A study on the bobath concept

A study on the bobath concept The Bobath Concept was established by the physiotherapist Berta Bobath and her husband Dr Bobath. Prior to the Bobath Concept emphasis was put on an orthopaedic approach using a range of treatments including massage, heat and splints (Raine, 2009, p.1). However, whilst treating a stroke patient, Berta Bobath found that facilitating movement in the affected limb had a profound effect on regaining function and with input from her husband they formed the Bobath Concept (Raine 2009, p.2). The Bobath Concept is still used by many practitioners with Lennon (2003, p.456) finding that out of the 1022 practitioners that took part in a questionnaire relating to stroke rehabilitation 67% preferred to use the Bobath Concept. However, despite significant use within neurological rehabilitation it has not been proven to be superior to other treatment approaches (Kollen et al, 2009, p.90). There are a number of neurological rehabilitation approaches available to practitioners. In studies analysing the use of approaches within physiotherapy for stroke patients it is apparent that the Bobath Concept and Motor Relearning are by far the most popular approaches with Johnstone and Proprioceptive Neuromuscular Facilitation (PNF) being used by some therapists (David and Waters 2000, p.74). This essay will aim to critically discuss the use of the Bobath Concept in stroke rehabilitation with reference to its current criticisms and lack of evidence to suggest its superiority compared with the other approaches Stroke is caused by deprivation of oxygen to part of the brain causing loss of consciousness and neural damage (Baer and Durward, 2004, p.76). Johansson (2000) suggest that the notion of plasticity comes from Merzenich and colleagues who found evidence to suggest that cortical maps can be modified by sensory input, experience and learning as well as in response to a lesion within the brain. This could therefore explain why the facilitation of movement advocated in the Bobath Concep t works well. The British Bobath Training Association (no date) suggests that the contemporary Bobath Concept consists of the facilitation of movement within the patients environment utilising a problem solving approach to enhance the motor control of the body. This concurs with the International Bobath Instructors Training Association (IBITA 2008, p.1). At the time of its inception the Bobath was revolutionary as it promoted the regaining of function in the affected limb instead of merely finding ways to compensate for the affected limbs dysfunction which in turn leads to the regain of motor control of the affected limb (Graham et al 2009, p.57). The Bobath Concept has developed over time and as a result the IBITA have put together a document to outline a set of current theoretical assumptions of the Bobath Concept to include: ‘1. Linking participation, activities and underlying impairments 2. Organization of human behaviour and motor control 3. The consequences of injury and dysfunction in the execution of movement 4. Recovery Neural and muscle plasticity Motor learning 5. Measurement of outcome’ (IBITA 2008, pp.1). The IBITA state that the Bobath Concept has promoted the link between treatment activities and the patient’s activities of daily living for a number of years and that specific goals must be set for the individual patient (IBITA 2008, p.2). This suggests that the Bobath Concept is a very individual approach and there are no set criteria that address every patient in the same way. Lennon and Ashburn (2000, p.670-671) performed a focus group with expert therapists. Both groups in the study suggested that goal setting was an important component of the therapy. However, one group stated that goals were decided in the assessment and based upon the patient’s problem areas where as the other group stated that goals were based on regaining motor control and movement. It can be seen in these groups that although goals were seen a s important therapists may not be making them patient specific. There are drawbacks with this study in that the group was very small however as the study was a focus group this would have been necessary to remain in control in the group situation. Furthermore, the therapists were chosen though selection from their interest group (Association of chartered physiotherapists with an interest in neurology and physiotherapists interested in the care of older people) and as a result it is unclear whether these therapists are actually Bobath focused practitioners. Raine (2007, p.147) argues that in their study they found that goal and task orientation that was functional to the patient was a major feature of Bobath therapy. The participants were all members of the BBTA and had extensive Bobath training and therefore it would be accepted that their understanding of the assumptions behind the Bobath Concept would be great as they are teaching the concept to others. However, the study does not show the carryover of these assumptions to the practitioners that are not members within the BBTA.