Facilitation
Neurodevelopmental Therapy
Neurodevelopmental therapy, also called the Bobath approach, aims treatment at reducing the inappropriate reflexes and training the muscles to achieve normal balanced reactions. This is achieved through analyzing postural reflex activity and producing normal patterns of movements to the extent possible, either passively or actively, with assistance as needed. This therapy has recently evolved to include restraining the unaffected or less affected arm or leg and requiring the patient to use the affected limb.
Proprioceptive Neuromuscular Facilitation
Like neurodevelopmental therapy, this technique seeks to retrain spastic muscles how to move normally. Patients are taught to roll on the floor, rise to sit, stand, and walk. The philosophy behind this facilitation is that motor behavior is a series of responses to a series of sensory demands. The stronger and less spastic muscles are enlisted in an effort to strengthen and provoke the weaker muscles. Range of motion exercises are performed on the diagonal, first on the stronger muscles and then moving on to the weaker parts of the hand or foot in an attempt to increase the proprioceptive feedback to the muscles.
Sensory Integration
The basic premise of sensory integration is that impaired processing of sensory stimuli results in abnormal motor responses. Therefore, the sensory information must be put in order so that the person with spasticity can use that information. Tasks are learned by continually repeating them, often with the therapist directing the limb and the patient remaining passive, so that the brain is "retrained" in the proper movements.
