What is Bobath?

Principles of Bobath

• Encouragement of normal movement patterns
• Focusing on quality of movement
• Normalisation of tone to facilitate active movement
• Positioning and posture in lying, sitting and standing
• Discouragement of compensatory movements
• Discouragement of muscle strength training
• Promotion of maximum functional recovery to improve quality of independence

Benefits of Bobath

• Normalise tone
• Regain motor control
• Make movements easier to achieve that are precise and goal directed
• Improve posture
• Lengthen tight muscles to help decrease spasticity and reduce contractures
• Improve ability with everyday activities
• Increase independence
• Achieve maximum potential

Bobath is currently used to treat neurological conditions including:

• Head Injury
• Stroke
• Spinal cord injury
• Cerebral Palsy
• Parkinson?s disease

Bobath concept

The Bobath concept is an approach to neurological rehabilitation that is applied in patient assessment and treatment (such as with adults after stroke,or children with cerebral palsy). The goal of applying the Bobath concept is to promote motor learning for efficient motor control in various environments, thereby improving participation and function. This is done through specific patient handling skills to guide patients through initiation and completion of intended tasks.This approach to neurological rehabilitation is multidisciplinary, primarily involving physiotherapists, occupational therapists and speech and language therapists. In the United States, the Bobath concept is also known as 'neuro-developmental treatment' (NDT).

The concept and its international tutors / instructors have embraced neuroscience and the developments in understanding motor control, motor learning, neuroplasticity and human movement science. They believe that this approach continues to develop.

History

The Bobath concept is named after its inventors: Berta Bobath (physiotherapist) and Karel Bobath (a psychiatrist/neurophysiologist). Their work focused mainly on patients with cerebral palsy and stroke. The main problems of these patient groups resulted in a loss of the standard postural reflex mechanism and regular movements.The Bobath concept was focused on regaining regular movements through re-education at its earliest inception. Since then, it has evolved to incorporate new information on neuroplasticity, motor learning, and motor control. Therapists that practice the Bobath concept today also embrace the goal of developing optimal movement patterns through the use of orthotics and appropriate compensations instead of aiming for ultimately "normal" movement patterns.

Stroke rehabilitation

In the Bobath Concept, postural control is the foundation on which patients begin to develop their skills. Patients undergoing this treatment typically learn how to control postures and movements and then progress to more difficult ones. Therapists analyze postures and movements and look for any abnormalities that may be present when asked to perform them. Examples of common abnormal movement patterns include obligatory synergy patterns. These patterns can be described as the process of trying to perform isolated movement of a particular limb, but triggering the use of other typically uninvolved muscles (when compared to normal movement) in order to achieve movement. Obligatory synergy patterns can be further subdivided into flexion and extension synergy components for both the upper and lower extremities. This approach requires active participation from both the patient and the therapist.Depending on the patient, rehabilitation goals may work to improve any or all of the following: postural control, coordination of movement sequences, movement initiation, optimal body alignment, abnormal tone or muscle weakness. Treatment will therefore address both negative signs such as impaired postural control, and positive signs such as spasticity.

Intervention strategies and techniques for Bobath consist of therapeutic handling, facilitation, and activation of key points of control. Therapeutic handling is used in order to influence the quality of the patients' movements and incorporates both facilitation and inhibition. Facilitation is a key technique used by Bobath practitioners to promote motor learning. It is the use of sensory information (tactile cue through manual contacts, verbal directions) to reinforce weak movement patterns and to discourage overactive ones. The appropriate provision of facilitation during the motor task is regulated in time, modality, intensity and withdrawal, all of which affects the outcome of motor learning. Inhibition can be described as reducing parts of movement/posture that are abnormal and interfere with normal performance. Key points of control generally refers to parts of the body that are advantageous when facilitating or inhibiting movement/posture.

Activities assigned by a Physical Therapist or Occupational Therapist to an individual who has suffered from a stroke are selected based on functional relevance and are varied in terms of difficulty and the environment in which they are performed. The use of the individual's less involved segments, also known as compensatory training strategies, are avoided. Carryover of functional activities in the home and community setting is largely attributed to patient, family and caregiver education.

The Bobath Concepts theoretical underpinning and practice is clearly documented in a contemporary book published by Wiley Blackman in 2009: Bobath Concept: Theory and Clinical Practice in Neurological Rehabilitation' written by the British Bobath Tutors Association (BBTA) and edited by Raine, Meadows and Lynch-Ellerington. The chair of ACPIN (Association of Chartered Physiotherapists in Neurology) reviewed this book and concluded :- “I am not really sure that it is clear from the book what the Bobath approach actually is”, “often the prose turns into jargon” and “this book will do little to quell the critics; in fact it will no doubt give them more fuel for the fire”.

Research

Paci (2003) conducted an extensive critical appraisal of studies to determine the effectiveness of the Bobath concept for adults with hemiplegia following a stroke. Selected trials showed no evidence proving the effectiveness of the Bobath Concept as the optimal type of treatment. Paci (2003) recommended that standardized guidelines for treatment be identified and described, and that further investigations are necessary to develop outcome measures concerning goals of the Bobath approach such as quality of motor performance.

Bobath therapy is nonstandardized as it responds, through clinical reasoning and the development of a clinical hypothesis, to the individual patient and their movement control problems. The decisions about specific treatment techniques are collaboratively made with the patient, and are guided by the therapist, through the use of goal setting and the development of close communication and interaction. Working to develop improved muscle tone, appropriate to the task, the individual and the environment, will enable better alignment and activation of movement, and allow for recruitment of, for example, arm activity in functional situations within various positions.

A study by Lennon et al. concluded that even under idealized conditions (patients with optimal rehabilitation potential, advanced trained therapists, unlimited therapy input and a movement analysis laboratory) the Bobath approach had no effect on the quality of gait for patients with a stroke.