Bobath concept
Encyclopedia
The Bobath concept is a broad and ever-evolving approach in 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 neurolog ical rehabilitation is multidisciplinary, primarily involving physiotherapists, but may also include occupational therapists and speech-language pathologists. In the United States, the Bobath concept is also known as 'neuro-developmental treatment' (NDT).
Despite widespread acceptance of the Bobath concept in stroke rehabilitation, literature has not found it to be superior compared to other treatment approaches.
) 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 normal postural reflex mechanism and normal movements. At its earliest inception, the Bobath concept was focused on regaining normal movements through re-education. 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 completely "normal" movement patterns.
.
Intervention strategies and techniques for NDT consist of therapeutic handling, facilitation, inhibition and 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 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 Concept is summarized in Adult Hemiplegia: Evaluation and Treatment, by Berte and Karel Bobath. The first, second, and third editions were published in 1970, 1978, and 1990, respectively.
"If they are to offer neurophysiologically sound approaches, clinicians must consider how the central nervous system creates the commands that drive and guide the hand to reach into space and grasp an object or the legs to take steps on flat or uneven ground." (Dobkin, 2000)
Rehabilitation (neuropsychology)
Rehabilitation of sensory and cognitive function typically involves methods for retraining neural pathways or training new neural pathways to regain or improve neurocognitive functioning that has been diminished by disease or traumatic injury....
that is applied in patient assessment and treatment (such as with adults after stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
, or children with cerebral palsy
Cerebral palsy
Cerebral palsy is an umbrella term encompassing a group of non-progressive, non-contagious motor conditions that cause physical disability in human development, chiefly in the various areas of body movement....
). 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 neurolog ical rehabilitation is multidisciplinary, primarily involving physiotherapists, but may also include occupational therapists and speech-language pathologists. In the United States, the Bobath concept is also known as 'neuro-developmental treatment' (NDT).
Despite widespread acceptance of the Bobath concept in stroke rehabilitation, literature has not found it to be superior compared to other treatment approaches.
History
The Bobath concept is named after its inventors: Berta Bobath (physiotherapistPhysical therapy
Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...
) 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 normal postural reflex mechanism and normal movements. At its earliest inception, the Bobath concept was focused on regaining normal movements through re-education. Since then, it has evolved to incorporate new information on neuroplasticity
Neuroplasticity
Neuroplasticity is a non-specific neuroscience term referring to the ability of the brain and nervous system in all species to change structurally and functionally as a result of input from the environment. Plasticity occurs on a variety of levels, ranging from cellular changes involved in...
, motor learning
Motor learning
Motor learning is a “relatively permanent” change, resulting from practice or a novel experience, in the capability for responding...
and motor control
Motor control
Motor control are information processing related activities carried out by the central nervous system that organize the musculoskeletal system to create coordinated movements and skilled actions...
. Therapists that practice the Bobath concept today also embrace the goal of developing optimal movement patterns through the use of orthotics
Orthotics
Orthotics is a specialty within the medical field concerned with the design, manufacture and application of orthoses. An orthosis is an orthopedic device that supports or corrects the function of a limb or the torso...
and appropriate compensations, instead of aiming for completely "normal" movement patterns.
Application in stroke rehabilitation
In Neurodevelopmental Treatment (NDT), 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 spasticitySpasticity
Spasticity is a feature of altered skeletal muscle performance in muscle tone involving hypertonia, which is also referred to as an unusual "tightness" of muscles...
.
Intervention strategies and techniques for NDT consist of therapeutic handling, facilitation, inhibition and 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 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 Concept is summarized in Adult Hemiplegia: Evaluation and Treatment, by Berte and Karel Bobath. The first, second, and third editions were published in 1970, 1978, and 1990, respectively.
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. Although selected trials showed no evidence proving the effectiveness of NDT as the optimal type of treatment, neither did they show evidence of non-efficacy because of methodological limitations. The Bobath therapy is nonstandardized and the decisions about specific treatment techniques are left to the individual therapist, who decides how to control muscle tone and how to achieve recruitment of arm activity in functional situations with various positions. 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."If they are to offer neurophysiologically sound approaches, clinicians must consider how the central nervous system creates the commands that drive and guide the hand to reach into space and grasp an object or the legs to take steps on flat or uneven ground." (Dobkin, 2000)
See also
- Occupational therapyOccupational therapyOccupational therapy is a discipline that aims to promote health by enabling people to perform meaningful and purposeful activities. Occupational therapists work with individuals who suffer from a mentally, physically, developmentally, and/or emotionally disabling condition by utilizing treatments...
- Physical therapyPhysical therapyPhysical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...
- Speech and language pathologySpeech and language pathologySpeech-Language Pathology specializes in communication disorders.The main components of speech production include: phonation, the process of sound production; resonance, opening and closing of the vocal folds; intonation, the variation of pitch; and voice, including aeromechanical components of...
- Brunnstrom ApproachBrunnstrom Approach-History:The Brunnstrom Approach, developed by the Swedish physical therapist Signe Brunnstrom, emphasises the synergic pattern of movement which develops during recovery from hemiplegia...