Bobath is Not About Symmetry. It’s About Optimising Cortical State.
- Karen Blagojevic
- 4 days ago
- 2 min read
Written by Karen Blagojevic.
One of the most persistent misunderstandings I encounter is the idea that therapists applying the Bobath Concept are focused on making patients “symmetrical.” We are not chasing symmetry. We are interested in optimising the state of the nervous system—specifically, state-dependent motor cortex excitability.
Selective movement does not simply appear because a patient “tries harder.” It emerges when the motor cortex, descending systems, spinal networks, and postural muscles are in the right state. Decades of neuroscience have shown that corticospinal output is highly state-dependent (Rothwell, 1997; Lemon, 2008). Motoneurons closer to firing threshold respond more effectively to cortical input. Postural muscle activity, proprioceptive input, and descending reticulospinal drive all contribute to bringing the system closer to that threshold (Sherrington, 1906; Baker, 2011).
This is why alignment matters—but not for aesthetic reasons. When limbs and body segments are aligned and postural muscles are appropriately active, the nervous system operates with less internal “noise.” Anticipatory postural adjustments and background tonic activity increase corticospinal gain and improve signal-to-noise ratio (Massion, 1992; Devanne et al., 1997). In practical terms, this means less diffuse co-contraction and greater specificity of activation.
When activation occurs in meaningful, task-driven synergies—rather than isolated effort—the cortex becomes more effective. Studies using transcranial magnetic stimulation demonstrate that corticospinal excitability increases when posture is engaged and stability is present (Tokuno et al., 2009). Bernstein described this decades ago: posture provides the stable platform upon which selective movement can emerge (Bernstein, 1967).
Clinically, this explains something we see every day. A patient who “could not move” suddenly demonstrates selective activation when the body is aligned, supported, and engaged appropriately. We have not created the movement. We have changed the state of the system so the cortex can access existing capacity.
This is not about symmetry.
It is about reducing noise, optimising excitability, and literally unlocking movement potential that was already there—but previously unexpressed.
That level of detail matters.
For me, the Bobath Concept provides a framework that integrates contemporary neurophysiology with detailed movement analysis, allowing my clinical reasoning to be grounded in how the nervous system truly functions, so that the path to optimising cortical excitability and unlocking selective movement becomes clearer, more intentional, and more systematically expressed within my rehabilitation programmes.
Ready to elevate your clinical practice? Discover the transformative power of the Bobath Concept and start your journey toward neuro-rehabilitation excellence. Get in touch with us today; info@bbta.org.uk.
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