TX3: BOBATH’S NEURODEVELOPMENTAL TREATMENT PT APPLICATIONS TEAM

DLSMHSI CRS PT Department AY 2018-2019

I. History Placing Maneuver
Brunnstrom Bobath ___________________________________________
___________________________________________
___________________________________________

3. Associated Reactions
___________________________________________
___________________________________________
___________________________________________
___________________________________________
II. Primary Principles Indication:
Brunnstrom Bobath ___________________________________________
___________________________________________
___________________________________________

In order to reduce detrimental effects of associated

reactions:
a. Movements are done slowly
b. Spread of excitation into spastic patterns can be
counteracted by inhibiting parts of these
patterns (RIP)
c. Inhibit spasticity immediately
Bobath NDT Principles d. At the start o treatment, excitation and effort are
- Retrain NORMAL movements on hemiplegic side kept to a minimum
- Avoid activities that increase ABNORMAL tone or e. Help patient learn to inhibit this spasticity by the
responses use of selective movements.
- Encourage and strengthen NORMAL movements on
trunk and extremities 4. Key Points of Control
- Use EXISTING motor control on HEMIPLEGIC side ___________________________________________
- If strength and control is not enough, use ___________________________________________
COMPENSATION and ADAPTATIONS on the AFFECTED ___________________________________________
side
Proximal Distal
A. Basic Premises
1. Sensations of movements are learned, not movement
per se.
2. Basic postural and movement patterns are learned
first which are later on elaborated to become
functional skills.
3. Skilled activity takes place against a background of
normal postural reactions.
Proximal Facilitates
B. Definition of Terms Key Points movement
1. Engram of Control of limbs
___________________________________________
___________________________________________
___________________________________________
Distal Key Facilitates
___________________________________________ Points of movement
Control of the trunk
2. Placing Response
___________________________________________
___________________________________________
___________________________________________
___________________________________________

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Lecture Hand-outs made for PT Batch 2020
TX3: BOBATH’S NEURODEVELOPMENTAL TREATMENT PT APPLICATIONS TEAM
DLSMHSI CRS PT Department AY 2018-2019
5. Handling ____________________________________
___________________________________________ ____________________________________
___________________________________________ ____________________________________
___________________________________________ o Flaccidity
___________________________________________ ____________________________________
Uses: ____________________________________
a. To establish normal alignment ____________________________________
b. To reduce or eliminate abnormal tone and
movement IV. Principle of Treatment
c. To re-educate muscles in normal patterns - Avoid movements that produce abnormal responses
d. To produce an active movement pattern in stroke in the involved side
patients - Develop patterns of posture and movement
- Incorporate hemiplegic side into all treatment
Strong and firm hand pressure is used to: activities
a. - Treatment → change in the quality of movement and
b. functional performance of the involved side
- Never exercise - ____________
Light pressure is used to: - Start and finish a treatment session with something
a. positive.
b. - Use _________________________; fast movements
c. can increase spasticity
- The patient must find the treatment
6. Reflex-inhibiting postures __________________________________.
___________________________________________ - After spasticity has been inhibited, follow with a
___________________________________________ purposeful movement – put it to use!
___________________________________________ - Encourage the patient to look at his or her arm.
- Tell a patient when a movement has been done
correctly so that the patient can feel it.
Active inhibits and - If spasticity starts, _______
- The patient often has to relearn movements, even on
movement facilitates his good side.

REMEMBER!
Best Inhibition: ______________________________
Bobath is against:
a.
RIPs
b.
a. For flexor spasticity of trunk and arm
c.
-
-
-
V. Treatment Methods
-
1. Modify sensory inputs through:
-
a.
-
b.
c.
b. For extensor and flexor spasticity of the LE
d.
-
2. Facilitate automatic reactions
-
3. Integrate normal movement patterns into the
-
developing nervous system
III. Movement Control Problems After Stroke
- Loss of normal movement responses
o
o
- Abnormal tone
o Spasticity
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Lecture Hand-outs made for PT Batch 2020
TX3: BOBATH’S NEURODEVELOPMENTAL TREATMENT PT APPLICATIONS TEAM
DLSMHSI CRS PT Department AY 2018-2019
A. Facilitation vs Inhibition 1. Stage of Flaccidity
Characteristics:
Facilitation - Severe loss of postural control in the trunk
- Flaccid paralysis of the UE and LE
- Poor sitting balance
- Requires assistance in bed mobility and transfers

Goals:
- ___________________________________________
___________________________________________
- ___________________________________________
___________________________________________

2. Stage of Spasticity
Characteristics:
- Spastic posturing appears when patient uses
excessive effort; not evident when relaxed
- First muscles affected:
Inhibition o
o
o
o

Goals:
- ___________________________________________
- ___________________________________________
- ___________________________________________
___________________________________________

3. Stage of Relative Recovery

Characteristics:
- Good control of weight-bearing on the hemiplegic leg
B. Sequencing of Treatment - Minimal flexor posturing of the arm
- Slow and uncontrolled quality of movement

Goals:
- ___________________________________________
- ___________________________________________

Emphasis of treatment: To correct patterns PRINCIPLE OF SHUNTING

C. Stage of Stroke Recovery

1. Stage of Flaccidity

2. Stage of Spasticity

3. Stage of Relative
Recovery

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Lecture Hand-outs made for PT Batch 2020
TX3: BOBATH’S NEURODEVELOPMENTAL TREATMENT
DLSMHSI CRS PT Department
Implications of Shunting:
1. PTs have a means of influencing the changing motor
output from the periphery.
2. By changing the relative positions of parts of the body
and limbs when handling a patient, we can change his
abnormal postural patterns and inhibit outflow of
excitation into established ‘shunts’ of the spastic
patterns.
3. We can direct the patient’s active responses:
spasticity is inhibited, more (N) postural reactions and
movements are facilitated.
IN BOBATH:
- Always incorporate the hemiplegic side in all
treatment activities
- PT should be on the hemiplegic side of directly in front
of the patient.
- Patient is always an active and motivated participant
during treatment
- Always inject verbal communication whenever
possible
PT APPLICATIONS TEAM
AY 2018-2019
References:
• Bobath, B. (1990). Adult Hemiplegia: Evaluation and
Treatment, 3rd ed.
• Davies, P. M. (1993). Steps to Follow: A Guide to the
Treatment of Adult Hemiplegia. Germany: Springer-
Verlag.
• Pedretti, L.W. & Early, M.B. (2001) Occupational
Therapy: Practice Skills for Physical Dysfunction, 5 th
ed.
• Radomski, M. (2008). Managing Deficit of First-level
Motor Control Capacities Using Rood and
Proprioceptive Neuromuscular Facilitation
Techniques. In Occupational therapy for physical
dysfunction (6th ed.). Philadelphia: Lippincott
Williams & Wilkins.
• Raine S., Meadows, L., & Lynch-Ellirington, M. (2009).
Bobath Concept: Theory and Clinical Practice in
Neurological Rehabilitation. UK: Wiley-Blackwell.
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Lecture Hand-outs made for PT Batch 2020