When evaluating and treating patients who have abnormalities in function, movement, or postural control as a result of a central nervous system injury, the Bobath concept is utilized as a problem-solving method. Over more than 50 years, this method of rehabilitation has developed from the work of Berta and Karel Bobath. modern understanding of neuronal plasticity, motor control, and motor learning, along with biomechanics, provide the foundation for modern practice.
The Bobath Concept is defined as “an inclusive, individualized therapeutic approach informed by contemporary movement and neurosciences to optimize movement recovery and potential for persons with neurological pathophysiology.” The idea offers a framework for analyzing functional movement by taking into account the fact that neurological dysfunction has an impact on the full individual. Regaining normal movement is the main goal of intervention, which minimizes abnormal and compensatory movement while acknowledging that a person’s lived experiences both before and after a neurological lesion might have an impact on movement issues. To increase exercise and involvement, a 24-hour interdisciplinary approach is prioritized.
Functional movement analysis, as it pertains to the Bobath concept, takes into account how sensory information affects the relative interactions between postural control, selective movement, and cognitive/perceptual processes. Similarly, control of the trunk and head is thought to be just as crucial as control over the upper and lower limbs. The integration of selected movement and postural control, the active alignment of every body segment, and the capacity to take in, process, and react to sensory data are all taken into account when evaluating the quality of movement performance. A clinical skill used by Bobath, facilitation is an active procedure that aims to affect sensory information by verbal, contextual, and therapeutic cues. The clinical reasoning process is informed by the client’s reaction to facilitation.
A clearly defined model of Bobath clinical practice has been lacking in the current evidence base. This creates confusion as to what actually the Bobath concept is in clinical practice and leads to misinterpretation and misrepresentation within the literature.
The IBITA Education Committee commenced work on developing a Model of Bobath Clinical Practice under the leadership of Susan Ryerson in 2008. This model is the clinical parallel to the publication by Vaughan-Graham et al., (2009) which outlines the theoretical underpinning of a contemporary Bobath concept.
The aim of this model is to identify what is unique to the Bobath concept in terms of contemporary neurorehabilitation. The model is not a model of ‘best practice’ and therefore does not seek to include all of the basic requirements of assessment that every therapist would routinely undertake.
The model seeks to identify the following:
The Education Committee has presented successive versions of this model for review and discussion by the IBITA membership, solicited feedback and made subsequent revisions.
The model was published in the journal of Disability and Rehabilitation Michielsen M, Vaughan-Graham J, Holland A, Magri A, Suzuki M (2017): The Bobath concept – A model to illustrate clinical practice. Dec 17:1-13. doi: 10.1080/09638288.2017.1417496. [Epub ahead of print]
The article describes the clinical application of the Bobath concept in terms of the integration of posture and movement with respect to the quality of task performance, applying the Model of Bobath Clinical Practice.
Implications for rehabilitation include:
According to Raine (2006), Raine (2007), and the International Bobath Instructors Training Association (2008), the Bobath idea is applicable to people of all ages and with all levels of physical and functional handicap. Bobath therapies are response-based, multidimensional, complicated, client-centered, and reflective (Cott et al. 2011).
In line with the ICF, the Bobath concept acknowledges that in order to maximize activity and participation, it is necessary to comprehend how the client’s health condition, personal characteristics, and environmental and individual contexts relate to each other. This understanding allows for the identification of meaningful functional goals as a component of the intervention plan (Vaughan-Graham et al. 2009; WHO 2002).
Functional movement analysis is the process of characterizing how people move when performing a task in their daily lives or when completing a particular portion of a task. The Bobath idea takes work completion into account. In order for the Bobath clinician to ascertain how the movement deviates from conventional motor behavior, including an examination of the compensatory methods employed, a thorough observational investigation of movement sequences during task performance is required. Task analysis includes both tactile and visual components, and the Bobath clinician’s therapeutic handling competence informs the analysis and aids in the process of clinical reasoning. Task analysis and intervention based on the Bobath concept are predicated on an appreciation of the dynamic relationship between postural control and task performance, wherein the generation of coordinated sequences of movement necessitates selective movement control (Vaughan-Graham et al. 2009). In addition to task completion and support needed, the Bobath concept takes into account the type of task performance, or the effectiveness and quality of task performance, which is a crucial component of assessment and treatment (Levin & Panturin 2011).
As a distinctive feature of intervention, the Bobath notion has always used and still does. Making the task possible by expert manual labor, adjustments to the surrounding environment, and verbal signals is referred to as facilitation. The ability to integrate movement control, a broad theoretical and professional practice knowledge base, and the Bobath clinician’s stereognostic capacity—which is the ability to understand, integrate, and carry out therapeutic handling—are all necessary for effective facilitation.
Aspects of the clinical presentation that the Bobath doctor finds noteworthy and which therefore impact the clinical reasoning process are known as critical cues. Aspects of alignment, movement patterns, musculoskeletal problems, particular reactions to facilitation—or lack thereof—client preferences, comorbidities, and strengths and limitations in cognition and perception are examples of critical cues.
After considering all of the data, the Bobath doctor starts formulating a working hypothesis—or hypotheses—to guide the clinical presentation. By means of this procedure, the Bobath clinician obtains pertinent and crucial clues concerning postural control, selective movement, movement sequences, and task performance. Additional movement analysis, tailored to the specific client’s context, is guided by the information gathered. The methodical collection of information needed for the clinical reasoning process depends on the theoretical background, professional practice expertise, and skill level of each clinician.
Acknowledging the client’s health status and any related limits, the Bobath physician bases their intervention on a movement diagnosis and, consequently, a working hypothesis. The movement diagnosis is a summary of the key findings from each functional movement analysis and the unique clinical presentation’s attributes. Therefore, the Bobath clinician addresses the unique effects of the neurological disease on the client from the viewpoints of movement, perception, and cognition rather than “the neurological condition.”
The system’s natural flexibility has always been leveraged by the Bobath concept for the client’s advantage. Rather of approaching this from a compensatory standpoint, the Bobath clinician aims to achieve recovery (Levin 2009). While acknowledging the limitations of the neurological impairment, the Bobath physician also acknowledges the client’s potential for a good functional recovery, supported by the concepts of neuromuscular plasticity and motor learning. From the standpoint of sensorimotor rehabilitation, the Bobath clinician aims to minimize aberrant motor behavior and compensation. According to Levin and Panturin (2011) and Michaelsen et al. (2006), functional movement analysis from the standpoint of the Bobath concept acknowledges that recovery based on compensatory movement may limit the restoration of usual motor activity.
The Bobath physician will choose a suitable working hypothesis based on the movement diagnosis and probable identification. In terms of postural control, task performance, selected movement, and movement sequences, this will direct the intervention plan. By reflecting “on-action” and “in-action,” the Bobath clinician can make iterative revisions to the working hypothesis, hypotheses, and movement diagnosis based on the client’s reaction to the intervention (Schon 1983).
Optimizing activity, participation, and subsequently subjective quality of life is the goal of treatment interventions. In order to attain effective muscle activation for success in a given activity or endeavor, clients must learn to interpret crucial cues in a competent, logical, and methodical step-by-step progression tailored specifically to them. In order to preserve, repair, or update body schema and maximize feed-forward postural control and movement control, treatment should offer a rich supply of afferent information (i.e. competent facilitation).
The Bobath clinician anticipates particular changes in postural control, task performance, selective movement, and/or movement sequences as a result of the intervention. This is the outcome of intricate interactions between the cognitive, perceptual, and action systems. In order to validate or refute the hypothesis, this is a critically reflective process that expands the Bobath clinician’s professional practice knowledge and expertise. Positive changes in relation to the intervention are significant because they demonstrate the validity of the hypothesis, the client’s potential, and the Bobath clinician’s skill. In addition to evaluating interventions from a quantitative standpoint using relevant, validated outcome and objective measures that show meaningful and significant change, the Bobath clinician also considers the quality and efficiency of the movement or task, i.e., formatively and diagnostically within a treatment session (Levin & Panturin 2011).
BITA Education Committee July 2019
Any therapist who uses the title/description, “Bobath Trained” or “Bobath therapist”, must have completed a Basic Bobath course and a minimum of two (2) IBITA Advanced courses, including one within the previous five (5) years.
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