What is Bobath concept?

The Bobath concept is a problem-solving approach used in the evaluation and treatment of individuals with movement and postural control disturbances due to a lesion of the central nervous system. It is named after Berta Bobath, a physiotherapist, and her husband Karl, a psychiatrist/neuropsychiatrist, who proposed the approach for treating patients affected with Central Nervous System anomalies.

How to approach patients with Hemiplegia

Patients with hemiplegia are classified into flaccid and spastic type

Flaccid Type

The Feature: The flaccidity is th initial period following a stroke. patients cannot initiate any voluntary movement on their affeted side. They aren’t able to move and their muscles are generally loosened they will have a small amount of contraction.

Treatment

Passive range of motion : maintain ROM and encourage muscle function stimulating the brain and neural networks that help you move. and also it avoids additional complications such as contractures of joints.

Electrical stimulation: It can encourage communication between the brain and muscles. Functional Electrical Stimulation(FES) can send an electrical impulse directly to patients’ affected muscles.

Optimal positioning: Patients can’t maintain optimal positioning correctly and this can lead to increased pain and swelling in the limb, and subluxation of shoulder joint. We can make optimal positioning with proper assistance exposing to gravity to build muscle tone.

Spastic Type

The Feature: patients have muscle tone increased and stiffness, uncoordinated movements in the affected region. They also have difficulty balancing in sitting and standing position. Spasticity can make compensatory movement when patients try to move functionally.

Treatment

> Stimulate propriocepton and re-educate movement pattern for optimal motor learning.

> Improve physical orientation and input proper sensory on affected region.

> Reduce spasticity with muscle relaxation and increase muscle strength with manual therapy.

Hand treatment of patients with Hemiplegia

1. Postural control: good sitting is a prerequisite for hand treatment because proper trunk upright with back support can provide patients with the stability of shoulder joint and scapula and also the mobility of hand.

2. Anticipatory for reaching: maintaining the appropriate alignment of the shoulder complex on the trunk while facilitating context-based task practice will create a demand for APAs (Anticipated Postural Adjustments) : Incorporating this into daily functional activity is crucial for carry-over.

In reaching to grasp, the hand starts to open at the beginning of the reaching pattern.

3. Improve hand orientation: Initial hand position provides the nervous system with an awareness of the distance and amplitude the arm and hand must movement cover the distance to the target.

4) Anticpatory for grasping: accurate sensorimotor memories (the acquisition of implicit knowledge about object properties associated with repeated manipulations of the same object)

5) Goal-directed function: task – dependent optimal control (various tasks allow their upper limb to control accurately They all play a role in developing the ideation and creation of the components of the functional task)

References

1. 1. [2015, reaching and grasping course in bobath memorial hospital]
   2. [2016, bobath basic course in bobath memorial hospital]
   3. [How to overcome flaccidity after stroke / Medically reviewed by Mariah Cairer PT, DPT / May 5, 2023]
   4. [BBTA : British Bobath Tutors Association – You Tube channel