Bobath concept
The Bobath concept is a therapeutic approach designed for assessing and treating individuals with motor impairments due to neurological conditions, such as stroke or cerebral palsy. Originating in the UK in the 1940s, this method—often referred to as neurodevelopmental therapy (NDT) in the United States—was pioneered by Berta and Karel Bobath, who focused on the potential for recovery in those previously thought to be permanently impaired. The concept emphasizes observation and assessment to understand a patient's existing abilities and limitations, followed by the creation of tailored treatment plans that engage both patients and their families.
The Bobath concept promotes various physical therapy techniques aimed at improving movement and reducing discomfort. Occupational therapy is also an essential component, helping patients regain lost skills necessary for daily living, such as dressing or feeding themselves. While it has been a widely accepted standard in neurological rehabilitation for decades, the Bobath concept has faced some criticism over its variability and lack of standardized measures. Nevertheless, many practitioners continue to advocate for its effectiveness, affirming that patients can achieve significant improvements in motor function and overall quality of life through this holistic approach.
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Bobath concept
The Bobath concept is a way of assessing and treating children and adults with impaired motor skills caused by a neurological condition. In the United States, the treatment is usually called neurodevelopmental therapy (NDT). The Bobath concept originated in the United Kingdom in the 1940s and was the earliest form of treatment for those affected by neurological disorders.
The concept was developed to treat stroke patients at a time when such patients were assumed to be permanently damaged by their condition. It is based on the concept that people who have a neurological condition can regain at least some of the motor functions affected by their condition. Treatment under the Bobath concept involves observing the patient, and determining what function or functions they have, what functions they would like to have, and the best way to make that possible. The Bobath concept continues to be a popular form of treatment for stroke patients, children and young adults with cerebral palsy, and others with neurological conditions that affect movement of the body.
Background
The Bobath concept was developed by German physical therapist Berta Bobath and her husband, physician Karel Bobath. The couple began studying physiotherapy in London in 1941. They became very interested in the problems experienced by patients who have had strokes, or the death of brain cells caused when a clot or other problem restricts oxygen to the brain. They also began to study children with cerebral palsy, a condition that results from some injury to the brain either before or just after birth.
Both types of patients may experience difficulty using their arms and legs, speaking, and performing everyday activities because of the damage to their brains and nervous systems. Prior to the 1930s, it was thought little could be done for these patients or others who suffered brain damage from a fall, illness, or other injury. Treatment most often consisted of using braces or other devices to help the patient sit or stand and building up the strength of any unaffected body parts to help compensate for the ones that did not function properly.
Based on her prior knowledge of how the body worked, Berta Bobath was convinced that patients with neurological disorders could regain at least partial motor function. She began experimenting with ways to do this and developed the Bobath concept. Together, Berta and Karel Bobath spent many years studying how neurological conditions caused movement impairments and what could be done to correct the deficiencies. They traveled to teach others their techniques, which became the treatment standard for patients with neurological impairments that affect motor skills.
Overview
When the brain or central nervous system is injured by trauma, illness, or a lack of oxygen, it affects many aspects of a patient’s life. The person may experience impairment of his or her cognitive abilities, motor skills, or social and emotional capabilities. The Bobath concept assumes that each patient can experience some improvement of these impairments and overcome some of the limitations caused by their neurological condition.
To accomplish this, the Bobath concept promotes an approach that uses observation, assessment, and various forms of physical therapy in a patient- and family-focused treatment plan. The process begins with observing the patient and determining what limitations and abilities are present. The therapist will analyze how the patient moves and what skills are present for thinking, reasoning, and communication. The therapist also meets with the patient and family to understand what abilities and functions are most important to them and what goals they have for the patient. Then a plan is formulated to help the patient achieve as many of these functions and goals as possible.
In many cases, a patient with a neurological disorder experiences difficulty with movement. For instance, many cerebral palsy patients experience rigid joints that prevent a fluid walking motion. They may have spasms that make their arms, legs, or heads move in a spasmodic fashion, or be unable to sit up or hold their heads up without support because of weak muscles. The patient may also experience discomfort because of spasms or because the condition causes the body to stay in a position without sufficient support from bones and muscles. A physiologist using the Bobath concept will determine ways to exercise, massage, or otherwise treat the patient’s muscles to restore as much movement as possible. By doing this, the patient experiences improved physical function and reduced discomfort.
The treatment plan includes not only therapy to help improve physical function but also a type of treatment called occupational therapy that helps a patient recover lost skills. For instance, patients who have had a stroke or suffered a traumatic brain injury may lose the ability to dress and feed themselves or to write. This can happen because the part of the brain that remembers how to do these things is not functioning properly, or because the brain cannot get the proper signals through the nerves to the patient’s limbs to complete the task. In the Bobath concept, an occupational therapist determines what is interfering with the ability to complete the task and devises a way to help the patient regain some or all of the skills that have been lost. This can include retraining the patient in how the task is done, providing adaptive tools to help with the tasks, or teaching the patient to accomplish the task in a different way.
The Bobath concept has been the standard method of patients’ neurological rehabilitation for many decades. However, in the mid-twentieth century, some controversy arose about the validity of the approach. Some neurophysicists claimed that the techniques used had become so varied and non-standard that it was no longer right to attribute the process used to the Bobaths. Others have criticized the lack of standard measures to define the quality of recovery. This has led some practitioners to stop connecting their process with the Bobath concept. However, other experts point out that there has been no evidence either for or against the Bobath concept being more or less effective than other techniques.
Bibliography
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“The Bobath Concept Explained.” Headsup, 20 July 2015, headsup.co.uk/the-bobath-concept-explained/. Accessed 14 Sept. 2018.
“Bobath Therapy.” Bobath Centre for Children with Cerebral Palsy,www.bobath.org.uk/about-us/bobath-therapy. Accessed 14 Sept. 2018.
“Bobath Under Fire.” Frontline, 6 Jan. 2010, www.csp.org.uk/frontline/article/bobath-under-fire. Accessed 14 Sept. 2018.
Kollen, Boudewijn J., et al. “The Effectiveness of the Bobath Concept in Stroke Rehabilitation: What Is the Evidence?” Stroke,Apr. 2009, www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.108.533828. Accessed 14 Sept. 2018.
“Neurodevelopmental Treatment.” Kenndey Krieger Institute, www.kennedykrieger.org/patient-care/patient-care-programs/outpatient-programs/physical-therapy-clinic/neurodevelopmental-treatment. Accessed 14 Sept. 2018.
“Stroke.” Mayo Clinic,www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113. Accessed 14 Sept. 2018.
“What Is Bobath Therapy?” Bobath Children’s Therapy Centre Wales, www.bobathwales.org/specialist-service/what-is-bobath-therapy/. Accessed 14 Sept. 2018.