Bobath Approach: Neuro-Developmental Techniques

NEURO-DEVELOPMENTAL
TECHNIQUES
BOBATH APPROACH
Sensorimotor
Approaches
Bobath Approach
Burnnstorm Movement Theory
Rood Approach
PNF
Neurological
Approaches
THEORETICAL
BASIS
Neurodevelopmental Model
Reflex Theory
Hierarchical Theory
Systematic Approach
BOBATH CONCEPTS &
PRINCIPLES
 Developed in 1940’s in United Kingdom by Dr. Karel Bobath (Neuropsychiatric)
and his wife Berta (Physiotherapist).
“The aim of treatment for children with disabilities

due to brain damage is to prepare them and guide
them towards their greatest possible
independence and to prepare them for as normal
adolescence and adult lives as can be achieved”
(Bobath, 1984)
BASIC IDEA OF BOBATH
 The abnormal patterns must be stopped not by modifying the sensory
input, but 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 patient the patient is given the opportunity to experience

normal movement.
BASIC IDEA OF BOBATH
 The sensory information of correct movement is absolutely necessary for
the development of improved motor control.
 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.
ORIGINAL THEORETICAL
FRAMEWORK
 Based on the works of Jackson, Sherrington, and Magnus who described
nervous system as HIERARCHICAL in nature.
 MODEL
 Higher brain centers exerted control over lower-level

centers.
 Eg. The cerebral cortex control supersedes that of the
brainstem.
OLD THEORY
 CNS viewed as the “controller” (Hierarchical Brain Organization).
 “Positive signs” including spasticity and abnormal coordination of

movement are the most important aspects of sensorimotor impairments.
 Static positions and postures used for treatment, work on components of

motion.
 Muscle and postural tone determine the quality of the patterns of posture
and movement used in functional activities.
NEW THEORY
 The CNS determines the pattern of neural activity to establish the context
for movement initiation and execution (System Model).
 Client is an active participant in the session.
 The “negative signs’, including weakness, impaired postural control are

recognized as equally important as the “positive signs” in limitations of
function.
 Task goals, experience, individual learning strategies, movement synergies,

energy and interests all affect the quality of the final action.
BOBATH APPROACH IN CVA
 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.
 Secondary problem: muscle strength and muscle activity.

BOBATH CONCEPT
 A LIVING CONCEPT
 It has undergone changes in its theoretical base to
accommodate developments in the fields of
neurophysiology, biomechanics, and typical
development.
 HOLISTIC APPROACH
 It involves the whole patient, his sensory, perceptual

and adaptive behavior, and motor problems.
PRINCIPLES OF TREATMENT
 Normalize muscle tone.
 Inhibit primitive reflexes.
 Facilitate normal postural reactions.
 Treatment should be developmental.

TECHNIQUES TO BE USED
 Handling.
 Weight bearing over the affected limb.
 Utilize positions that allow use of the affected limbs.

Problems in adult patient with
stroke
 Abnormal tone.
 Loss of postural control.
 Abnormal coordination.
 Abnormal functional performance.

Treatment goals
 Decrease the influence of spasticity and abnormal coordination.
 Improve control of the involved trunk, arm and leg.
 Retain normal, functional patterns of movement.

BASED ON BOBATH
 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.

BASED ON BOBATH
 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.

PRINCIPLES OF TREATMENT BASED
ON BOBATH
 Increase active use of the involved side.
 Provide practice to improve motor performance that lead to motor
learning.
Stages of the hemiplegic
patient and bobath approach
 INITIAL FLACCID STAGE
 Focus on positioning and movement in bed to avoid the typical

postural patterns of hemiplegia.
 STAGE OF SPASTICITY
 A continuation of the previous stage with the goal of breaking down

the total patterns by developing control of the intermediate joints.
 STAGE OF RELATIVE RECOVERY
 Aims at improving the quality of gait and the use of the

affected hand.
PRINCIPLES OF TREATMENT IN
CHILDREN WITH CEREBRAL PALSY
 Treat the child as a whole.
 Basis for intervention is normal movement and their interrelationships.
 Treatment incorporates facilitation and inhibition using key points of

control:
 Abnormal tone is always inhibited.
 Normal responses, once elicited, are always

repeated.
KEY POINTS OF CONTROL
 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

FACILITATION-INHIBITION
 Facilitation is a mean by which movement is made easy, made possible,
and made necessary.
 Inhibition involves decreasing the use of pathological movements and
the effects of tonal dysfunctions on movement.
 Facilitation and inhibition may be used simultaneously and may be
applied throughout the session.

HANDLING
 Manner of controlling the patient through tone influencing patterns.
 Normal patterns of activity used to modify abnormal patterns of posture
and movement.
 Total TIPs: whole body is controlled in a reversal of the
abnormal pattern.
 Partial TIPs: some body parts remain free to move.
 TIPs are utilized via KPCs.

TECHNIQUES OF TREATMENT
 Initial flaccid stage: last for few day to 7 week or may be longer.
 Problems: confused & disoriented.
 No balance or arm support on affected side
 Fear of fall
 Abnormal attitude on affected side
 No midline orientation Treatment: self orientation on affected side.
 Carry weight on affected side
 Bilateral functioning- interplay.

TECHNIQUES OF TREATMENT
 Explain the fact of affected side.
 Passive movement.
 Proprioceptive feedback.
 Nursing preparation-Positioning & handling.
 Weight bearing exercises.
 Trunk balance in sitting.
 Mobilization of shoulder girdle.

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NEURO-DEVELOPMENTAL

“The aim of treatment for children with disabilities

 The basic patterns of posture& movement , the righting reaction &

 In this way patient the patient is given the opportunity to experience

 Treatment therefore, concentrate on handling the patient in such a way as

 Higher brain centers exerted control over lower-level

 “Positive signs” including spasticity and abnormal coordination of

 Static positions and postures used for treatment, work on components of

 Client is an active participant in the session.

 The “negative signs’, including weakness, impaired postural control are

 Task goals, experience, individual learning strategies, movement synergies,

 Main problem: the abnormal coordination of movement patterns

 Secondary problem: muscle strength and muscle activity.

 It involves the whole patient, his sensory, perceptual

 Inhibit primitive reflexes.

 Facilitate normal postural reactions.

 Treatment should be developmental.

 Weight bearing over the affected limb.

 Utilize positions that allow use of the affected limbs.

 Loss of postural control.

 Abnormal functional performance.

 Improve control of the involved trunk, arm and leg.

 Retain normal, functional patterns of movement.

tone or produce abnormal reflex patterns in the involved side.

 Treatment should be directed toward the development of normal

patterns of posture and movement.

reestablish symmetry and increased functional use.

 Treatment should produce a change in the quality of movement and

functional performance of the involved side.

 Provide practice to improve motor performance that lead to motor

 Focus on positioning and movement in bed to avoid the typical

 A continuation of the previous stage with the goal of breaking down

 STAGE OF RELATIVE RECOVERY

 Aims at improving the quality of gait and the use of the

 Basis for intervention is normal movement and their interrelationships.

 Treatment incorporates facilitation and inhibition using key points of

 Normal responses, once elicited, are always

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

and made necessary.

 Inhibition involves decreasing the use of pathological movements and

the effects of tonal dysfunctions on movement.

 Facilitation and inhibition may be used simultaneously and may be

applied throughout the session.

 Normal patterns of activity used to modify abnormal patterns of posture

 Total TIPs: whole body is controlled in a reversal of the

 Partial TIPs: some body parts remain free to move.

 TIPs are utilized via KPCs.

 Problems: confused & disoriented.

 No balance or arm support on affected side

 Abnormal attitude on affected side

 No midline orientation Treatment: self orientation on affected side.

 Carry weight on affected side

 Bilateral functioning- interplay.

 Nursing preparation-Positioning & handling.

 Weight bearing exercises.

 Trunk balance in sitting.