The Bobath Concept is an approach to neurological rehabilitation applied in patient assessment and treatment (such as with adults after stroke, or children with cerebral palsy). The purpose of applying the Bobath concept is to promote motor learning for efficient motor control in various environments, thus increasing participation and function. This is done through special patient handling skills to guide the patient through initiation and completion of the intended task. This neurological rehabilitation approach is multidisciplinary, mainly involving physiotherapists, occupational therapists and speech and language therapies. In the United States, the Bobath concept is also known as' nerve developmental care " (NDT).
His concepts and his international tutors/instructors have embraced neurosciences and developments in understanding motor control, motor learning, neuroplasticity, and the science of human movement. They believe that this approach continues to grow.
Video Bobath concept
Criticism
The concept that Bobath can "evolve" and still be called Bobath has been challenged by the president of the American Academy of Cerebral Palsy and Developmental Medicine and chairman of the British Physiotherapist Association in Neurology (ACPIN). This prominent physiotherapist believes that some of the original principal teachings of the founders have now been abandoned, while other people's ideas (non Bobath therapists & scientists) have been unfairly named Bobath.
There are many uses of the Bobath concept among therapists in stroke rehabilitation. However, a large review of Bobath's randomized controlled trial (RCT) for stroke rehabilitation found only three significant examples of differences in support of Bobath, but 11 supported alternatives. The authors conclude that therapists should base their treatment methods on "evidence-based guidelines, accepted motor learning rules, and biological mechanisms of functional recovery, rather than therapeutic preferences for any named therapeutic approach". This review shows that this approach is now considered "obsolete" in some European countries and therefore is no longer taught.
In 2018 a major review of upper limb intervention after stroke found significant positive effects for certain constraint and task therapy and the use of additional biofeedback and electrical stimulation. However, they conclude that the use of Bobath therapy is not supported.
In the UK, the NHS review of stroke rehabilitation by Professor Tyson concluded that "the strength of evidence that specific functional training tasks and effective strength exercises, while Bobath does not, suggests that a paradigm shift is needed in British stroke physiotherapy..... The harder it is to justify the use Bobath concept or related techniques ". Recently Professor Tyson and Dr Mepsted wrote comprehensive and critical reviews of Bobath/NDT methods, theories, and effectiveness.. See also an interesting exchange of letters between the above authors and Bobath's mentors.
National evidence-based guidelines for stroke rehabilitation have been published for the UK, the Netherlands, Canada, Australia and New Zealand; but none of them is the recommended Bobath approach. By contrast, in 2016 the American Stroke Association concluded that although the effectiveness of NDT/Bobath (compared with other treatment approaches) has not been established that it is still "considered" as a treatment option for mobility. However this is the lowest classification of acceptable treatments. The two groups of their highest recommendations ("must do" and "reason to do") contain a variety of treatments for which there is much better evidence. NDT/Bobath is not listed as an option for arm/hand rehabilitation. Also in 2016, revised RCP guidelines for stroke do not mention Bobath/NDT, while many alternatives are recommended. The important thing is they state that if treatment is not mentioned then it is not recommended and does not need to be funded. They also stated that therapists using the method should objectively review their choice in light of the evidence supporting the recommended alternative. Furthermore, patients receiving such interventions should be informed that it is outside mainstream practice.
The Bobath (NDT) approach is also widely used in children with cerebral palsy (CP). However, when the effectiveness of interventions for CP treatment is reviewed by Novak et al. they conclude, "As a result, there is no situation where one of the goals of NDT can not be achieved with more effective treatment, thus by reason of wanting to do the best for children with CP, it is difficult to rationalize a sustainable place for traditional NDT in clinical care ". They consequently recommended "stop the provision of NDT ever popular."
The dichotomy between the popularity and institutional funding of this approach versus the negative findings of most RCTs has been excused on the grounds that RCT may not be suitable for neurorehabilitation. However, the website of the British Bobath Tutors Association does not cite the RCT minorities that support their approach.
Maps Bobath concept
History
Bobath's concept is named after its discoverers: Berta Bobath (physiotherapist) and Karel Bobath (a psychiatrist/neurophysiologist). Their work is focused primarily on patients with cerebral palsy and stroke. The main problem of this group of patients resulted in the loss of normal postural reflex mechanisms and normal movement. At the beginning of its formation, the Bobath concept is focused on regaining normal movement through re-education. Since then, it has evolved to include new information on neuroplasticity, motor learning and motor control. The therapist who practices the current Bobath concept also embraces the goal of developing an optimal motion pattern through the use of appropriate orthotics and compensation, rather than aiming for a completely "normal" pattern of movement.
Stroke rehabilitation
In the Bobath Concept, postural control is the foundation on which patients begin to develop their skills. Patients who undergo this treatment usually learn how to control posture and movement and then advance to more difficult. The therapist analyzes posture and movement and looks for abnormalities that may exist when asked to do so. Examples of common abnormal motion patterns include mandatory synergy patterns. These patterns can be described as attempts to isolate a particular extremity, but trigger the use of other muscles that are not normally involved (when compared with normal movement) to achieve movement. The compulsory synergy pattern can be further divided into components of flexibility and extension synergies for upper and lower extremities. This approach requires the active participation of patients and therapists. Depending on the patient, the purpose of rehabilitation may work to correct any or all of the following: postural control, coordination of movement sequence, initiation of movement, optimal body alignment, abnormal tone or muscle weakness. Treatment will therefore overcome both negative signs such as postural control disorders, and positive signs such as flexibility.
Intervention strategies and techniques for the Bobath consist of therapeutic handling, facilitation, and activation of key control points. Therapeutic treatment is used to influence the quality of patient movement and combines both facilitation and inhibition. Facilitation is the main technique used by Bobath practitioners to promote motor learning. This is the use of sensory information (tactile instructions through manual contact, oral direction) to strengthen weak movement patterns and to prevent overactive ones. Provision of appropriate facilitation during motor tasks is regulated in time, modalities, intensity and withdrawal, all of which affect motor learning outcomes. Inhibition can be described as reducing the abnormal movements/postures and disrupting normal performance. The main points of control generally refer to the beneficial parts of the body when facilitating or inhibiting the movement/posture.
Activities assigned by Physical Therapist or Occupational Therapist for individuals suffering from a stroke are selected based on functional relevance and vary in the event of adversity and the environment in which they are performed. The use of less involved segments of individuals, also known as compensation training strategies, is avoided. Carryover functional activities at home and community settings are mostly associated with the education of patients, families and caregivers.
The theoretical concepts and practices of Bobath Concepts are clearly documented in a contemporary book published by Wiley Blackman in 2009: Bobath Concepts: Theory and Clinical Practices in Neurological Rehabilitation 'written by the British Bobath Tutors Association (BBTA) and edited by Raine, Meadows and Lynch-Ellerington. The Chairperson of ACPIN (Registered Physiotherapist Association in Neurology) reviews the book and concludes: - "I'm not really sure of the book what Bobath's approach is," "Often prose turns into jargon" and " quell criticism: the fact will no doubt give them more fuel for fire ".
Research
Paci (2003) conducted an extensive critical assessment of the study to determine the effectiveness of Bobath concepts for adults with hemiplegia after stroke. The selected trials show no evidence to prove the effectiveness of Bobath Concepts as the optimal type of care. Paci (2003) recommends that standardized treatment guidelines be identified and described, and that further investigation is needed to develop measures of outcomes regarding the objectives of the Bobath approach such as motor quality performance.
Bobath therapy is not standard because it responds, through clinical reasoning and the development of clinical hypotheses, to individual patients and their motion control issues. Decisions about specific treatment techniques are made in conjunction with the patient, and guided by the therapist, through the use of goal setting and the development of close communication and interaction. Working to develop improved muscle tone, according to task, individual and environment, will enable better movement alignment and activation, and allows for recruitment, for example, arm activity in functional situations in various positions.
A study by Lennon et al. concluded that even under ideal conditions (patients with optimal rehabilitation potential, trained therapists, infinite therapy input and motion analysis laboratories) Bobath approach has no effect on the quality of gait for patients with stroke.
Institution
The Neuro-Developmental Care Association (NDTA) was established to do Bobath work; it offers certification in NDT to manage adults with brain stroke or trauma and to manage and care for children with cerebral palsy and other neuromotor disorders. People who have this certification are sometimes called "neural developments".
See also
- Occupational therapy
- Physical therapy
- Speech and language pathology
- Brunnstrom Approach
- Frenkel Exercises
References
- This article is based on a translation of related articles from Wikipedia Germany, accessed on May 4, 2005.
External links
- http://www.bobath-es.com (in Spanish)
- Bobath Theory (in German)
- Neuro-Developmental Care Web Site
- Official Site Site Bobath Foundation (in Spanish)
- Bobath Wales Children's Therapy Center
- Scottish Bobath
- Bobath Care is based in the UK for individuals and guidance for professionals
- www.manchesterneurotherapy.co.uk/
Source of the article : Wikipedia
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