 NDTA Inc. (1998) Neurodevelopmental treatment philosophy (draft document)