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Bobath Approach Notes
Bobath Approach Notes
Bobath Approach Notes
This document is developed by Daniel Dominick G. Te, PTRP for the PT students of Cebu Doctors’ University. Using this document for other
purposes, kindly seek permission at danieldominickte@gmail.com .
CONCEPTS AND PRINCIPLES OF TREATMENT The Bobath approach rests on a number of
principles that include:
1. Treatment should avoid movements and • Encouragement of normal movement
activities that increase muscle tone or patterns
produce abnormal responses in the • Focusing on quality of movement
involved side. Movements the patient • Normalization of tone to facilitate active
performs with or without the physical movement
therapist’s help should not be done with • Positioning and posture in lying, sitting
undue effort. Effort leads to increased and standing
spasticity and produces widespread • Discouragement of compensatory
associated reactions. movements
• Discouragement of muscle strength
AUTOINHIBITION: training
• Process by which physical therapist • Promotion of maximum functional
inhibits unwanted spread of activity recovery to improve quality of
throughout the affected parts of the independence
body.
• Physical therapist helps patient to STAGES OF HEMIPLEGIA
use only parts of the total spastic
patterns and prevent the 1. STAGE OF FLACCIDITY (ACUTE
reassertion by handling. HEMIPLEGIA)
− Severe loss of postural control in the
2. Treatment should be directed toward the trunk and flaccid paralysis of the
development of normal patterns of posture hemiplegic arm and leg
and movement. The movement patterns
− Poor sitting balance and cannot
selected are not based on the
perform ADLs in sitting
developmental sequence but on patterns
− Bed mobility tasks and transfers need
important for function.
assistance
• This program provides a foundation − Should frequently subluxes inferiorly
that promotes the highest level of
− Treatment focused on positioning and
functional recovery based on
movement in bed to avoid the typical
relearning normal movement rather
postural patterns of hemiplegia
than on compensation.
2. STAGE OF SPASTICITY
COMPENSATORY REHABILITATION is
− Enough trunk control to sit and stand
responsible for:
without loss of balance, and walk with a
• Increase in spasticity brace or cane
• Inactivity of the involved side − Trunk is asymmetric, lateral flexion or
rotation backward in the hemiplegic
3. The hemiplegic side should be ribcage, flexor spasticity in the
incorporated into all treatment activities to hemiplegic arm
re-establish symmetry and increase − Goal of Rx: break down total patterns of
functional use. Alignment and symmetry of spasticity by developing control of
the trunk and pelvis are necessary for good individual joints
alignment and symmetry of the extremities. − UE spasticity is inhibited through
scapular mobilization and UE weight
4. Treatment should produce a change in the bearing (WB)
quality of movement and functional
performance of the involved side. 3. STAGE OF RELATIVE RECOVERY
If they never demonstrated spasticity OR
5. Adaptive equipment is used when responded to inhibition techniques:
absolutely necessary for safety, but not as − Can walk well without asymmetry of
a first resort and not as a replacement for
posture due to good control of WB and
treatment. minimal flexor posturing
− Can move hemiplegic arm with isolated
Bobath approach is based around the brains
control of shoulder and elbow to grasp
ability to adapt to change and reorganize and
objects
recover after neurological damage.
This document is developed by Daniel Dominick G. Te, PTRP for the PT students of Cebu Doctors’ University. Using this document for other
purposes, kindly seek permission at danieldominickte@gmail.com .
Problems: protective responses, and poor WB on the
− Opening of hands to initiate grasp hemiplegic hip.
− Controlling humeral and forearm
rotation for placement POSTURAL CONTROL
− Need for excessive concentration − Automatic activation of muscles to
− Slow and uncoordinated movements maintain control of the body for posture
and movement
− Rx aimed at improving the quality of gait
and the use of affected hand. 3. Loss of specific motor abilities and task-
specific behaviors such as rolling, sitting
TYPICAL PROBLEMS IN HEMIPLEGIA up, walking, dressing or bathing
independently.
1. Problems associated with CNS damage
includes abnormal tone, abnormal patterns 4. Most patients avoid WB on affected side.
of extremity movements and atypical
posture 5. FEAR
− May be the most debilitating factor for
a. Flaccid Stage many patients
− Most common at onset of CVA − Major factor affecting spasticity
− (-) placing response
6. Sensory loss
b. Mixed Tone
− Trauma to shoulder is common 7. Neglect
This document is developed by Daniel Dominick G. Te, PTRP for the PT students of Cebu Doctors’ University. Using this document for other
purposes, kindly seek permission at danieldominickte@gmail.com .
NORMALIZATION OF TONE/INHIBITION − Use of symmetrical, bilateral UE
TECHNIQUES may be accomplished by patterns to maintain alignment of the
using one or more of the following upper trunk and shoulder girdle and
techniques: prevent the arm from being neglected
• WB over the affected side or abnormally positioned
• Trunk rotation − Eg. clasping of hands and WB during
• Scapular protraction task performance in sitting and
• Anterior pelvic tilt standing
• Facilitation of slow, controlled
movements CLINICAL APPLICATION
• Proper positioning
• Technique to lengthen muscle and • Bobath Concept concerns sensory,
realign joints perception and adaptive behavior along
with the motor problem that involves
REFLEX-INHIBITING PATTERNS the whole patient.
− Active movements that both inhibit • It is a goal-orientated and task-specific
abnormal tone and encourage or approach, aiming to organize the
facilitate active movement responses internal (proprioceptive) and external
(exteroceptive) environment of the
For Flexor Spasticity of UE nervous system for efficient functioning
− Extension of neck and spine of the individual.
− ER of arm and shoulder • It is an interactive process between
− Extension of elbow and wrist patients and therapists.
− Forearm supination
− Thumb abduction Therapy focuses on the following:
• Neuromuscular system, spinal cord and
For Extensor Spasticity of LE higher CNS centers to change motor
− Hip abduction, extension and ER performance
− Knee extension • Neuroplasticity, an interactive nervous
− DF of ankles and toes system, and individual expression of
− Abduction of big toe movement
• Overcoming weakness of neural drive
*Also rotation of shoulder girdle against after a UMN lesion through selective
pelvis and vice-versa activation of cutaneous and muscle
receptors
FACILITATION TECHNIQUES (Sensory
Stimulation Techniques) Motor control
− Use of tactile and proprioceptive input • Therapists should have the knowledge
to increase the intensity and duration of of the principles of motor learning:
muscle contraction active participation, opportunities for
− Applied directly to muscle or via joint practice, and meaningful goals.
approximation to stimulate muscle • Bobath concept demands training in
contraction around the joint different real-life situations rather than
− Performed with the body in normal just practicing in the therapy
alignment and directed toward areas of department.
the body that are critical for a normal • Task-specific muscle activation
movement pattern patterns and sensory input enables
− Once muscle contraction is successful completion of the task in
established, return to guided different contexts and environments,
movement to use the muscle taking in to account the perceptual and
contraction in a movement pattern cognitive demands.
• Therapy addresses abnormal,
B. COMPENSATORY TRAINING stereotypical movement patterns that
− Directed toward interfere with function. It is aimed at
1. Incorporating the involved arm into preventing development of spasticity
task performance and improving residual function.
2. Teaching patterns of compensation Therapists can influence hypertonia at
that do not encourage the a non-neural level by influencing
development of spasticity and muscle length and range.
associated reactions
This document is developed by Daniel Dominick G. Te, PTRP for the PT students of Cebu Doctors’ University. Using this document for other
purposes, kindly seek permission at danieldominickte@gmail.com .
Therapists work on tone to improve movement,
not to normalize tone. Tone can be reduced by:
• Mobilization of muscles and stiff joints
• Muscle stretch
• Practice of more normal movement
patterns
• Through a more efficient, less effortful
performance of functional tasks
• Weight-bearing
This document is developed by Daniel Dominick G. Te, PTRP for the PT students of Cebu Doctors’ University. Using this document for other
purposes, kindly seek permission at danieldominickte@gmail.com .