Bobath Concept

The Bobath concept (synonym: Neurodevelopmental Treatment – NDT) is a concept used in physiotherapy as well as in occupational and speech therapy for the treatment of patients with cerebral movement disorder (CP) regardless of age. The development of the concept is based on the experience of the gymnastics teacher Dr. h. c. Berta Bobath (1907-1991). She noticed that spasticity (spasmodically increased tension of the skeletal muscles, caused by damage to the nervous system) can be influenced by targeted training. Her personal key experience in establishing this theory was the treatment of a severely spastic patient. At that time, the doctrine in Europe was that spasticity could not be influenced and therefore only a strengthening of the “healthy” side was necessary. This strengthening should compensate for hemiplegia (hemiplegia – complete paralysis of one side of the body). With her experience as a gymnastics teacher, she was able to perform specific relaxation and muscle strengthening exercises and found that not only could the patient’s tone (muscle tension) be reduced, but that it was possible for the patient to initiate his own movements. Together with her husband Karel (1906-1991), they researched the background of the success of the therapy.

Indications (areas of application)

  • Apoplectic insult (synonyms: stroke, apoplexy, cerebral infarction, cerebrovascular accident) – it is a sudden disease of the brain characterized by the occurrence of either intracranial hemorrhage (cerebral hemorrhage), ischemia (reduced blood flow) of a cerebral vessel, or other seizure triggers
  • Craniocerebral trauma (TBI) – generic term for both closed and open skull injuries with perforation (opening) of the dura mater (hard and outer meninges) resulting in damage to the brain. The severity of a traumatic brain injury (TBI) is coded by Roman numerals (TBI I, TBI II, TBI III).
  • Hypoxic brain injury – severe impairment of brain performance due to oxygen deficiency. As a result of the deficiency, there is death of brain cells, which are defined as non-regenerative according to current research. The brain damage can occur, for example, due to the occurrence of a heart attack or a drowning accident.
  • Brain tumors – e.g. astrocytomas, oligodendrogliomas, meningiomas.
  • Genetic alterations of the nervous system
  • Developmental disorders and delays

Contraindications

  • Severe heart disease
  • Malignant (malignant) tumors with metastases (daughter tumors)
  • Fever

The procedure

The concept, in addition to the significant discovery of tonus influence, is based on the consideration of the human body as a whole of body and mind. Furthermore, it was established by Karel Bobath and later empirically proven by researchers that due to the plasticity (reshaping ability) of the human brain, a redistribution and restructuring of processes that previously took place in non-functioning brain areas can be taken over by healthy brain areas. Moreover, in the Bobath thought model, it was assumed that sensory stimuli (sensory perceptions) can cause voluntary movements. According to this pattern, the treatment techniques developed are intended to cause inhibition (inhibition), stimulation (stimulation), and facilitation (enabling the interaction of nerves and muscles) of a movement in patients. Not only inhibition, but also stimulation serves to influence tone. Facilitation, on the other hand, is intended to bring positioning, balance and support reactions closer to normal. From the Bobath-Therapeuten Deutschlands e. V. the partially already mentioned principles were compiled:

  • The changeability (openness of the concept).
  • Holism
  • Goal-relatedness of the therapy (individual independence and autonomy).
  • Neurological foundation (only scientifically proven procedures may be added to the list of exercises in therapy).
  • Developmental motor skills (the inclusion of the patient’s age in the selection of therapeutic approaches).
  • Everyday life relatedness
  • Approach based on the individual (only a program tailored to the patient leads to the achievement of the therapeutic goal).
  • Work related to the therapy and care for relatives.

The nature of the patient’s response to passive movement by the therapist is considered to evaluate the effectiveness of therapy. Unlike many other therapeutic approaches, in the Bobath concept there is no list from defined exercises, so that the further development of the measures is always continued. Of particular therapeutic importance is the Bobath concept for patients with cerebral palsy (a disease whose origin is often an early childhood brain damage and is noticeable by disturbances in the voluntary coordination of movement due to an influence on the nervous and muscular system), which is today considered the most successful concept for the treatment and care of these patients. The Bobath concept is considered the most successful pattern in the care and therapy of patients with cerebral movement disorders. The following aspects should be emphasized as benefits to the patient:

  • Improvement of the interaction of healthy and paralyzed side.
  • Relearning of lost movements and skills.
  • Inhibition (inhibition) of spasticity and correction of abnormal movement and postural patterns.
  • Prevention (prevention and prevention) of pain.
  • Increasing flexibility and regaining the former independence.

Possible complications

  • None