The Bobath concept is used in physiotherapy, rehabilitation and nursing care and is an important area in the therapy of diseases of the central nervous system. Physiotherapy according to Bobath is used to treat people who have suffered damage to the brain and spinal cord. These include stroke (ischemia in the brain), cerebral hemorrhages, brain tumors, inflammation such as in multiple sclerosis (MS) or other defects of the brain and nerve cells.
In the brain, damaging events, such as a stroke, attack areas and lead to cell death. Due to this event, disturbances in movement behavior and control occur. The consequences are a reduced quality of movement, due to spastic or flaccid paralysis or reduced sensorimotor functions.
If a defect of the central nervous system occurs in an adult, these lost regions can no longer be restored. However, in the brain, the switched-off functions can be taken over by other areas. Part of Bobath physiotherapy is the repetition of movement sequences.
In this way, weakened functions manifest themselves and reappear. Physiotherapy according to Bobath is integrated into everyday life and is not performed as a tight exercise concept. With the help of the physiotherapist, the patient should be introduced to everyday activities again and perform them as much as possible independently.
During the activities, the weakened body region is not neglected but rather integrated. Important here is the perception of the patient. He must not only be aware of his healthy side, but also continue to use his affected side.
Patients affected by a problem of the central nervous system lose the feeling for the position of their body in space. Physiotherapy according to Bobath aims to promote the ability to hold these parts and to move them in a controlled manner. Control involves a certain muscle tone that adapts to the quality of the movement.
The interaction of the agonists and antagonists of the respective muscle groups is important for the motor function of the body and for balance. It is explicitly mentioned that physiotherapy according to Bobath does not eliminate the central cause. The focus of physiotherapy according to Bobath is the patient, who is supported according to his goals and existing possibilities.
The brain of a baby/child has to process a flood of stimuli from the environment and is therefore very powerful. So it is important to show the baby many things and let him try them out, so that he gets many influences from the environment and more and more areas in the brain can develop. In adults, the brain is still in the learning process, but most of the nerve tracts are already developed.
In the beginning it is enough for the baby/infant to perceive its environment lying on its back. But after a few months this is no longer sufficient and the baby tries to catch even more stimuli by changing position. So the baby starts to roll from the supine position to the prone position.
The older the baby becomes, the more he or she feels the need to move into the upright body position in order to not only see but also feel and perceive his or her environment with more senses. The promotion of new movement sequences, as provided for in Bobath physiotherapy, is therefore very important. A prerequisite for this is good control of posture and movement.
So we come back to the concept of Bobath, which promotes this control. There are children/babies who have weaknesses in motor and sensory functions. This does not necessarily have to have a central cause and can also be temporary.
Physiotherapy according to Bobath can be used to work against these weaknesses. Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system. In MS, inflammation of the myelin sheath of the nerve cells and demyelination occur.
The destruction of the myelin sheaths slows down the speed of the nerve tracts considerably, which in turn leads to impaired sensorimotor functions. Patients suffering from MS lose the sense of their body in space and balance. Movements become weaker, are no longer fluid or no longer lead to the desired effect.
As a result, independence is considerably restricted and everyday movements are lost. Often young adults with MS are affected who are in the middle of life and have to care for themselves or others. Through Bobath physiotherapy, everyday activities are integrated into the daily routine.By repeating the procedures, the patients should become safer and re-train these lost functions.
This results in the build-up of muscular strength and a higher stability. The body gets new stimuli by the change of the starting positions and the sensors get new imput to deal more with their environment. You are looking for further information about multiple sclerosis?
- Symptoms of multiple sclerosis
- Physiotherapy for MS
- Physiotherapy for MS
- Exercises in MS
Health insurance companies can cover the costs of physiotherapy in Bobath. However, the prescription for physiotherapy must be ordered with the supplement CNS. This is done under a doctor’s prescription and is based on neurological principles.
Additional services such as prescription fees or a personal contribution are also included. The costs of prescription fees are always around 10 € per prescription. The cost of the co-payment depends on how the patient is insured.
The costs vary according to insurance and time of day, as the regular prices may also change. Under certain circumstances, there are groups of people who can be exempted from all fees/costs. Proprioceptive Neuromuscular Facilitation (PNF) is a treatment concept and was created in the 1940s by Dr. Herman Kabat and later developed further by the physiotherapist Maggi Knott.
Our body possesses certain sensors (proprioceptors) in joints, tendons and muscles that record the body’s sense of position. These are controlled and stimulated by techniques from PNF. In this way, the brain gets a feeling for the position of the body sections in space, their movements and the force they require.
Resistance, tension and pressure on joints, stretching and certain movement patterns are used. In order to stimulate the receptors in the skin, eyes and ear, tactile, acoustic and visual stimuli are additionally applied in PNF. In this case, the physiotherapist uses commands, touch or spatial orientation.
All movement sequences in the PNF run diagonally and are linked to an activity from everyday life. With the diagonal movement patterns, lost functions are learned again and integrated into the daily routine. Techniques from the PNF can be used for Bobath physiotherapy to practice individual activities again.
Comprehensive information on this topic can be found in the article Proprioceptive Neuromuscular FacilitationThe treatment/physical gymnastics according to Bobath and according to Voita, are both suitable as therapy for central diseases. However, they have different treatment approaches and activation points. The treatment according to Voita, is always an excellent basic treatment.
Physiotherapy according to Bobath, on the other hand, is considered a comprehensive therapy. In the physiotherapy according to Bobath, complete activities from everyday life are taken as exercise. At Voita the foundation for the execution of activities is created.
Movements are triggered by reflexes that are anchored in us. They can also be activated when the central nervous system is damaged. There are zones on our body to which pressure is applied and the body reacts with a movement.
Everyday patterns of movement are restored to the central nervous system through automatic mechanisms and repetitions. Because only individual movement sequences are taught to the patient during treatment according to Voita and these happen automatically, undesirable co-movements are also trained in the activity. Not every exercise is suitable for every neurological patient.
Depending on the severity of the disease and the mobility of his body, one must resort to suitable exercises. Balance is always important in order to be stable and secure in all positions. Gravity, a smaller support surface or resistance must not prevent the person from assuming an upright posture.
For this reason it is important to train postural control in the exercises. In the Bobath concept, there are exercises like the piano player who controls this postural control. Piano player: The starting position is sitting on a chair or a bed.
Now the patient gets the order to play an imaginary piano. However, the keyboard is very wide and he must try to get to the end of the keys. So he taps through to the edge and tilts strongly to the side with his trunk.
Depending on how far the patient gets, he lifts half of his buttocks. With this lifting of the buttocks half, the supporting surface is reduced and the body has less fixed points on the couch where it can hold itself.Then he changes sides and taps his fingers through to the other side. Lifting: If the patient is already in the seat, he can perform another exercise.
This exercise comes from the concept of PNF (Proprioceptive Neuromuscular Facilitation) and is called lifting. It serves to promote the straightening and strengthening of the trunk. There is a leading arm and a following arm.
The hand of the following arm holds the wrist of the leading arm. The patient’s hands, head and trunk are inclined to the hip, which is opposite the leading shoulder. The physiotherapist stands behind the patient and once places one hand on the back of the patient’s head and on the leading hand.
Finally, the patient is instructed to first spread the fingers towards the ceiling and move the leading arm towards the leading shoulder. The head turns with the patient and looks behind the leading hand. Meanwhile the physiotherapist sets a resistance and the patient’s hand turns with the movement.
When the leading hand is raised towards the leading shoulder, a diagonal movement of all participating body parts and straightening of the trunk and head is created. Resistance from the physiotherapist strengthens the muscles. The physiotherapist also adds additional stretching (Initial Stretch).
Exercise 3: In the next exercise, the patient moves from a sitting position to a standing position and moves forward slightly so that his heels are firmly on the floor. Both legs are not too close together and are hip-wide apart. The physiotherapist sits next to the patient on his weaker side and the patient supports his affected arm on the palm of the physiotherapist’s hand.
The physiotherapist’s other arm grasps the patient’s posterior pelvis. The weakened leg, is fixed by the physiotherapist by placing his own leg in front of the patient’s leg and preventing him from bending forward when standing up. In this way it is positioned in the upright position.
Then the patient should tilt his upper body forward and stand up. The inclination of the torso to the front is important so that the force is directed in the desired direction of movement. The pelvis is supported by the physiotherapist’s arm and directed forwards/upwards. For this exercise, a certain stability must be guaranteed when standing up.
