The Bobath concept is an approach to neurological rehabilitation that is applied in patient assessment and treatment (such as with adults after stroke[1] or children with cerebral palsy[2]).
The main problems of these patient groups resulted in a loss of the standard postural reflex mechanism and regular movements.
[7] The strategies and techniques utilized in Bobath therapy encompass therapeutic handling, facilitation, and activation of pivotal control points.
[6] Facilitation plays a central role in Bobath therapy, fostering motor learning by utilizing sensory cues (such as tactile contact and verbal guidance) to reinforce weak movement patterns and discourage excessive ones.
Carryover of functional activities in the home and community setting is largely attributed to patient, family and caregiver education.
[8] Paci (2003) conducted an extensive critical appraisal of studies to determine the effectiveness of the Bobath concept for adults with hemiplegia following a stroke.
[9] Paci (2003) recommended that standardized guidelines for treatment be identified and described and that further investigations are necessary to develop outcome measures concerning goals of the Bobath approach such as quality of motor performance.
The decisions about specific treatment techniques are collaboratively made with the patient and are guided by the therapist through the use of goal setting and the development of close communication and interaction.
In 2018, a major review of upper limb interventions following stroke found significant positive effects for constraint and task specific-therapies and the supplementary use of biofeedback and electrical stimulation.
In the UK, an NHS review of stroke rehabilitation by Professor Tyson concluded that "the strength of evidence that task-specific functional training and strength training is effective, while Bobath is not, indicates that a paradigm shift is needed in UK stroke physiotherapy..... it is increasingly difficult to justify the continued use of the Bobath concept or its associated techniques".
[21] More recently Professor Tyson and Dr Mepsted have both written comprehensive and critical reviews of Bobath/NDT methods, theory and effectiveness.
[24] National evidence-based guidelines for stroke rehabilitation have been published for England, Netherlands, Canada, Australia, and New Zealand; yet in none of these is the Bobath approach recommended.
To overcome this problem, they described a range of strategies that will be implemented to encourage best evidence-based practices and de-implement traditional (NDT/Bobath) methods of working at both an individual and organizational level.
Thus, on the grounds of wanting to do the best for children with CP, it is hard to rationalize a continued place for traditional NDT within clinical care”.