1/4 Hour Neuro #64: "Combining Professional Practice and NPT" - Laurent Anelli

Welcome to the Neuro Quarter Hour

Today, we have Laurent Anelli, a physiotherapist and osteopath, who will enlighten us on the integration of Neuro-Postural Reprogramming (NPT) into his practice. His innovative approach, combining traditional methods with NPT, generated considerable interest at our last seminar in February. Laurent, who balances a multitude of concepts, has fully embraced this tool, providing valuable insights for therapists questioning the relevance and methods of integrating NPT.

Many professionals wonder if this approach is right for them, if they will find the time to apply it in practice, or how to move beyond the habits formed during their initial training in physiotherapy or osteopathy. Laurent shares his journey, the challenges encountered, and the solutions discovered to facilitate this integration, particularly by making connections between NPT and specific manipulations.

Background and Discovery of NPT

Laurent, a physiotherapist and osteopath, discovered NPT while seeking a better understanding of posturology. After an initial training that he found interesting but lacking in explanation of the underlying mechanisms, he turned to a more neuro-centered approach. The desire to understand why and how treatments worked led him to deepen his knowledge, which is not always easy at the start of a new training program.

He emphasizes that integrating new techniques requires time and adaptation, especially when accustomed to established protocols. Initially, the results with NPT were not immediately satisfactory, but Laurent persevered to find the right balance with his daily practice.

Integrating NPT into Daily Practice

With Physiotherapy Patients

With physiotherapy patients, whom Laurent sees several times a week for 30 minutes, it is easier to gradually integrate NPT. He begins with classic rehabilitation (manual therapy, mobilizations, strengthening) and introduces NPT when blockages persist or improvement plateaus. The goal is to optimize performance, even at low levels, for example, by using visual fixations during strengthening exercises.

With Osteopathy Patients

Osteopathy consultations allow more time (about an hour), enabling more comprehensive postural assessments. Laurent must quickly identify problems and propose relevant corrective exercises, combining NPT with his osteopathic techniques.

Evidence of Effectiveness and Limitations of NPT

Laurent recounts the case of a patient with a knee prosthesis, whose rehabilitation stalled despite various basic sensory and visual stimulations. A diagnosis revealed an underlying pathology requiring arthrolysis. After the operation and normal recovery of range, the simple application of NPT (stimulating the eyes and foot sensitivity) allowed for immediate regaining of range. This demonstrates that while NPT is a powerful tool for functional issues, it does not replace the treatment of mechanical pathologies.

NPT often acts by lifting sensory and nerve locks that the brain may set up, especially after trauma or surgery, thereby restoring better range and enhancing joint and muscle work.

The Role of Primitive Reflexes in Osteopathic Practice

Laurent places significant importance on primitive reflexes in osteopathy. Quick tests, such as dorsal flexion-extension, allow him to detect their presence. He has found that releasing a primitive reflex, notably the Moro reflex, can facilitate an osteopathic manipulation in stressed or tense patients. However, he has also observed that sometimes, the manipulation itself can reintegrate the reflex.

He often gives home exercises to reinforce the integration of reflexes, which he selects simply (mobility exercises, strengthening, or neuro-stimulations with a ball), so that the patient is an active participant in their rehabilitation.

The Link Between Osteopathic Manipulation and NPT

Laurent has noted that manipulating the thoracic vertebrae, particularly for an Asymmetrical Tonic Neck Reflex (ATNR), can have a significant impact. These manipulations affect the parasympathetic nervous system, located at the level of the thoracics, thereby rebalancing the entire nervous system. This "reset" can relieve stress reflexes such as the Moro or Abnormal Protective Reflexes (APR), which block other primitive reflexes.

After such manipulation, patients often report immediate relief and improved range, confirming the interconnection between body mechanics and the nervous system. The resulting relaxation of muscle tone facilitates the therapist's work.

Quick Testing and Targeting Brain Hemispheres

In physiotherapy, in his office equipped with a small gym, Laurent uses quick testing, particularly walking, to assess patients. This allows him to determine whether the problem originates from the brainstem or cerebellum, and on which side. This information is crucial for targeting exercises. For example, if a patient's shoulder is painful, he can stimulate the affected side a little more or alternate to rebalance, drawing inspiration from the principle of working the opposite side in case of immobilization to prevent atrophy.

These experiences provide valuable feedback to improve the training and testing offered.