Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
BOBATH APPROACH
BY
GAJANAN BHALERAO
What is Bobath
therapy?
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 specialised handling.
Who were the
Bobaths?
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.
Why is it used for
strokes?
Because Bobath therapy is a useful
treatment for neurological-based movement
disorders. Having a stroke can cause
cerebral palsy in babies and young children,
but there is a major difference between
children and adults who have had a stroke;
adults who have lost certain abilities can tap
into their previous experiences to relearn
skills, whereas young children will have no
previous experience of a normal movement
to tap into, and have to be taught.
What effect does it
have?
tone.
Sherringtone(1947) stated that normal movement need a
background of normal tonus.
Tonus & the coordination of movement are indivisible;
they depend on each other.
The abnormal types of postural tone & the stereotyped
total motor patterns we see in our patient are the result
of disinhibition, I.e. of a release of lower pattern of
activity from higher inhibitory control.
Such release does not only produce muscular signs, such
as exaggerated stretch & tendon reflexes, but abnormal
patterns of coordination.
Abnormal qualities of postural
tone.
Inhibition is very important factor in control of posture &
movement.
With increase of inhibitory control of the maturing brain,
the organism increasingly gains more selective control of
posture against gravity.
This process fallows cephalocaudal direction.
Although the limbs & parts of body achieve a partial
independence in this way, their emancipation from the
total patterns is never complete.
The movement of a limb remains to some extent always
subordinate to the control of the whole organism.
Abnormal qualities of postural
tone.
The action of total pattern has to be inhibited prior to
the inhibition of a localized action.
This means that normal functional & skilled activity
are largely a matter of inhibitory control.
The quality of coordination & its development in
early childhood depends, therefore, on increase of
inhibitory control & not on increase of muscle power.
Inhibition is a active at every level of the CNS.
The difference between lower & higher levels of
integrations only the matter of complexity.
Abnormal qualities of postural
tone.
Selective movement of parts of body & limbs need
inhibition of those parts of patterns which unnecessary for
specific function.
Inhibition doesn't only make selective movement possible,
but plays a imp role in the grading of movement, I.e. it is
an important factor in reciprocal innervations. It is the
balanced activity of excitation & inhibition during a
movement which control speed, range & direction.
Inhibition on excitation & changes & moulds it for the
purpose of coordination. It modifies & control action.one
might say that inhibition is control.
Abnormal qualities of postural
tone.
The brain damaged patient suffers from a lack of
inhibitory control over his movements.
This itself show release of tonic reflex activity,
i.e. spasticity in abnormal total patterns.
Spasticity will increases, producing deterioration
of his movements. Movements become slowed
down, laboured, or he may become too stiff to
move altogether.
Abnormal qualities of postural
tone
When observing a spastic patient
one is struck by the fact that
spasticity shows itself in definite
pattern of abnormal coordination
& that is not confined to a few
isolated muscles.
The patients posture &
movement are stereotyped &
typical, & he is more or less fixed
in few abnormal pattern of
spasticity which he cannot change
or can do so only with excessive
effort.
Abnormal qualities of postural
tone
Therefore, movements,
which need a coastally
changing background of
postural control &
adjustment, are prevented.
To think to posture as
separate from movement
is highly artificial, for
posture is in fact, in
constant flux & should be
regarded as temporarily
arrested movement.
Reciprocal innervation
In intact organism, spinal inhibition becomes
modified by higher central nervous influences &
allows reciprocal innervation, a more adequate
response to the multitude of stimuli which enters the
central nervous system in normal condition of life.
Agonist, antagonist & synergists are pitted against
each other in finely graded way giving necessary
interplay of muscles group for fixation with mobility
& optimal mechanical conditions for muscle power.
Reciprocal innervation
In normal circumstances all the required degrees
of reciprocal interaction in various parts of the
body and limbs necessary for postural fixation,
grading of movement & for the maintenance of
equilibrium are present.
Disturbed reciprocal innervation described above
are responsible for the way in which a patient is
fixed n few abnormal patterns, & for the
difficulty in coordinating movement & their
grading.
Reciprocal innervation
The degrees of fixation in stereotyped postural
patterns depends on the severity of spasticity in
individuals case & are the result of the release of
abnormal postural reflexes which interact with
each other.
Treatment aims at inhibition of abnormally
release patterns of coordination & the facilitation
of the higher integrated automatic reactions of
normal postural control & of those of more
voluntary activity.
Reciprocal innervation
Treatment helps the patient to develop & increase
his control over the disinhibited action of tonic
reflex activity by use of patterns which inhibit
spasticity.
Through inhibition his movement are channeled
into more normal patterns of function.
With the helps of therapist, the patient gains
control over the released abnormal non-functional
motor patterns
THANK
YOU
NORMAL AUTOMATIC
POSTURAL CONTROL
NORMAL AUTOMATIC
POSTURAL CONTROL
Normal postural activity forms the
necessary background for normal
movement & for functional skills.
The basic patterns of coordination which
underly & make possible voluntary &
skilled activities are those of normal
postural reactions against gravity.
NORMAL AUTOMATIC
POSTURAL CONTROL
This normal postural reflex mechanism consist of
a great number of dynamic postural reactions
which work together, reinforce each other &
interact for the purpose of protection against
falling & against injury to muscles & joints.
They are active during & before a movement is
performed, & they give us the ability to
counteract gravity, without fatigue, & to adjust
our posture when we are in an uncomfortable
position.
NORMAL AUTOMATIC
POSTURAL CONTROL
They make us able to move in spite of having to
keep up against gravity, for ex walking up &
down the stairs.
They make us change our posture automatically
before we move inn order to make the intended
movement possible & easy.
Such postural adjustment called as postural sets
They are postural changes in anticipation of, as
well as accompanying any movement.
NORMAL AUTOMATIC
POSTURAL CONTROL
They make us able to move in spite of having to
keep up against gravity, for ex walking up &
down the stairs.
They make us change our posture automatically
before we move inn order to make the intended
movement possible & easy.
Such postural adjustment called as postural sets
They are postural changes in anticipation of, as
well as accompanying any movement.
NORMAL AUTOMATIC
POSTURAL CONTROL
Postural adjustment occur not only as a
result of sensory feedback in response to
unexpected perturbations, but also as a
result of feed forward in anticipation of
expected, self generated perturbations
Postural reactions
They are Active movement
Although Sub cortically controlled &
Automatic
Give head & trunk control
Maintain or restore normal alignment of
body
Maintain & regain balance
Posture
There is no dividing line between posture
& movement, but fluid transition from one
to the other.
Posture is a part of every movement, and if
a movement is arrested at any stage, it
becomes a posture.
Postural reactions
The development of coordination in early childhood
goes step by step with the development of postural
reaction with their appearance, modifications &
disappearance when more complex & more voluntary
skilled activities are acquired.
The development of automatic postural control of
movement has been called principle mobility by
schaltenbrand (1927).
The knowledge of development of coordination is
necessary for the treatment of all patient with upper
motor neuron lesions.
RIGHTING REACTIONS
The righting reactions are automatic reactions
which serve to maintain & restore the normal
position of head in space & its normal
relationship with the trunk, together with normal
alignment of trunk & limbs.
They develop in childhood & are well advanced
at age of 5 months of age.
Rotation around the body axis plays an important
role in these activities.
RIGHTING REACTIONS
Gradually modifies & become integrated into
more complex activities, such as the equilibrium
reactions & voluntary movement.
There are essential in the building up of motor
patterns for adult life.
Throughout life they are necessary for getting up
from the floor, for getting out of the bed, for
sitting up, for kneeling down, etc.
EQUILIBRIUM REACTIONS
Equilibrium reactions are automatic reactions which
serve to maintain & restore balance during all our
activities, especially when we are in danger of falling.
All equilibrium reactions reactions, tonus changes &
movement changes have to be well coordinated,
quick, adequate in range & well timed (Rademaker,
1935, Weisz1938)
Tested either by the body moving body against a
fixed support such as the ground, or by means of a
movable platform or tilting table.
AUTOMATIC ADAPTATION OF
MUSCLES TO CHANGE OF POSTURE