Bobath Concept - Application in Stroke Rehabilitation

Application in Stroke Rehabilitation

In Neurodevelopmental Treatment (NDT), postural control is the foundation on which patients begin to develop their skills. Patients undergoing this treatment typically learn how to control postures and movements and then progress to more difficult ones. Therapists analyze postures and movements and look for any abnormalities that may be present when asked to perform them. Examples of common abnormal movement patterns include obligatory synergy patterns. These patterns can be described as the process of trying to perform isolated movement of a particular limb, but triggering the use of other typically uninvolved muscles (when compared to normal movement) in order to achieve movement. Obligatory synergy patterns can be further subdivided into flexion and extension synergy components for both the upper and lower extremities. This approach requires active participation from both the patient and the therapist. Depending on the patient, rehabilitation goals may work to improve any or all of the following: postural control, coordination of movement sequences, movement initiation, optimal body alignment, abnormal tone or muscle weakness. Treatment will therefore address both negative signs such as impaired postural control, and positive signs such as spasticity.

Intervention strategies and techniques for NDT consist of therapeutic handling, facilitation, inhibition and key points of control. Therapeutic handling is used in order to influence the quality of the patients' movements and incorporates both facilitation and inhibition. Facilitation is a key technique used by Bobath practitioners to promote motor learning. It is the use of sensory information (tactile cue through manual contacts, verbal directions) to reinforce weak movement patterns and to discourage overactive ones. The appropriate provision of facilitation during the motor task is regulated in time, modality, intensity and withdrawal, all of which affects the outcome of motor learning. Inhibition can be described as reducing parts of movement/posture that are abnormal and interfere with normal performance. Key points of control generally refers to parts of the body that are advantageous when facilitating or inhibiting movement/posture.

Activities assigned by a Physical Therapist or Occupational Therapist to an individual who has suffered from a stroke are selected based on functional relevance and are varied in terms of difficulty and the environment in which they are performed. The use of the individual's less involved segments, also known as compensatory training strategies, are avoided. Carryover of functional activities in the home and community setting is largely attributed to patient, family and caregiver education.

The Bobath Concept is summarized in Adult Hemiplegia: Evaluation and Treatment, by Berte and Karel Bobath. The first, second, and third editions were published in 1970, 1978, and 1990, respectively.