The Bobath approach is based on the Bobath concept, which is a problem solving approach used to treat adults and children with neurological problems. It was an approach that was created by a physiotherapist Berta Bobath in the 1950s, after she discovered that she could change the way people moved after stroke. Back then, there was little understanding of the neuroscience of recovery, and people were told to use their less affected side only to compensate for their paralysis. Her treatment was remarkably effective in helping people regain what was lost during a time when it was thought that the brain was not able to change.
We now know that the brain is capable of learning new skills even after it has been injured and that it is incredibly plastic. This process is known as neuroplasticity. Neuroplasticity involves the creation of new nerve cells (neurons) or connections that exist within the brain and spinal cord, resulting in short term and long-term adaptations in structure and function.
The Bobath concept is widely practised worldwide but only a small proportion of therapists are skilled enough to teach it. The contemporary concept has taken aboard new literature and scientific development in the study of human movement, and is now much more holistic and defined.
The Bobath concept provides an interaction between assessment and treatment; how the patient responds to the treatment forms part of the assessment and this helps inform the next part of the treatment. If the person responds well, the treatment is adjusted to reinforce the change or to build on it, and if they don’t respond well, the treatment is adjusted to make the task easier or to create a more positive response instead.
In that respect, the Bobath concept is response-based and supported by hypotheses that are either confirmed or rejected along the way. This allows faster pattern recognition and understanding of the patient’s movement potential, than if a pre-determined protocol of treatment is used.
Thoughtfully, the therapist and patient are also constantly communicating and adapting with each other in verbal and non-verbal ways. Together with skilled handling and manipulation of the environment (known as facilitation), the Bobath therapist can strongly influence the way in which the patient can move differently within each treatment session.
The International Bobath Tutors Training Association have created the following diagram to help illustrate the concept:
(Image credit – Vaughan-Graham and Cott, 2017)
Our therapists are trained in the Bobath concept and our clinical lead neurological physiotherapist, Keegan Bow, is currently training to be a Bobath instructor under the tutorage of the Australian Bobath Tutors Association (ABTA).
International Bobath Instructor Training Association, www.ibita.org
Vaughan‐Graham, J., & Cott, C. (2017). Phronesis: practical wisdom- the role of professional practice knowledge in the clinical reasoning of Bobath instructors. Journal of evaluation in clinical practice, 23(5), 935-948.