Using a Neurodevelopmental Treatment Certification Course to Bolster Data Collection Opportunities

Background & Purpose: Neurodevelopmental Treatment (NDT) has been utilized as a practice model in neurorehabilitation for children for many years. The current NDT contemporary practice model (CPM) has evolved along with developments in neuroscience and neuroplasticity. For clinicians who use the NDT-CPM, there is a perception, based on anecdotal clinical experience, that this treatment practice approach is effective and helps facilitate improved function and participation for the children served. There is limited evidence to support the efficacy of NDT-CPM in the treatment of children with CP and other neuromuscular conditions. There are certification courses for clinicians through the Neuro-Developmental Treatment Association that are taught by certified Instructors. This case series served as a pilot study for using one such certification course, involving a 6-week practicum, to collect data to strengthen the evidence for the efficacy of NDT.

Case Description: Data were collected for 14 children pre- and post- participation in the course practicum. They were between the ages of 1.9 and 7.4 years, 43% female, and 38% ambulatory. Subjects received between 7 and 23 NDT treatment sessions, with a mean of 11.5 sessions. The Canadian Occupational Performance Measure (COPM) and the Functional Independence Measure for children (WeeFIM) were administered pre- and post- practicum to assess impact. Assessors were not involved in treatment.

Outcomes: On the COPM, 21% (n=3) of children had a clinically meaningful change (MCID=2 points) in performance, while a different 21% (n=3) had a clinically meaningful change in satisfaction. For the bulk of the children, change in performance and satisfaction were < 1, though the group was too small to draw concrete conclusions. The children with meaningful change were as a group, older and had more total NDT sessions. WeeFIM scores did not show meaningful change.

Discussion: This case series demonstrated some positive changes for 6 of 14 children who were part of a pilot study examining the efficacy of NDT. It was hypothesized that a certification course could be used as a platform to collect data to advance the assessment of NDT-CPM for children with CP. However, the minor impact on outcomes in this case series suggests the need for a different venue for data collection to help generate research on the efficacy of NDT. The treating clinicians were novices to NDT-CPM and were in early stages of motor learning in the application of this model. Utilizing certified NDT-CPM clinicians, a future study could be warranted for children above a certain age, who all have a similar diagnosis, and who receive a prespecified number of sessions. Qualitative research may also support the assessment of the benefits of NDT-CPM, as the families whose children were part of this case series expressed positive comments and impressions for the experience.