Bobath concept

Bobath method was developed by Berta Bobath, who came originally from Germany along with her husband Karel Bobath who was from Czechoslovakia. Together they emigrated to Great Britain, where they worked on this concept and established the Bobath center in London.

It is a neuro-developmental therapy, which is at large used in the world for treating especially children who suffer from cerebral palsy, but also for treating various neurological diseases in the adulthood - it is for instance widely used for treating the conditions after stroke.

With the start of the 20th century prevailed an opinion that people with central nervous system disorder can not improve the control of their movement with any treatment approach or method. Some approaches only recommended the patients to strengthen the unaffected functions, or exercise the undamaged part of the body, but there were also such opinions that all physiotherapeutic methods are useless. But the Bobaths demonstrated with their revolutionary thoughts, that improvement of the affected area is possible. Thus people affected by stroke could improve and increase their movement range on the damaged side of the body. They supported the idea that the human body is functioning as a whole, walking and its quality depends also for example on the position of the shoulder joint.

Cerebral palsy was taken by Bobaths as a nonprogressive disease, which forms on the base of damaged (undeveloped) child’s central nervous system. This damage then logically affects the brain development, and the maturing process of the central nervous system brings forwards several visible symptoms connected to this. Most often it leads to developmental disorder of the child in certain aspects and at the same time there is severed tension between muscles and imperfect coordination of the movement.

BOBATH METHOD AND THE TREATMENT OF CEREBRAL PALSY

The base of this successful therapy is a very detailed examination, during which the physiotherapist is focusing on the daily activities, which the child is able to perform without any help, eventually how much assistance he/she needs, but also activities which the child is not able to perform. Furthermore the quality of the muscle tension is observed, as well as quality of the performed movement. Based on these examinations Bobaths specified the classification of the cerebral palsy, which servers for easier communication between the therapists and multidisciplinary team. Bobath concept is built on a teamwork between the parents, physiotherapists, speech therapist and ergotherapist.

The therapist determines the goal and the treatment plan and how to achieve these goals based on the results from the examinations. Reaction and perception of the affected individual is very important for successful therapy and used techniques. One of the key factors of the therapy is handling the child.

Handling

The handling technique leads to optimization of the pathological tone of the muscles, thanks to that the child can correctly perform the movement the easiest way possible. Handling is afterwards used by the parents in daily activities. How to manipulate with the child, how to carry the child, feed, dress, in which positions and situations to play with the child in order to support the correct development.

Sensomotoric stimulation

Another important element of the therapy is the sensomotoric stimulation which pushes the correct development of the child forward. Among other techniques, exercising on unstable surfaces is incorporated in the sensorimotor stimulation, for example: gym ball, overball, balance disc, posturomed, BOSU and many other. Therefore the Bobath technique is very successful for treating imbalance and joint disorders (for example: frozen shoulder, hip joint pain).

BOBATH EXERCISE AFTER STROKE

As was already stated above, Bobaths found out that it is possible to overcome the stroke, improve the patient’s condition and coordination thanks to selected exercises from their concept, which helps these people to fully engage again in daily activities.

Thanks to their findings they discovered, that the patients don’t have problem with lack of balance power, but they are unable to perform various movement combinations of the moving stereotypes. However there are exercises that will help you to involve your body into correct moving stereotypes. Through these exercises we try to suppress the incorrect movement reaction formed during the damage of the central nervous system (CNS) and conversely, induce new and correct movement reactions focused on the support of a more stable walking, stronger grip, and other daily activities about which healthy person doesn’t even think and does them automatically.

It’s an important exercise, which will gradually improve control and stability of your trunk, which is an unthinkable part of confident walking, holding, getting up from the bed etc… You can start with the exercise immediately, if you are not in acute condition after the stroke and you need to focus on the so called “tuning” of the movement. Key factor is a free coordination of your movement and slightly stable standing position without the help of the second person.

The exercise is focusing on several basic levels:

• Exercise in a bridge position - Helps to fully involve the trunk.
  
• Exercise in a plank position - Helps to improve the coordination of the upper body and arms
  
• Exercising walking - Helps to improve coordination during walking with a goal to to achieve a normal rhythmic walking. While perfecting the walking, it is important to constantly feel the confidence when you fully transfer your weight on the affected side. Feeling the support helps us to consciously and targetedly control the walking ability. In these certain positions we work with the changes of the resting basis and transferring the center of the gravity.
  
• Exercising walking on the healthy side We try to again achieve improved coordination during walking, this time exercise on the healthy leg, and achieve a normal rhythmic walk. It is necessary to be fully concentrated on the correct performance of the exercise, we recommend you to exercise in front of a mirror. It will be better to teach your brain to perform the movement as correctly and consciously as possible. As soon as you perform the movement with precision and with a maximum concentration, then you can incorporate it unconsciously into the daily life activities. The feeling of improvement and regained confidence is the best motivation for the exercise.

EXERCISING BY US AT THE FYZIOKLINIKA

We will provide you with the best care in our facility, with the correct execution of the exercises. With every exercise and especially by the Bobath concept, it is important to keep executing the exercise precisely, so that there would be a positive effect. Our physiotherapist will therefore, especially from the beginning, help you with control and correct performance of the exercises.

The most important thing is to start. You will see that together we’ll make it, and we will improve the errors, which you would be probably unconsciously making in the beginning. Even here applies the proverb “many hands make light work”... :) Count on it, that with time your walk and posture will become more and more confident.

Author: Mgr. Iva Bílková, FYZIOklinika physiotherapy Ltd., Prague, Czech Republic
Source: Internet: praxis-seiter.de, information acquired during college studies, B. Bobath: Adult hemiplegia, 1996