The Bobath Approach, developed by Dr. Karel Bobath and Mrs. Berta Bobath, is a neuro-developmental therapy originally designed for children with cerebral palsy and later adapted for adults with motor problems, particularly due to cerebrovascular accidents (CVAs). It is based on a hierarchical model of the nervous system, emphasizing holistic rehabilitation that normalizes muscle tone and enhances movement patterns while incorporating neuroplasticity principles. The approach focuses on facilitating normal postural reactions and involves active participation in motor skill learning for effective recovery.

1. Bobath Approach/Neuro
Developmental Therapy
Dr. Manjit Kumar
Faculty of paramedical sciences
Rama University Kanpur
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2. History…
• Developed by Dr. Karel Bobath, a
neuropsychiatrist, and Mrs. Berta Bobath, a
physical therapist
• 1943 – while working with children with cerebral
palsy
• https://en.wikipedia.org/wiki/Berta_Bobath#:~:t
ext=The%20Bobath%20technique%20was%20firs
t,the%20Western%20Cerebral%20Palsy%20Centr
e.
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3. Original theoretical framework…
• Based on the works of Jackson, Sherrington,
and Magnus
 who described nervous system as HIERARCHICAL
in nature
• Model
 Higher brain centers exerted control over lower-
level centers
 Eg. The cerebral cortex control supercedes that of
the brainstem
https://www.britannica.com/science/neuroplasticity
/Cross-modal-reassignment
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4. Original theoretical framework…
• Hypothesis
 A neurologic insult will lead to a release of the
lower-level centers from higher-level center
inhibitory control, resulting in stereotypical
postures, primitive movement patterns and
predominant reflex activity
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC
10060839/
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5. Adult hemiplegia..
• Treatment approach was later on expanded to
include the rehabilitation of adults with motor
problems, particularly CVA
• Main problem: the abnormal coordination of
movement patterns combined with abnormal
postural tonus (Bernstein, 1967)
• Secondary problem: muscle strength and muscle
activity
• https://shop.elsevier.com/books/adult-
hemiplegia-evaluation-and-
treatment/bobath/978-0-7506-0168-9
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6. Bobath concept…
• Is a living concept, it is not static
 It has undergone changes in its theoretical base
to accommodate developments in the fields of
neurophysiology, biomechanics, and typical
development
• Holistic approach
 It involves the whole patient, his sensory,
perceptual and adaptive behaviour, and motor
problems
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC879
7128/https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC8797128/
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7. Traditional View
• Principles of treatment
– Normalize muscle tone
– Inhibit primitive reflexes
– Facilitate normal postural reactions
– Treatment should be developmental
Techniques
– Handling
– Weight bearing over the affected limb
– Utilize positions that allow use of the affected
limbs
– Avoidance of sensory input that affect muscle
tone
https://studylib.net/doc/5488291/principles-of-
bobath-approach
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8. Previously…
• The control of movement was thought to be
dependent on the normal postural reflex
mechanism
 E.g. utilizing righting reactions and equilibrium
reactions in association with normal postural tone
https://studylib.net/doc/5488291/principles-of-
bobath-
approachhttps://studylib.net/doc/5488291/princi
ples-of-bobath-approach
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9. Reconstruction of
the
NDT approach
Hierarchical Theory
Systems Theory
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10. Premise
Different parts of the CNS influence one another
Nervous system is capable of initiating, anticipating, and
controlling movements
– feedforward and feedback mechanisms
CNS has the ability to shape and/or renew itself in response to
practiced activities: neuroplasticity
https://www.ndta.org/Resources/Frequently-Asked-
Questions#:~:text=NDT%20is%3A&text=An%20advanced%20
%22hands%2Don%22,to%20improve%20basic%20body%20fu
nctions.&text=Engaging%20and%20motivating.
• https://www.ndta.org/Resources/Frequently-Asked-
Questions#:~:text=NDT%20is%3A&text=An%20advanced%20
%22hands%2Don%22,to%20improve%20basic%20body%20fu
nctions.&text=Engaging%20and%20motivating.
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11. Evidence on neuroplasticity
(Fisher, BE and Sullivan, KJ, 2001)
• Neuroplasticity can occur on the lesioned side of the
cerebral cortex following CVA when provided appropriate
practice in using involved side
• Rehabilitation strategies should promote recovery rather
than compensation
• Techniques should incorporate the following:
– Active participation in motor skill learning
– Specific skills training and strengthening directed to the
involved limbs
– Intense, task-specific practice that optimizes the
sensorimotor experience
– https://www.ndta.org/Resources/Frequently-Asked-
Questions#:~:text=NDT%20is%3A&text=An%20advanced%20
%22hands%2Don%22,to%20improve%20basic%20body%20f
unctions.&text=Engaging%20and%20motivating.
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12. THANK YOU
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