Okay, here goes my 1st ever blog! My original aim was to present the main topics of discussion about the evidence (or otherwise) for the Bobath concept as they appeared in the icsp discussion (found here http://www.csp.org.uk/icsp/topics/rationale-evidence-bobath-neurological-physio and http://www.csp.org.uk/icsp/topics/novak-review-casts-doubt-efficacy-bobath-should-we-embrace-or-ignore-it ) and to let all contributors make their points in a wider forum. However this has fallen foul of the terms and conditions of icsp and their copyright rules, so I have to summarise the contributions in my own words. I have tried to do this as openly and even-handedly as I can. You can always go back to the original icsp thread to check it out.
So here is the 1st topic What is Bobath?
On 1st October the British Bobath Tutors Association (BBTA) posted a response to neurology network ICSP thread discussion on their website. This (in italics) is the parts that relate to the current definition of the Bobath Concept
We have read with interest the various opinions and discourse put forward and would like to clarify our perspective on some aspects of the discussion threads. Perhaps it would be most helpful to direct contributors and readers to the most recently published papers on the contemporary Bobath concept by Vaughan-Graham et al 2014. The first paper reviews the knowledge base in relation to a contemporary Bobath concept and outlines the ‘cornerstones’ as being;
- Integration of posture and movement with respect to quality of task performance
- Selective manipulation of sensory information to positively affect motor control and perception (body schema)
- Provision of a theoretical framework for clinical practice
- A focus on a clinically reasoned, inclusive, individualised approach, exploring potential for positive functional change
In short, Vaughan-Graham et al describes the Bobath concept as an inclusive, individualised, problem-solving, living concept based on a systems approach to motor control, with particular emphasis on movement analysis and motor recovery from the perspective of the integration of postural control, task performance and contribution of sensory inputs. The concept is based on contemporary theories of motor control and motor learning.
We sincerely hope that some of the issues raised in the discussion threads have been addressed here. More information is available at www.bbtauk.org.
This is a summary of my reply referring to the Vaughan-Graham paper posted on 4 Oct, 2015
The Vaughan-Graham paper gives a new definition and list of underlying assumptions (now called “conceptual perspectives”). The Bobath concept is now defined as “an inclusive, individualized, problem-solving, living concept based on a systems approach to motor control, with particular emphasis on movement analysis and motor recovery from the perspective of the integration of postural control, task performance and contribution of sensory inputs”.
The theoretical Foundations of Bobath from Figure 2 of the paper are:
- An inclusive, individualized, remediation focused problem-solving approach
- Based on contemporary theories of motor control, neuromuscular plasticity and motor learning
- To optimize activity and participation thereby improving quality of life
The ‘key aspects of clinical practice’ are:
- Movement deficits are limitations in the range of motor patterns normally available to healthy individuals
- Movement analysis and treatment is based upon the integration of postural control and task performance, and the control of selective movement for the production of coordinated sequences of movement
- Sensory information from multiple sources plays a fundamental role in motor control
- Facilitation, including manipulation of the environment and therapeutic handling, is a skilled aspect of intervention
- Favours motor solutions that optimize quality/efficiency of movement
- Movement quality should be one determinant of effectiveness
Although the jargon has changed a little from earlier definitions, but is no less impenetrable, the generic nature of the definition and ‘perspectives’ has not. They could just as easily be applied to any other flavour of neuro physio. Only perspective #7 is specific to Bobath. So is Bobath really just every-day neurological physiotherapy with facilitation?