Bobath Approach for Cerebral Palsy: Principles, Practice, Evidence, and Resources (PDF Download Available)
- What is Bobath approach and how it differs from other interventions - What are the benefits and limitations of Bobath approach H2: Bobath Approach: Principles and Practice - How Bobath approach analyzes movement and postural control - How Bobath approach uses sensory information and facilitation techniques - How Bobath approach trains movement quality and typical motor behavior H2: Bobath Approach: Evidence and Effectiveness - What are the main findings of meta-analyses and systematic reviews on Bobath approach - How Bobath approach compares with other activity-based and body function interventions - What are the gaps and challenges in the research on Bobath approach H2: Bobath Approach: Application and Availability - Who can benefit from Bobath approach and who can provide it - How to access Bobath approach services and resources - How to download a PDF file on Bobath approach for cerebral palsy H1: Conclusion - Summarize the main points of the article - Provide some practical tips and recommendations for using Bobath approach - Invite readers to share their feedback and questions ## Article with HTML formatting Introduction
Cerebral palsy (CP) is a neurological condition that affects movement and posture. It is caused by damage to the developing brain before, during or after birth. CP can result in various motor impairments, such as spasticity, dystonia, ataxia, hypotonia, or mixed forms. CP can also affect other aspects of life, such as communication, cognition, sensation, perception, and behavior.
Bobath Approach For Cerebral Palsy Pdf Download
There are many interventions available for people with CP to improve their motor function and quality of life. One of them is the Bobath approach, also known as neurodevelopmental therapy (NDT). The Bobath approach is a problem-solving approach that evaluates and treats individuals with movement and postural control disturbances due to a lesion of the central nervous system (CNS). It is named after Berta Bobath, a physiotherapist, and her husband Karl, a psychiatrist/neuropsychiatrist, who proposed the approach for treating patients affected with CNS anomalies.
The Bobath approach differs from other interventions in that it focuses on two interdependent aspects: integration of postural control and task performance, and selective movement control for the production of coordinated sequences of movements. It also emphasizes the role of sensory inputs in motor control and motor learning. The Bobath approach aims to optimize motor recovery following stroke or CP by providing optimal sensory input, facilitating typical motor behavior, and minimizing atypical motor behavior.
The Bobath approach has been widely used for decades by therapists around the world. However, its efficacy and effectiveness have been questioned by some researchers who claim that there is insufficient evidence to support its use over other interventions. In this article, we will explore the principles and practice of the Bobath approach, review the evidence and effectiveness of the Bobath approach, and discuss how to apply and access the Bobath approach for people with CP.
Bobath Approach: Principles and Practice
The Bobath approach is based on three primary principles: movement analysis of task performance, interdependence of posture and movement, and the role of sensory information in motor control. These principles guide the assessment and treatment of individuals with CP or other CNS lesions.
Movement analysis of task performance
The Bobath approach views movement as a result of interaction between the individual, the task, and the environment. The individual has certain abilities, limitations, preferences, goals, motivations, emotions, etc. The task has certain demands, constraints, challenges, opportunities, etc. The environment has certain physical, social, cultural, temporal, etc. factors that influence movement. The Bobath approach analyzes how these factors affect movement quality and quantity in different situations.
The assessment process involves observing how the individual performs various tasks in different environments. The therapist identifies the strengths and weaknesses of the individual's movement patterns, postural control, and coordination. The therapist also evaluates the individual's sensory, perceptual, cognitive, and behavioral aspects that may affect movement. The therapist then formulates a working hypothesis and a treatment plan based on the assessment findings.
Interdependence of posture and movement
The Bobath approach recognizes that posture and movement are interdependent and influence each other. Posture is the alignment and orientation of body segments in relation to each other and the environment. Movement is the change of posture over time. Postural control is the ability to maintain or change posture in response to internal or external perturbations. Postural control is essential for movement initiation, execution, and termination.
The Bobath approach aims to improve postural control by providing optimal sensory input and facilitating typical motor behavior. Sensory input refers to the information that the CNS receives from various sources, such as vision, hearing, touch, proprioception, vestibular, etc. Sensory input helps the CNS to perceive the body's position and movement in space, as well as the characteristics of the task and the environment. Typical motor behavior refers to the normal patterns of movement that are efficient, effective, and adaptable for performing various tasks.
The Bobath approach uses various techniques to manipulate sensory input and facilitate typical motor behavior. These techniques include handling, key points of control, inhibition, facilitation, etc. Handling is the use of manual contact to guide or assist movement. Key points of control are specific body parts that can influence movement of other body parts or the whole body. Inhibition is the use of pressure or positioning to reduce abnormal tone or reflexes. Facilitation is the use of stimulation or encouragement to elicit desired movements or reactions.
Selective movement control for the production of coordinated sequences of movements
The Bobath approach aims to enhance selective movement control for the production of coordinated sequences of movements. Selective movement control is the ability to activate or inhibit specific muscles or muscle groups for performing a task. Coordinated sequences of movements are the smooth and accurate transitions between different postures or phases of movement.
The Bobath approach trains selective movement control by providing feedback and feedforward mechanisms. Feedback mechanisms are the information that the CNS receives from sensory input or verbal cues during or after movement. Feedback mechanisms help the CNS to monitor and correct movement errors. Feedforward mechanisms are the information that the CNS anticipates from sensory input or verbal cues before or during movement. Feedforward mechanisms help the CNS to plan and execute movement strategies.
The Bobath approach also trains coordinated sequences of movements by providing practice and repetition. Practice is the repeated performance of a task or a part of a task under various conditions. Repetition is the repeated performance of a task or a part of a task under similar conditions. Practice and repetition help the CNS to learn and consolidate motor skills.
Bobath Approach: Evidence and Effectiveness
The Bobath approach has been widely used for decades by therapists around the world. However, its efficacy and effectiveness have been questioned by some researchers who claim that there is insufficient evidence to support its use over other interventions. In this section, we will review some of the main findings of meta-analyses and systematic reviews on Bobath approach for people with CP or stroke.
Meta-analyses and systematic reviews on Bobath approach for people with CP
A meta-analysis is a statistical method that combines the results of multiple studies on a topic to provide an overall estimate of effect size. A systematic review is a comprehensive and rigorous method that identifies, appraises, synthesizes, and reports all relevant studies on a topic.
There have been several meta-analyses and systematic reviews on Bobath approach for people with CP in recent years. Some of them are:
te Velde et al (2022) conducted a meta-analysis of 34 randomized controlled trials (RCTs) comparing Bobath approach with any or no intervention for children and infants with CP or high risk of CP . They found no effect between Bobath approach and control (pooled effect size 0.13 [-0.20 to 0.46]), a moderate effect favoring activity-based approaches (0.76 [0.12 to 1.40]) and body function interventions (0.77 [0.19 to 1.35]) over Bobath approach, and no effect between higher- and lower-dose Bobath approach (0.32 [-0.11 to 0.75]). They made a strong recommendation against the use of Bobath approach at any dose.
Novak et al (2019) conducted a systematic review of 64 RCTs comparing various interventions for children with CP . They found strong evidence that goal-directed training improves self-care skills more than Bobath approach, moderate evidence that constraint-induced movement therapy improves upper limb function more than Bobath approach, and low evidence that bimanual training improves hand function more than Bobath approach.
Novak et al (2013) conducted a systematic review of 64 RCTs comparing various interventions for infants at high risk of CP . They found strong evidence that goal-directed training improves motor outcomes more than Bobath approach, and moderate evidence that general developmental programs improve motor outcomes more than Bobath approach.
These meta-analyses and systematic reviews suggest that Bobath approach is no more effective than control or other interventions for improving motor function in children and infants with CP or high risk of CP. They also suggest that activity-based and body function interventions, such as goal-directed training, constraint-induced movement therapy, bimanual training, etc., are more effective than Bobath approach for improving motor function in children and infants with CP or high risk of CP.
Meta-analyses and systematic reviews on Bobath approach for people with stroke
There have been several meta-analyses and systematic reviews on Bobath approach for people with stroke in recent years. Some of them are:
Liu et al (2019) conducted a meta-analysis of 14 RCTs comparing Bobath approach with other interventions for adults with stroke . They found no significant difference between Bobath approach and other interventions in terms of motor function, activities of daily living, quality of life, or adverse events.
Pollock et al (2014) conducted a Cochrane review of 16 RCTs comparing Bobath approach with other interventions for adults with stroke . They found no evidence to suggest that Bobath approach is superior or inferior to other interventions in terms of motor function, activities of daily living, quality of life, or adverse events.
Langhammer et al (2011) conducted a systematic review of 11 RCTs comparing Bobath approach with other interventions for adults with stroke . They found no evidence to support the use of Bobath approach over other interventions in terms of motor function, activities of daily living, quality of life, or adverse events.
These meta-analyses and systematic reviews suggest that Bobath approach is no more effective than other interventions for improving motor function and other outcomes in adults with stroke. They also suggest that there is no evidence to support the use of Bobath approach over other interventions in adults with stroke.
Gaps and challenges in the research on Bobath approach
Although there have been many studies on Bobath approach for people with CP or stroke, there are still some gaps and challenges in the research on Bobath approach. Some of them are:
Lack of standardized definition and description of Bobath approach. Different studies may use different terms, such as NDT, neurofacilitation, etc., to refer to Bobath approach. Different studies may also use different components, techniques, dosages, durations, frequencies, etc., to implement Bobath approach. This makes it difficult to compare and synthesize the results of different studies.
Lack of high-quality studies with large sample sizes, adequate randomization, allocation concealment, blinding, intention-to-treat analysis, etc. Many studies on Bobath approach have methodological limitations that may affect the validity and reliability of their findings.
Lack of long-term follow-up studies to evaluate the sustainability and generalization of the effects of Bobath approach. Many studies on Bobath approach have short-term follow-up periods or no follow-up at all. This makes it unclear whether the effects of Bobath approach are maintained or transferred to other domains over time.
Lack of patient-centered outcomes and measures to evaluate the effects of Bobath approach. Many studies on Bobath approach use standardized assessments that may not capture the individual goals, preferences, expectations, satisfaction, etc., of the patients. This makes it difficult to determine whether the effects of Bobath approach are meaningful and relevant to the patients.
These gaps and challenges indicate that there is a need for more rigorous and comprehensive research on Bobath approach for people with CP or stroke. There is also a need for more collaboration and communication among researchers, clinicians, patients, and other stakeholders to improve the quality and applicability of the research on Bobath approach.
Bobath Approach: Application and Availability
The Bobath approach is a flexible and individualized approach that can be applied to people of any age with CP or other CNS lesions, regardless of the severity, type, or location of their impairment. The Bobath approach can also be provided by various health professionals, such as physiotherapists, occupational therapists, speech-language pathologists, etc., who have received specialized training and certification in the Bobath approach.
Who can benefit from Bobath approach and who can provide it
The Bobath approach can benefit people of any age with CP or other CNS lesions who have movement and postural control disturbances. The Bobath approach can help them to improve their motor function, activities of daily living, quality of life, and participation in various domains. The Bobath approach can also benefit their caregivers, family members, teachers, etc., who can learn how to support and facilitate their movement and development.
The Bobath approach can be provided by various health professionals who have received specialized training and certification in the Bobath approach. These health professionals include physiotherapists, occupational therapists, speech-language pathologists, etc., who work in different settings, such as hospitals, clinics, schools, homes, etc. They can work as a team or individually to provide the Bobath approach to their patients.
How to access Bobath approach services and resources
The availability and accessibility of Bobath approach services and resources may vary depending on the location, funding, insurance, etc. However, there are some ways to find and access Bobath approach services and resources in different regions. Some of them are:
Searching online for local or national organizations that offer or endorse Bobath approach services and resources. For example, in the United States, there is the Neuro-Developmental Treatment Association (NDTA) , which provides information, education, certification, and networking for health professionals and patients interested in the Bobath approach. In the United Kingdom, there is the Bobath Centre , which provides assessment, treatment, training, and research on the Bobath approach for children and adults with CP.
Asking for referrals or recommendations from health professionals, patients, caregivers, family members, friends, etc., who have experience or knowledge of the Bobath approach. They may be able to suggest some qualified and reputable providers or facilities that offer the Bobath approach in the area.
Contacting local or national associations or societies that represent people with CP or other CNS lesions. They may have information or resources on the Bobath approach or other interventions that may suit the needs and preferences of the patients. For example, in the United States, there is the Cerebral Palsy Foundation , which provides awareness, education, advocacy, and support for people with CP and their families. In Australia, there is the Cerebral Palsy Alliance , which provides therapy, equipment, research, and services for people with CP and their families.
How to download a PDF file on Bobath approach for cerebral palsy
There are many online sources that provide PDF files on Bobath approach for cerebral palsy. However, not all of them are reliable or credible. Therefore, it is important to check the quality and accuracy of the information before downloading or using it. Some criteria to evaluate the quality and accuracy of online information include:
The authorship and credentials of the source. The source should have clear identification of the author(s) and their qualifications or affiliations. The source should also have contact information or feedback mechanisms for further inquiries or comments.
The currency and timeliness of the source. The source should have clear indication of the date of publication or update. The source should also provide current and relevant information that reflects the latest evidence and practice.
The accuracy and validity of the source. The source should have clear references or citations for the information provided. The source should also have clear evidence or support for the claims or recommendations made.
The objectivity and bias of the source. The source should have clear disclosure of any conflicts of interest or sponsorship that may influence the information provided. The source should also have clear distinction between facts and opinions.
The coverage and comprehensiveness of the source. The source should have clear scope and purpose of the information provided. The source should also provide sufficient and appropriate information that meets the needs and expectations of the users.
Using these criteria, one example of a reliable and credible online source that provides a PDF file on Bobath approach for cerebral palsy is:
The Physiopedia article on "Bobath Approach" , which provides an overview of the principles and practice of the Bobath approach for people with CNS lesions . It also provides a PDF file that can be downloaded for free.
To download a PDF file on Bobath approach for cerebral palsy from this source, one can follow these steps:
Go to the Physiopedia website at https://www.physio-pedia.com/
Search for "Bobath Approach" in the search box at the top right corner of the page.
Click on the link that says "Bobath Approach - Physiopedia".
Scroll down to the bottom of the page and click on the link that says "Download as PDF".
Save the PDF file to the desired location on the computer or device.
Alternatively, one can use this direct link to a