Bobath Approach in neurophysiotherapy,detail on bobath approach,note on bobath approach slides
- 1. Bobath Approach Concepts and Principles By Dr.Shahid Shabbir DPT,MS.NMPT
- 2. History… • Developed by Dr. Karel Bobath, a neuropsychiatrist, and Mrs. Berta Bobath, a physical therapist • 1943 – while working with children with cerebral palsy
- 3. DEFINITION • Bobath concept is a problem solving approach to the assessment and treatment of individuals with disturbances of function, movement and postural control due to a lesion of the central nervous system • (IBITA 1996,Panturin E. 2001)
- 4. Basic idea of Bobath Approach • The abnormal patterns must be stopped not only by modifying the sensory input, but also by giving back to the patient the lost or undeveloped control over his out put in developmental sequence. • The basic patterns of posture & movement , the righting reaction & equilibrium responses are elicited by providing the appropriate stimuli while the abnormal patterns are inhibited. • In this way the patient is given the opportunity to experience normal movement
- 5. • The sensory information of correct movement is absolutely necessary for the development of improved motor control. • Postural control is viewed as the foundation for all skill learning • NDT uses physical handling techniques & key points of control
- 6. Basic idea of Bobath approach • Treatment therefore, concentrate on handling the patient in such a way as to inhibit abnormal distribution of tone & abnormal postures while stimulating or encouraging the next level of motor control. • Postural alignment + stability Facilitated • Excessive tone +abnormal movement Inhibited
- 7. Adult hemiplegia.. • Treatment approach was later on expanded to include the rehabilitation of adults with motor problems, particularly CVA • Main problem: the abnormal coordination of movement patterns combined with abnormal postural tonus (Bernstein, 1967) • Secondary problem: muscle strength and muscle activity
- 8. Traditional View • Principles of treatment – Normalize muscle tone – Inhibit primitive reflexes – Facilitate normal postural reactions – Treatment should be developmental • Techniques – Handling – Weight bearing over the affected limb – Utilize positions that allow use of the affected limbs
- 9. Problems in the adult patient with stroke • Abnormal tone • Loss of postural control • Abnormal coordination • Abnormal functional performance
- 10. Goals… • Decrease the influence of spasticity and abnormal coordination • Improve control of the involved trunk, arm and leg • Retain normal, functional patterns of movement in the adult stroke patient
- 11. Principles of treatment: • Treatment should avoid movements and activities that increase muscle tone or produce abnormal reflex patterns in the involved side • Treatment should be directed toward the development of normal patterns of posture and movement.
- 12. Principles of treatment • The hemiplegic side should be incorporated into all treatment activities to reestablish symmetry and increased functional use • Treatment should produce a change in the quality of movement and functional performance of the involved side
- 13. Stages of hemiplegia and the Bobath Approach • Initial Flaccid Stage - Tx focus on positioning and movement in bed to avoid the typical postural patterns of hemiplegia • Stage of Spasticity - tx is a continuation of the previous stage with the goal of breaking down the total patterns by developing control of the intermediate joints
- 14. Stages of hemiplegia and the Bobath Approach • Stage of Relative Recovery: - Tx aims at improving the quality of gait and the use of the affected hand
- 15. • Treatment incorporates facilitation and inhibition using key points of control • abnormal tone is always inhibited • normal responses, once elicited, are always repeated
- 16. What are key points of control (KPC)? • Parts of the body where the therapist can most effectively control and change patterns of posture and movement in other body parts – Proximal: shoulder/scapula, pelvis/hip – Distal: jaw, wrist, ankle, – Head may be a proximal or distal KPC
- 17. Proximal key points: • Located closer to the source, usually at the head, trunk, or large joints • Used to influence posture and movement in all three planes (sagittal, frontal, and transverse)
- 18. Distal key points: • Located away from the source, usually at the upper and lower extremities level • Used to allow the client to engage in activities with minimal control of the therapist
- 19. KEY POINT OF CONTROL • Head and trunk flexion decreases shoulder retraction, trunk and limb extension (key point of control: head and trunk) • Humeral external rotation and flexion to 90 degrees decreases flexion tone of the upper extremity (key point of control: humerus) • Thumb abduction and extension with forearm supination decreases flexion tone of the wrist and fingers (key point: the thumb)
- 20. KEY POINT OF CONTROL • Femoral external rotation and abduction decreases extensor/adductor tone of the lower extremity (key point of control: hip)