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Bobath Approach Concepts and Principles: by DR - Shahid Shabbir DPT, Ms - NMPT

The Bobath approach is a treatment technique developed in the 1940s to address motor control impairments from central nervous system lesions like cerebral palsy. It uses specific handling techniques and focuses on inhibiting abnormal tone and movement patterns while facilitating normal alignment, stability and motor control. Treatment progresses from addressing posture and movement in bed to improving gait and hand function. Key techniques include using proximal and distal "key points of control" on the body to influence movement in other areas. The goal is to develop improved motor control and functional performance.

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355 views

Bobath Approach Concepts and Principles: by DR - Shahid Shabbir DPT, Ms - NMPT

The Bobath approach is a treatment technique developed in the 1940s to address motor control impairments from central nervous system lesions like cerebral palsy. It uses specific handling techniques and focuses on inhibiting abnormal tone and movement patterns while facilitating normal alignment, stability and motor control. Treatment progresses from addressing posture and movement in bed to improving gait and hand function. Key techniques include using proximal and distal "key points of control" on the body to influence movement in other areas. The goal is to develop improved motor control and functional performance.

Uploaded by

rabia khalid
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Bobath Approach

Concepts and Principles


By
Dr.Shahid Shabbir
DPT,MS.NMPT*
History…
• Developed by Dr. Karel Bobath, a
neuropsychiatrist, and Mrs. Berta Bobath, a
physical therapist
• 1943 – while working with children with
cerebral palsy
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)


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
• 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
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
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
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
Problems in the adult patient with stroke

• Abnormal tone
• Loss of postural control
• Abnormal coordination
• Abnormal functional performance
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
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.
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
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
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
• Treatment incorporates facilitation and
inhibition using key points of control
• abnormal tone is always inhibited
• normal responses, once elicited, are always
repeated
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
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)
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
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)
KEY POINT OF CONTROL
• Femoral external rotation and abduction
decreases extensor/adductor tone of the lower
extremity (key point of control: hip)
THANKUUUuuu……

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