神經發展治療理論應用在腦性麻痺兒童的過去、現在與未來

The Past, Present, and Future of the neuro-developmental Treatment Approach Mainly on Applying to Treat Children with Cerebral Palsy

林鋐宇(Hung-Yu Lin)

《職能治療學會雜誌》 23卷 (2005/10) Pp. 26-37

https://doi.org/10.6594/JTOTA.2005.23.03

摘要

神經發展治療(neuro-developmental treatment, NDT)理論在復健的領域中佔有相當重要的地位，這個在半世紀前就已經形成並加以運用在臨床的理論，至今仍被國內外復健專業人員所倚重，尤其是應用在中風病人與腦性麻痺兒童的治療上。然而，這個玻巴斯(Bobath)夫婦口中之「活的概念」並非是一成不變的，在這幾十年來，由於動作科學與醫學的演進，促進了NDT理論的汰舊換新，國外探討此理論演變的各種文獻也一直沒有間斷，讓這個已經產生相當變化的理論仍能繼續盛行。這些演變的觀點，分散在NDT理論中的各個層面，因此有必要對此理論的演進方向作進一步探討與整理。
筆者將參與八週NDT訓練之經驗與近幾年的相關文獻加以綜合統整，從理論的轉移、重要觀念的轉變、評估的模式等幾個方向探討NDT理論的變與不變，以釐清NDT理論在新、舊觀念間的差異，並且由理論面與技術面探討NDT理論未來發展的趨勢。希望藉由這篇對NDT理論的過去、現在、和未來發展所作的綜合性探討，能夠提供職能治療專業人員在應用此理論時有更明確的方向。

關鍵字

神經發展治療理論 ； 玻巴斯 ； 腦性麻痺 ； 治療性操作

並列摘要

Neuro-developmental treatment(NDT) approach plays an important role in the field of rehabilitation, this approach was formulated and applied in clinic settings a half century ago , and it still be treated as an important theory in dealing with patients with stroke and children with cerebral palsy nowadays. However, the ”living concept”, which was mentioned by Mr. and Mrs. Bobath, is not unalterable. Due to the evolution of movement science and medical fields in the decades, some wrong concepts were removed from the original NDT approach and inputted some prevailing concepts in the present NDT approach. There have been a lot of articles and research contributed in discussing the evolution of this approach, those discussions make NDT theory keep prevailing; these views of evolution, disperse each aspect in NDT theory, it is necessary to discuss and synthesize the evolution of this approach.
The author synthesized the experience of eight-weeks NDT professional course and the recent references in few directions, including the transference of the theory, the transference of important concepts in NDT approach, and the assessment format of NDT approach to clarify the difference between the present and past concepts. The author also discussed the future of NDT approach from theoretical and technical directions. Hopefully, this article could clearly deliver more correct concepts and directions of NDT approach to occupational therapists.

並列關鍵字

neuro-developmental approach ； Bobath ； cerebral palsy ； therapeutic handling