Current assumptions underlying The Bobath Concept

The CNS is a complex organisation consisting of systems and subsystems. It uses a shifting focus of control depending on many biomechanical, neuroanatomical and environmental issues.

The CNS and neuromuscular system can adapt and change their structural organisation in response to intrinsic and extrinsic information i.e. they are plastic.

The manipulation of afferent input can directly effect a change in the structural organisation of the CNS through spatial and temporal summation and the facilitation of pre and postsynaptic inhibition.

Changes within in the structure of the CNS can be organised or disorganised producing adaptive or maladaptive sensorimotor behaviour.

Motor skill is based on reciprocal innervation and sequential recruitment within the Henneman principle, providing selectivity of movement control combining stability with mobility. this gives selectivity of movement control by combining stability with mobility.* Movement control is dependent on an integrated neurological and muscular system.

Selective movement control of the trunk and limbs, both concentric and eccentric are interdependent and interactive with a postural control mechanism.

The recovery of selective movement is a prerequisite for efficient postural control, alignment, and function.

Rehabilitation is a process of learning to regain motor control and should not be the promotion of compensation that can occur naturally as a result of a lesion and also as a result of therapy.

The cellular mechanisms underlying learning are the same mechanisms that take place during the development, refinement, and re-learning of motor control. These mechanisms can result in long or short-term learning i.e. carry-over or no carry-over.

Key aspects of implementation

Assessment

The International Classification of Function (ICF)(WHO 2001) provides a basis for assessment of the individual's ability to perform functional activities and participate in life situations, and for analysing the underlying impairments which may result in dysfunction1.

The individual is evaluated in terms of total function within all appropriate environments and the assessment is individualised to address specific bio-psycho-social needs.

The aim of the assessment is to identify and analyse problems with functional activities and participation in daily life situations, as well as to analyse movement components and underlying impairments.

Goal of intervention

1 World Health Organisation (2001) International Classification of Functioning, Disability, and Health (ICF)GenevaWHO

The goal of intervention is to optimise overall function (activities and participation.)

Goal setting and intervention are interactive processes requiring the involvement of the individual and, where appropriate, his caregivers.

Analytical problem solving is used to set up a treatment plan, in consultation with the individual1.

1 NDTA Inc. (1998) NDT - Theoretical overview

Intervention strategies

Intervention seeks solutions for motor behaviour which interferes with successful performance of an activity. Treatment strategies address underlying impairments, task-specific components of posture and movement, the functional activity itself and its integration into participation in relevant situations in daily life. Cognitive, emotional and behavioural factors are addressed in order to enable the individual to engage in task-related problem solving.

The therapist tries to optimise postural and movement strategies in order to re-establish effective task performance. Specific handling techniques and facilitation of normal movement patterns are amongst the many strategies used to achieve functional goals1, and are modified and withdrawn as independant control is acquired. The task and the environment may be structured to facilitate succesful performance by directing the individual's attention to and awareness of the task as well as by reducing the physical demands of the task. Effective intervention involves a total management strategy across 24 hours per day, and preventative and promotive measures have to be included.

Assessment and treatment are ongoing, with continuous evaluation of the response of the individual and with adjustment of goals and of the treatment plan. Changes in function are monitored and outcome is measured. Throughout, the therapist ensures that cognisance is taken of research findings in the field of neurological rehabilitation and that, following critical evaluation of published material, the approach to intervention is evidence-based.

1 NDTA Inc. (1998) Neurodevelopmental treatment philosophy (draft document)

Reflections and Annotated Citations

Suggested Reading

Lennon S (1996) The Bobath concept: a review of the theoretical assumptions that guide physiotherapy practice in stroke rehabilitation. Physical Therapy Reviews, 1, 35-45

Lennon S & Ashburn A (2000) The Bobath concept in Stroke Rehabilitation: A focus group of the experienced physiotherapists' perspective. Disability and Rehabilitation; 22: (15), 665-674

Lennon S, Baxter D & Ashburn A (2001) Physiotherapy based on the Bobath concept in Stroke Rehabilitation: A survey within the UK. Disability and Rehabilitation; 23: (6), 254-262

Lennon S (2001) Gait Re-epducation based on the Bobath concept in two patients with hemiplegia following stroke. Physical Therapy; 81: 924-935

Luke C, Dodd KJ, Brock K (2004) Outcomes of the Bobath concept on upper limb recovery following stroke. Clinical Rehabilitation; 18: 888-898

Mayston M (1992) The Bobath Concept- Evolution and Application. Medicine and Science in Sport; 36: 1-6

Mayston M (2001) The Bobath Concept Today. Synapse; Spring edition.32-35
www.ACPIN.net
www.bobathlondon.co.uk

Mayston M (2005) The Bobath Concept: A view from the United Kingdom. The Neuro-developmental Treatment association; (NDT Network); (2), 12

Mudie MH et al (2002) Training Symmetry of weight distribution after stroke: a randomised controlled pilot study comparing task-related reach, Bobath and feedback training approaches. Clinical Rehabilitation; 16: 582-592

Paci M (2003) Physiotherapy based on the Bobath concept for adults with post stroke hemiplegia. A review of the effectiveness of the studies. Journal of Rehabilitation Medicine; 35: 2-7

Raine S (2006) Defining the Bobath concept using the Delphi technique. Physiotherapy Research International; 11: (1), 4-13

Smedal T, et al (2006) Balance and gait improved in patients with MS after physiotherapy based on the Bobath concept. Physiotherapy Research International;; 11: (2), 104-116

Van Vliet P, Lincoln NB & Robinson E (2001) Comparison of the content of two physiotherapy approaches for stroke. Clinical rehabilitation; 15: 398-414

Van Vliet P, Lincoln NB, Foxall A (2005) Comparison of Bobath based and movement science based treatment for stroke: a randomised controlled trial. Journal of Neurology, Neurosurgery and Psychiatry; 76: 503-508

Wang R, et al (2005) Efficacy of Bobath versus orthopaedic approach on impairment and function at different motor recovery stages after stroke: a randomised controlled study. Clinical Rehabilitation; 19,155-164

Poster Presentations on the Bobath Concept