BOBATH

APPROACH
Bobath Approach 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.

8/1/2014
The basis of the approach is to give
children an experience of normal
movement by enabling the child to
respond actively to specialized handling.


8/1/2014
Three important facts:
it is impossible to superimpose normal
movement patterns on abnormal ones, the
abnormal patterns need to be suppressed
(inhibited)
the importance of sensory-motor experience
(we do not learn a movement but the
sensation of movement)
by moving the proximal part of the body it is
possible to influence and to change the
movements of the distal parts
Treatment is planned for each child via
assessment. Some of the areas that will be
assessed are:
the patterns of movement the child
presents with;
age-appropriate movements that the child
may not be achieving or may find difficult;
the child's present capabilities;
examination of the child's posture in
different situations and positions

Principles of Treatment
Need to change the pattern of abnormal
postural tone to be able to work for enhanced
functional skills.
Use various types of handling to affect
changes:
Tone Influencing Patterns/Posture
Facilitation
Stimulation
Principles of Treatment
Systematic Preparation for Function:
Engagement with child
Address neural and non-neural components
Improve alignment of body parts
Improve muscle activity
Address sensory/perceptual needs
Give experience of and practice more normal
patterns of coordination in selected tasks to
promote transfer of skills into daily life.

Principles of Treatment
Problem Solving Approach
Using purposeful, play centred and goal directed
activities
Carry Over and Management
Active participation by patient, with gradual
reduction in handling or assistance
Self correction and self initiation
Forward looking long term outcome
Training/education of parents
8/1/2014
The Bobath Approach
The main aim of treatment is:
to encourage and increase the child's
ability to move and function in as
normal a way as possible.
to help the child to change his
abnormal postures and movements so
that he or she is able to comfortably
adapt to the environment and develop
a better quality of functional skills.
Change is Possible: Each child's postural
(muscle) tone is changeable, not only in
relation to activity and moods, but also
in response to being handled.


8/1/2014
Positioning is very important in Bobath
treatment.
Correct positioning helps improve
movements.
Experience of different positions is
necessary to improve overall body
control and reduce the risk of
unnecessary poor posture.

Handling a child using key points on the
body allows the therapist to manipulate
the child to correct their movements.
Help may be given with movements like
chewing, handling objects, moving
about, sitting or lying down.

8/1/2014
Handling = making a change
Through handling techniques the PT can
assess the childs potentials
Creates opportunities for the child to
experiment with movement and to
problem-solving for himself
Makes more normal movement possible
Changes with the response of the child

Inhibitory control: Reflex inhibiting
postures (R.I.P.)
- placed and held the patient in reflex
inhibiting postures to break up the
abnormal postural and movement patterns
- no spontaneous carry over into
movement and function occurred, as the
child had never previously experienced the
sensation of normal movements

Inhibition combined with stimulation and
facilitation
- after preparing and obtaining a more normal
postural tone the patient needs to learn to
move in many different combinations of more
normal movement patterns
- looked for possibilities of how to transmit to
the patient in order to enable them to
experience normal sensations of functional
movements they had either lost or never
developed

- The Bobaths realized the importance of
understanding normal development in order
to be able to understand abnormal
development and how to treat it.
- Then the Bobaths recognised the
importance of postural reactions (righting and
equilibrium reactions)
Dynamic treatment with control from Key
Points:
- key points of control(body parts,
mainly proximal - head, shoulders, pelvis)
from which abnormal patterns could be
controlled (inhibited), and the strength
and distribution of postural tone could be
influenced

At the same time normal movement
patterns could be facilitated or a specific
technique of stimulation could be used
From the key point of control the
therapist is able to control and guide the
movement of the whole body. The child
could be facilitated to react actively
where not actually held or controlled
8/1/2014
- The treatment should not follow rigidly the
developmental milestones
- During the treatment it is necessary to reduce
the therapists control, handing it over gradually
to the child and allowing him the control of his
own movements.
- Much guided control and repetition of the
required reactions may be necessary to assure
their quality.
Normal Development
Cephalo-caudal , caudo-cephalad, proximo-
distal, and distal-proximal
Dynamic stability before dynamic mobility
End range movement before midrange control
Symmetrically before asymmetrically
Anterior-posterior direction first then
laterally, then diagonally
Dynamic relationship between BOS, COG and
LOG (stability, readiness to move and with
weight shifting there is movement)
Physiological Flexion
Body concept (body awareness, schema,
image)
Postural control/set (orientation)
Psychological, emotional stability (security)
Muscle balance of development against
extensor group
Back musculature elongation
General Picture of Prematurity
Poor alignment / body schema
Poor stability and mobility
Structural differences: extended back,
anteriorly tilted pelvis, and changing
direction of muscles and joint
Insecurity: crying
Flexed Posture
Develops midline
Develops body awareness
Promotes security
Movement (purposeful)
Main Goal of Positioning
encourage development of flexion
avoid excessive extension
facilitate smooth antigravity limb movement
promote symmetrical posture
reduce cranio-facial flattening
provide support, containment, security
minimizes stress, promote sleep
decrease energy expenditure
provide tactile stimulation
encourage parent-infant interaction
enhance midline orientation, eye, hand,
motor control

Thank You.