Key points of control illustrations by examples
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This document discusses the principles of Neurodevelopmental Treatment (NDT) for children with cerebral palsy, focusing on the concept of key points of control that influence posture and movement through appropriate touch. It outlines the two types of key points—proximal and distal—and provides specific techniques to facilitate normal postures and movements. Additionally, it offers practical tips for therapists to ensure effective intervention while being mindful of the child's condition.
Key points of control illustrations by examples
- 1. KEY POINTS OF CONTROL IN CEREBRAL PALSY PRESENTER: SARA SHEIKH 3RD YEAR, 6TH SEMESTER OCCUPATIONAL THERAPY
- 2. NEURODEVELOPMENTAL TREATMENT (NDT) The concept is based on two fundamental principles about the nature of the CNS dysfunction: 1. The arrest, or retardation of normal movement is caused by the interference with normal brain maturation resulting from brain lesion 2. The resultant release of abnormal, or immature, postural reflex activity causes the observed abnormal patterns of posture and movement.
- 3. Intervention strategies and techniques for NDT consist of: • facilitation • inhibition • key points of control.
- 4. WHAT ARE KEY POINTS OF CONTROL? The way the child is touched during therapy has a powerful effect, so it must be ensured that this effect is positive. It helps to know that through just one point at one time, the child’s posture and movement pattern can be changed. These points are called Key Points of Control. Through these, the child can be stimulated as well as his spasticity inhibited and normal postures and movements facilitated.
- 5. TYPES OF KEY POINTS Key points are of two types: Pr oximal and Distal PROXIMAL KEY POINTS: DISTAL KEY POINTS: They are located closer to the Distal key points work only if the source of problem and child has some postural control facilitate more activity distally. proximally and are located away from the source of problem.
- 6. PROXIMAL KEY POINTS: HEAD, SHOULDER GIRDLE, TRUNK, PELVIS
- 7. HEAD POSITION: FACILITATES: Raising the head in prone, Extension in the rest of the sitting and standing body (if no STNR influence present)
- 8. SHOULDER GIRDLE POSITION: FACILITATES: Applying moderate pressure at Stabilises shoulder girdle, the shoulders while sitting. trunk and hips.
- 9. TRUNK POSITION FACILITATES Hold trunk firmly while sitting Promotes trunk and pelvic or standing stability and head control
- 10. PELVIC GIRDLE POSITION FACILITATES Push hip forwards, standing Stabilises pelvis and legs to with support. achieve a better standing. Hold pelvis while sitting. Better sitting balance and posture.
- 11. DISTAL KEY POINTS: ARMS/ELBOWS, HANDS, KNEES/LEGS, FEET
- 12. ELBOWS/ARMS POSITION: FACILITATES: Adduction of extended arms Stabilises shoulder girdle; Better head control in pulling to sit and vice versa.
- 13. HAND (BASE OF THUMB) POSITION: FACILITATES: Abduction of thumb with Opening of the fingers. supination and wrist extension.
- 14. KNEES/LEGS POSITION FACILITATES Grasp legs or knees while Better standing balance will be standing achieved.
- 15. FEET POSITION: FACILITATES: Pulling feet slightly upwards Extension of pelvic girdle and while in prone spine: weight bearing on elbows.
- 16. Overlap in effects of Proximal and Distal key points can occur, so the therapist can change or combine them as the child moves.
- 17. SOME COMBINATIONS OF KEY POINTS
- 18. HEAD AND ARMS POSITION: FACILITATES: Head raised with horizontally Extension of upper spine, abducted arms. opening of fingers and abduction of legs.
- 19. PELVIS AND SHOULDER GIRDLE POSITION FACILITATES Apply moderate pressure Trunk stability and head simultaneously at pelvic and control will be maintained shoulder girdles while throughout the movements. pulling to sit
- 20. SOME USEFUL TIPS • Keep your hands firmly on the child. Light movement and touch cannot be used to control or guide. • Be careful about positioning with children having asthma, lung infections, stomach or kidney problems. • Be careful about the choice of key point. It would be useless if you try to “pull-to-sit” a child by grabbing his hands when his shoulders/neck muscles are weak.