Changes in Bobath techniques & comparison of Bobath and Motor relearning program
Bobath concept :
The Bobath concept, based on the work of Berta and Karel Bobath, offers therapists working in the field of neurological rehabilitation a framework for their clinical interventions. It is the most commonly used approach in the UK. According to Lennon S et al (2000) Bobath concept and its main theoretical assumptions had changed since 1990. Although they recognize that over the last half-century the concept has undergone considerable developments, proponents of the Bobath concept have been criticized for not publishing these changes.
The Bobath concept, usually known as neuro-developmental treatment (NDT) in America, is one of the major approaches used to rehabilitate patients following stroke; however since the last publication of Bobath (1990), the concept has been taught via an oral tradition on postgraduate courses.
Bobath method is to improve quality of the affected body side's movements in order to keep both sides working as harmoniously as possible. While applying this method at work, physical therapist guides patient's body on key-points, stimulating normal postural reactions, and training normal movement pattern. Core themes defining Bobath program is analysis of normal movement, control of tone and facilitation of movement. Neuroplasticity was described as the primary rationale for treatment with therapists using afferent information to target the damaged central nervous system. Tone remained a major problem in the rehabilitation management of the hemiplegic patient; however much attention was also directed towards the musculoskeletal system. Both facilitation of normal movement components and task specific practice using specific manual guidance were considered critical elements of the Bobath concept. For Bobath therapists, physiotherapy has an important impact on both the performance components of movement and functional outcomes.
Motor relearning program (MRP):
Motor relearning program (MRP) is based on movement science, biomechanics and training of functional movement. Program is based on idea that movement pattern shouldn't be trained; it must be relearned.
Research input says Motor relearning program (MRP) is better than Bobath program:
Langhammer B et al (2000) examined whether two different physiotherapy regimes caused any differences in outcome in rehabilitation after acute stroke. They found physiotherapy treatment using the motor relearning program is preferable to that using the Bobath program in the acute rehabilitation of stroke patients.
Krutulyte G et al (2003) indicates that physiotherapy with task-oriented strategies represented by MRP, is preferable to physiotherapy with facilitation/inhibition strategies in comparison to Bobath program, in the rehabilitation of stroke patients.
Higher research technique i.e. Delphi technique proving the effectiveness of Bobath programs:
Raine S (2006) used the Delphi technique to enable experts in the field to define the current Bobath concept. The Delphi study was an effective research tool, maintaining anonymity of responses and exploring expert opinions on the Bobath concept. The experts stated that Bobath's work has been misunderstood if it is considered as the inhibition of spasticity and the facilitation of normal movement, as described in some literature. They agreed that the Bobath concept was developed by the Bobaths as a living concept, understanding that as therapists' knowledge base grows their view of treatment broadens.
The Bobath concept, based on the work of Berta and Karel Bobath, offers therapists working in the field of neurological rehabilitation a framework for their clinical interventions. It is the most commonly used approach in the UK. According to Lennon S et al (2000) Bobath concept and its main theoretical assumptions had changed since 1990. Although they recognize that over the last half-century the concept has undergone considerable developments, proponents of the Bobath concept have been criticized for not publishing these changes.
The Bobath concept, usually known as neuro-developmental treatment (NDT) in America, is one of the major approaches used to rehabilitate patients following stroke; however since the last publication of Bobath (1990), the concept has been taught via an oral tradition on postgraduate courses.
Bobath method is to improve quality of the affected body side's movements in order to keep both sides working as harmoniously as possible. While applying this method at work, physical therapist guides patient's body on key-points, stimulating normal postural reactions, and training normal movement pattern. Core themes defining Bobath program is analysis of normal movement, control of tone and facilitation of movement. Neuroplasticity was described as the primary rationale for treatment with therapists using afferent information to target the damaged central nervous system. Tone remained a major problem in the rehabilitation management of the hemiplegic patient; however much attention was also directed towards the musculoskeletal system. Both facilitation of normal movement components and task specific practice using specific manual guidance were considered critical elements of the Bobath concept. For Bobath therapists, physiotherapy has an important impact on both the performance components of movement and functional outcomes.
Motor relearning program (MRP):
Motor relearning program (MRP) is based on movement science, biomechanics and training of functional movement. Program is based on idea that movement pattern shouldn't be trained; it must be relearned.
Research input says Motor relearning program (MRP) is better than Bobath program:
Langhammer B et al (2000) examined whether two different physiotherapy regimes caused any differences in outcome in rehabilitation after acute stroke. They found physiotherapy treatment using the motor relearning program is preferable to that using the Bobath program in the acute rehabilitation of stroke patients.
Krutulyte G et al (2003) indicates that physiotherapy with task-oriented strategies represented by MRP, is preferable to physiotherapy with facilitation/inhibition strategies in comparison to Bobath program, in the rehabilitation of stroke patients.
Higher research technique i.e. Delphi technique proving the effectiveness of Bobath programs:
Raine S (2006) used the Delphi technique to enable experts in the field to define the current Bobath concept. The Delphi study was an effective research tool, maintaining anonymity of responses and exploring expert opinions on the Bobath concept. The experts stated that Bobath's work has been misunderstood if it is considered as the inhibition of spasticity and the facilitation of normal movement, as described in some literature. They agreed that the Bobath concept was developed by the Bobaths as a living concept, understanding that as therapists' knowledge base grows their view of treatment broadens.
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