By Cedric Fernandez

Introduction
Bobath therapy is an interdisciplinary approach to the management of cerebral palsy involving occupational therapy, physiotherapy and speech and language therapy. Bobath therapy is a holistic approach pioneered by Dr and Mrs. Bobath. The basis of the approach is to give children an experience of normal movement by enabling the child to respond actively to specialized handling.

The Pioneers Mrs.Berta and Dr.Karel Bobath

Berta Bobath was a physiotherapist, who had initially trained in remedial gymnastics. She understood normal movement and posture, and together with her husband Karel, who was a pediatric neurologist, Berta developed an approach to the treatment of cerebral palsy that would encourage a child to move and function as normally as possible, while Karel researched the neurological implications of the Bobath approach.

Fundamental theory
HIERARCHICAL THEORY which described the nervous system as hierarchial in nature -Based on the works of Jackson, Sherrington, and Magnus

Hypothesis
A neurologic insult will lead to a release of the lower-level centers from higher-level center inhibitory control, resulting in stereotypical postures, primitive movement patterns and predominant reflex activity

Treatment for
At its inception the Bobath Approach was specifically used only for children suffering from Cerebral Palsy Treatment approach was later on expanded to include the rehabilitation of adults with motor problems, particularly CVA

Treatment Approach

Main problem: the abnormal coordination of movement patterns combined with abnormal postural tonus
(Bernstein, 1967)

Secondary problem: muscle strength and muscle activity

The Bobath Approach.

has undergone changes in its theoretical base to accommodate developments in the fields of neurophysiology, biomechanics, and typical development involves the whole patient, his sensory, perceptual and adaptive behavior, and motor problems

Principles
Normalize muscle tone

Inhibit primitive reflexes

Facilitate normal postural reactions Treatment should be developmental

Techniques
Handling

Weight bearing over the affected limb

Utilize positions that allow use of the

affected limbs Avoidance of sensory input that affect muscle tone

Techniques of treatment
Initial flaccid stage Stage of spasticity Stage of relative recovery

Physiotherapy in First Stage

Turning over from supine to side-lying Clasped hands raised and moved side to side External rotation of arm in horizontal abduction Alternate flexion and extension of the elbow Preparing the patient for sitting up and standing Working for control of the leg Flexion and passive and slow extension with control of patient in supine position Lateral border of foot raised more than medial

Physiotherapy in First Stage

Extension in preparation for weight bearing - Alternate knee flexion/extension in dorsiflexed foot Preparing for walking without circumduction - Flexion of knee with hip extended - Extension of hip with knee flexed - Moving foot up and down against a wall

Physiotherapy in First Stage

Control of adduction and abduction at the hip in supine Sitting up from supine and side-lying Trunk balance in sitting Working for extended arm support in sitting Control of the arm at the shoulder Mobilizing the shoulder girdle

Physiotherapy in Second Stage

Treatment in sitting and standing up - Shifting chair to chair - Sitting with crossed legs - Controlled lowering of flexed affected limb - Moving dorsiflexed foot backward before standing up

Physiotherapy in Second Stage

Treatment for standing up and standing - Weight bearing on affected leg while starting to stand up - Extension of hip and knee with foot on ground - Stepping forward with affected leg with control by therapist

Physiotherapy in Second Stage

Treatment for walking The stance phase - Weight bearing and balancing of affected leg with unaffected foot in front The swing phase - Knee flexion with hips extended without pulling pelvis upwards - Alternating movements of flexion/extension - Dorsiflexion of spastic foot before step forward - Knee flexion when foot is backwards

Physiotherapy in Second Stage

Treatment in prone lying and kneeling - Patient kneeling forward and asked to lift unaffected arm - Rocking backwards and forwards balancing on affected knee - Kneel standing with weight on affected side - Extension of hip with flexed knee on stool

Physiotherapy in Second Stage

Treatment for control of movements of the arm - Moving trunk in all directions Working for independent and controlled movements of the elbow - While arm is flexed/abducted at shoulder - Moving clasped hands to face

Physiotherapy in Second Stage

Exercises the patient should do at home - Elevation of arms with clasped hands - Then turn palms upwards and outwards - Same movements with arms forward - Walking backward with palms on table - Standing with palms flat and raised against the wall

Physiotherapy in Third Stage

Treatment to improve the patients gait - working for dorsiflexion - Moving trolley with affected leg - Standing with legs crossed - Step backwards on affected leg - Walking with arms in extension - Rotation of pelvis while walking