BOBATH APPROACH

I. INTRODUCTION
-introduced by husband and wife Dr. Karel and Ms. Bobath
-Ms. Bobath observed while treating stroke patient with spastic arm
-focused first in the treatment of hemiplegic patients d/t CVD
II. PRINCIPLES OF BOBATH
a. Normal Movement
i. Normal Postural Reflex Mechanism
-consists of a great number and variety of movements which gradually develop
along with the infantile brain
1. Righting Reactions
-automatic reactions which serve to maintain and restore the normal
position of the head in space (face vertical, mouth horizontal) and its
normal relationship with the trunk together with the normal alignment
of the trunk and limbs
-example: when someone is about to lie down, or perturbed to their
sides.
2. Equilibrium reactions
-these are automatic reactions which serve to maintain and restore
balance during all our activities, especially when we are in danger of
falling. All equilibrium reactions, tone changes, and movement have to
be well-coordinated, quick, adequate in range and well timed
-reactions: small muscles, large muscles, gross movements
-example: when you shove someone
3. Automatic adaptation of muscle to changes on posture
-allows for smooth and well controlled mobility against the forces of
gravity
-“placing”
-example: hairdresser positioning the head of the client, muscles are
taking over the new position without any further a do
-muscles adapt automatically
ii. 3 pre requisites for voluntary activity
1. Normal postural tone for moderate intensity
-strong enough the act against gravity but should ne low enoigj yo give
weight to movement
2. Normal reciprocal innervations of muscles
-One has to have fixation proximally in order to move
3. Automatic movement patterns of the righting and equilibrium reactions

****normal sit to stand mechanisms: trunk forward over the lower extremity

****gait and stair climbing normal vs hemiplegic gait

III. PROBLEMS IN HEMIPLEGIA

a. Spasticity
-caused by the release of an abnormal posture reflex mechanism which results in
exaggerated static function at the expense dynamic postural control
-effects and characteristics:
pure loss of motion due to co contraction
incapability of motor control
they are not necessary strong even though they are in constant contraction
prevents normal postural reactions
-9 possible causes
Removal of presynaptic inhibition of 1A circuit
Hyper activity of gamma motor neurons
CNS plasticity
Alpha motor neuron mutability
Post synaptic super sensitivity
Deficit in reciprocal inhibition
Depression of autogenous inhibition
Depression of recurrent inhibition
Abnormal spread of impulses
-typical posture:
 Head: lateral flexion toward from the involve side; rotation away from
the involve side
 Scapula: depression and retraction
 Shoulder: adduction, IR
 Elbow flexion
 FA pronation
 Wrist in flexion with ulnar deviation
 Fingers in flexion
 Trunk in lateral flexion towards the affected side, rotation toward the
involve side
 Pelvis posterior elevation; retraction
 Hip: IR Ex and Add
 Knee Ex
 Ankle PF Supination Inversion
 Toes: Flexion
**MC site of fracture in hemiplegic patients: Hip and Radial fracture why?
Because of the spastic rotation
**empathy to the hemiplegic patient
***spastic muscles are not necessarily stron
***spasticity prevents postural reactions therefore fall is a precaution
***weak sensory feedback due to the sutained tension
***antagonist later on develop weakness
-typical synnergy
b. Factors that influences spasticity
i. Fear-
 ii. Stress, emotion- the emotional lability of the patient should be taken into
account
iii. Effort- don’t make the treatment hard
iv. Pain – don’t make anything hurt
v. Temperature- low temperature
c. What can we do to decrease?
i. Positioning- chair, w/c, weight bearing, on bed
ii. Rotation- sitting, lying