Bobath Approach

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Introduction

The Bobath concept is a problem-solving approach used in the evaluation and treatment of individuals with movement and postural control disturbances due to a lesion of the central nervous system. It is named after Berta Bobath, a physiotherapist, and her husband Karl, a psychiatrist/neuropsychiatrist, who proposed the approach for treating patients affected with Central Nervous System anomalies.

They developed this approach for effective management of neuro-motor dysfunctions manifested by children with cerebral palsy (CP). Earlier, braces, passive stretching, and surgery were the most common forms of interventions. The Bobath concept provided a new reference that viewed children with CP as having difficulty with postural control and movement against gravity.

An international association was established in 1983 by a group of experienced Bobath instructors to facilitate the development of Bobath Concept. Since 1996, it is known as International Bobath Instructor Training Association (IBITA).

What is NDT?

Neurodevelopmental treatment is based on the premise that the presence of normal postural reflex mechanisms is fundamental to a motor skill's performance. The normal postural reflex mechanisms consist of righting and equilibrium reactions, reciprocal innervation, and coordination patterns. The release of abnormal tone and tonic reflexes seen in CP interfered with the development of righting and equilibrium reactions.

It is an interactive problem-solving approach that focuses on continuing reassessment with attention to individual goals, developing working hypotheses, treatment plans, and relevant objective measures to evaluate interventions.

• Regardless of severity, individuals of any age with damage to their CNS can be handled with this approach. This makes the approach different from other forms of treatment, like motor relearning or constraint-induced movement therapy, which can only work on high functioning individuals.
• It is congruent with the International Classification of Functioning, Disability, and Health. It lays emphasis on two interdependent aspects important for optimizing motor recovery following stroke:
  1. Integration of postural control and task performance.
  2. Selective movement control for the production of coordinated sequences of movements.
  3. In addition, the contribution of sensory inputs to motor control and motor learning has always been a vital focus of the Bobath concept.

Clinical Application of Bobath Concept

Motor Control

Bobath Concept concerns sensory, perception and adaptive behaviour along with the motor problem that involves the whole patient. It is a goal-orientated and task-specific approach, aiming to organise the internal (proprioceptive) and external (exteroceptive) environment of the nervous system for efficient functioning of the individual. It is an interactive process between patients and therapists.

Therapy focuses on the following:

• Neuro-muscular system, spinal cord and higher centres to change motor performance.
• Neuroplasticity, an interactive nervous system, and individual expression of movement.
• Overcoming weakness of neural drive after a UMN lesion through selective activation of cutaneous and muscle receptors.

Therapists should have the knowledge of the principles of motor learning: active participation, opportunities for practice, and meaningful goals. Bobath concept demands training in different real-life situations rather than just practicing in the therapy department. Task-specific muscle activation patterns and sensory input enables successful completion of the task in different contexts and environments, taking in to account the perceptual and cognitive demands.

Therapy addresses abnormal, stereotypical movement patterns that interfere with function. It is aimed at preventing development of spasticity and improving residual function. Therapists can influence hypertonia at a non-neural level by influencing muscle length and range.

Therapists work on tone to improve movement, not to normalise tone. Tone can be reduced by:

1. Mobilisation of muscles and stiff joints.
2. Muscle stretch.
3. Practice of more normal movement patterns.
4. Through a more efficient, less effortful performance of functional tasks.
5. Weight-bearing.

Musculoskeletal system

The Bobath approach addresses the problems that occur as a result of impairment of the developing central nervous system that affect the individual's sensory - motor, cognitive, perceptual, social and emotional development

• It is an approach/concept, not a method.
• It recognises that all clients with neurodisability have the potential for enhanced function.
• It recognises the need for thorough analysis of each patient's functional skills.
• It is based on available knowledge evidence.
• It is an important approach to the rehabilitation of patients with neurological injuries.
• In the United States the Bobath concept is usually referred to as 'neuro-developmental treatment' (NDT).
• It is based on the brain's ability to remodel and reorganise (neuroplasticity).
• It is a multidisciplinary approach, involving physiotherapists, occupational therapists and speech and language therapists.
• Individuals with CNS pathophysiology have dysfunction in posture and movement and subsequent functional activity limitations.

Living Concept

• The NDT/Bobath approach continues to be enriched with the emergence of new theories, new models and new information in the movement sciences. There have been changes in the concept of NDT but some aspects are remain the same.

Aspects that remain the same are:

1. It is a problem solving and assessments approach.
2. Tone plays an important role in movements pattern and postural control and directly effect the performance of functional tasks.
3. Handling is the main method for better functional and postural performance of tasks.
4. Individuals are encourage for active participation during treatment sessions.
5. Functional training is important of milestone developments.

Aspects that have been changed:

1. Neural and none neural components can be affected by tone.
2. Spasticity is rarely a major source of patient's movements disorders. In addition, as the characteristics of the population with CNS pathophysiology change, the approach continues to evolve.

Controversy about the effectiveness of NDT

There are some controversies that NDT is one of some therapeutics that should be no longer use , you can read about it more HERE

Sources

• Bobath concept

• International Bobath Instructors Training Association