Learning to clinically reason with the Bobath Concept - BBTA courses escalator.

Written by Sarah Guy.

Clinical reasoning, the thinking and decision-making process (Higgs and Jones, 2000) associated with clinical practice is a skill.  It underpins everything we do as therapists and is a characteristic of an autonomous profession (Edwards et al 2004).  It can be difficult to teach, due to its complexity but also because it becomes an automatic process within skilled clinical practice (Delaney and Golding 2014). Perfecting it takes practice, dedication and time. 

Critical factors in effective clinical reasoning include knowledge base (organisation and retrieval of the knowledge), cognitive skills (analysis and synthesis of knowledge) and construction of meaning within context (Jones et al 2000). It involves structured reflection, the ability to reflect in and after action and a metacognitive process i.e. thinking about thinking (Schell 1998 in; Laver-Fawcett 2007). Many models of clinical reasoning exist to assist and understand this process and it has been extensively studied within health care professions.

The Bobath Concept can be viewed as one such model i.e. a framework by which the clinician can integrate theoretical knowledge (from movement science, neuroscience and clinical research) with patient values and goals and finally the clinicians own clinical experience and expertise. This is in line with the components of evidence based practice proposed by Sackett et al (1996).

Clinical expertise or in other words professional craft knowledge includes knowledge within the professional domain. It includes our handling and assessment skills. It has been described as being at the core of the professional identity of physiotherapists, seen as both a defining characteristic and an important determinant with respect to technical competence. It includes intuitive knowledge or professional judgment, cognitive aspects of practical knowledge and experimental knowledge. “Therapeutic touch” or facilitation, a key skill within the Bobath Concept, is an aspect of professional craft knowledge (Vaughan-Graham 2009). As a skill, it takes practice, coaching and reflection to perfect. This takes time and commitment.

The phrase ‘learning to do Bobath’ often makes me uneasy. The reason for this is inextricably linked with the thoughts above. On a Bobath course are you learning a ‘method’ to treat a particular issue (e.g. spasticity) in a particular patient group (eg. stroke)? or alternatively, are you engaging with applied theoretical knowledge whilst also developing core therapeutic skills of movement analysis and movement facilitation within a structured framework for clinical decision making? I would argue strongly that the latter is true.

As such the aim of BBTA tutors and Bobath courses is to enhance the knowledge base and core clinical skills of each individual participant within a structured framework that allows them to move forward and become more effective practitioners. This is not for one patient group (stroke) with one particular problem (spasticity) but rather for the assessment, treatment and management of a wide variety of neurological conditions and patient presentations from the least to the most able.

Finally can we expect to become skilled and expert practitioners overnight (or even within one course)? As mentioned earlier skill development takes time, practice and reflection, and it can be helped by expert guidance. We may benefit from this guidance intermittently and we may need different types and depths of guidance as our skills develop having continually applied them within our daily clinical practice.

Educational opportunities within the Bobath Concept provide a structured continuous journey to develop those skills. This journey starts with introductory modules which begin with an understanding of the concept, a focus on structured movement and task analysis, and introduction to skilled handling both within assessment and treatment. Patient demonstrations enable the participant to see the Concept in action.  Bespoke short courses provide a focus on specific areas of training-need within clinical teams. 

Skills can be further enhanced with attendance on a Basic Bobath course which is run over a number of modules and includes theoretical and practical sessions and patient demonstrations. Participants can deepen their understanding of neurophysiology, professional craft skills and clinical application in the treatment of patients under the supervision of the Bobath Tutors. A period of self-directed learning through a project enables consolidation of these skills. 

For those wanting to further refine and expand their skill base, Advanced Bobath courses take these skills to the next level.  Again each course is underpinned by up to date theoretical knowledge and professional craft and clinical reasoning are practiced and consolidated through practice with other participants and during patient treatment sessions with supervision from skilled Bobath tutors. 

If you want to start, or continue, a journey of developing your professional craft skill and clinical reasoning for your neurological patients recovery, look at the BBTA website www.bbta.org.uk or contact us on info@bbta.org.uk for further information.

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