Physiotherapy on neurological basis according to Bobath | Neurophysiological physiotherapy

Physiotherapy on neurological basis according to Bobath

The Bobath concept was developed in the middle of the 20th century by the married couple Berta (physiotherapist) and Dr. Karel (neurologist) Bobath. Although the neurophysiological basic hypotheses on which the therapy was developed are outdated today, this does not diminish the success of the therapy in the treatment of neurologically ill children and adults. The treatment concept according to Bobath is based on the assumption that neurological disorders of the central nervous system, which often manifest themselves, among other things, through altered muscle tension and abnormal movement patterns, can be influenced by recurring sensitive stimuli and the offering of normal movement sequences in such a way that almost normal movement development can be stimulated.

The Bobath couple took advantage of the plasticity (i.e. the brain‘s ability to “reorganize”) to learn or regain new functions by networking and activating other areas of the brain. In children with congenital neurological disorders, who have no previous experience of movement, the normal motor age-appropriate development from head control to upright walking serves as the basis for recognizing abnormal movement patterns and developmental deficits.The adult with an acquired neurological disorder must be picked up and supported at the level of his current movement disorder, which may range from loss of all movement functions to minor residual symptoms such as incomplete fine motor skills. Stroke patients in particular often offer a very high potential for regaining motor and mental abilities.

From certain key points (e.g. shoulder and pelvis) the abnormal movement patterns are inhibited by regulating muscle tension and healthy movement sequences are repeatedly initiated (“ground in”). Essential techniques are the stimulation of active functional movements, posture and gait training, but also passive techniques such as positioning and mobilization of a paralyzed patient. If it is not possible to achieve physiological movement development, substitute functions are trained and the use of aids is accompanied.

The starting positions in therapy range from treatment on the lap in infants to gait training for adults with hemiplegia. The treatment successes such as regulation of muscle tension, improvement of joint mobility and self-activity are based on biomechanical changes such as muscle build-up and strength. For the best possible therapeutic success, all those involved in the care of the patient – especially the relatives – should be instructed in the so-called handling (storage, carrying, moving, etc.)

of the patient. It is essential for the success of the therapy that the movement sequences that are offered again and again relate to everyday abilities and skills (everyday life = therapy), as this can increase the learning success and motivation of the patient immensely. Successes such as reaching for a toy, turning around in bed, getting dressed independently or regaining the ability to walk are more conducive to the patient’s own activity than a complicated exercise achieved in therapy. For the implementation of physiotherapy on a neurophysiological basis according to Bobath for children and adults, an additional qualification of the therapist is necessary.