The Bobath approach is a problem-solving method for evaluating and treating individuals with movement and postural control disturbances due to central nervous system lesions, primarily focused on neurodevelopmental treatment for conditions like cerebral palsy. It emphasizes individualized therapy, addressing both strengths and weaknesses, and integrates sensory inputs to optimize motor recovery. The approach fosters active participation and task-specific training to improve motor function while considering the patient’s overall condition.

1. BOBATH APPROACH
Dr. Himani Kaushik (PT)
MPT NEUROLOGY

2. Objectives:
➢ Discuss the concepts and principles underlying the Bobath approach
➢ Application of Bobath approach

3. BOBATH APPROACH / NDT
★ The Bobath concept is a problem-solving approach used in the
evaluation and treatment of individuals with movement and postural
control disturbances due to a lesion of the central nervous system.
★ It is named after Berta Bobath, a physiotherapist, and her husband
Karel Bobath, a psychiatrist/neuropsychiatrist, who proposed the
approach for treating patients affected with Central Nervous System
anomalies.
★ Procedure: in a “trial & error” fashion in 1948.
★ Concept of compensatory training.
★ Neglects the potential of hemiplegic side.

4. ● They developed this approach for effective management of neuro-motor dysfunctions manifested by
children with cerebral palsy (CP).
● Earlier, braces, passive stretching, and surgery were the most common forms of interventions.
● The Bobath concept provided a new reference that viewed children with CP as having difficulty with
postural control and movement against gravity.
● Neurodevelopmental treatment is based on the premise that the presence of normal postural
reflex mechanisms is fundamental to a motor skill's performance.
● The normal postural reflex mechanisms consist of righting and equilibrium reactions, reciprocal
innervation, and coordination patterns.
● The release of abnormal tone and tonic reflexes seen in CP interfered with the development of righting
and equilibrium reactions.
● Bobath was totally contraindicated to understand the concept of motor control theory at that time i.e.
based on:

5. REFLEX - HIERARCHICAL THEORY: (Given by Charles Sherrington)
Reflex Theory
Movement is
controlled by stimulus
response.
Reflexes are the basis
for movement:
reflexes are combined
into actions that
create behavior.
Hierarchical Theory
Characterized by a
top-down structure, in
which higher centers
are always in charge
of lower centers.

6. BOBATH & CORTICAL PLASTICITY

7. ● It is an interactive problem-solving approach that focuses on continuing reassessment with attention to
individual goals, developing working hypotheses, treatment plans, and relevant objective measures to
evaluate interventions.
● Therapist should have:
➔ Good posture & movement analysis skills

8. ● Regardless of severity, individuals of any age with damage to their CNS can be handled with this
approach. This makes the approach different from other forms of treatment, like motor relearning or
constraint-induced movement therapy, which can only work on high functioning individuals.
● It is congruent with the International Classification of Functioning, Disability, and Health. It
lays emphasis on two interdependent aspects important for optimizing motor recovery following stroke:
a. integration of postural control and task performance and
b. selective movement control for the production of coordinated sequences of movements.
c. In addition, the contribution of sensory inputs to motor control and motor learning has always
been a vital focus of the Bobath concept.
Therapy is never stereotypic.

9. KEY POINTS OF BOBATH APPROACH
1. WHAT IS THE CURRENT FUNCTIONAL STATUS OF THE MY PATIENT?
2. HOW MUCH IS HE/SHE ABLE TO PERFORM ACTIVITIES USING HIS/HER
PARETIC SIDE OR HOW MUCH IS THE ACTIVITY IS BEING DONE BY THE
PATIENT THROUGHOUT THE DAY USING PARETIC SIDE?
3. WHAT ARE THE DIFFERENT UNDERLYING CAUSES BEHIND THAT FOR NOT
RECRUITING THE PARETIC SIDE INTO THE DAILY ACTIVITIES?

10. PRINCIPLES OF BOBATH APPROACH
★ NDT THERAPY WORKS
★ ALWAYS TREAT THE PATIENT AS A WHOLE
★ WORK SIMULTANEOUSLY ON PATIENTS STRENGTHS & WEAKNESSES
★ INDIVIDUALIZED FOR EVERY PATIENT BASED ON ICF MODEL
★ GAIN THE INFORMATION FROM PAST, PRESENT & FUTURE
★ TEAMWORK IS CRITICAL FOR REHAB PURPOSES
★ UNDERSTANDING THE CONCEPT OF TYPICAL DEVELOPMENT (MOTOR CONTROL)
★ TRANSFERENCE OF TRAINING IN DAILY LIFE
★ HANDS ON INTERVENTION TO ENHANCE MOTOR LEARNING & FUNCTIONS

11. CLINICAL APPLICATION OF BOBATH CONCEPT
MOTOR CONTROL
● Bobath Concept concerns sensory, perception and adaptive behaviour along with the
motor problem that involves the whole patient.
● It is a goal-orientated and task-specific approach, aiming to organize the internal
(proprioceptive) and external (exteroceptive) environment of the nervous system for
efficient functioning of the individual. It is an interactive process between patients and therapists.
● Therapy focuses on the following:
a. neuro-muscular system, spinal cord and higher centres to change motor performance,
b. neuroplasticity, an interactive nervous system, and individual expression of movement.
c. overcoming weakness of neural drive after a UMN lesion through selective activation of cutaneous
and muscle receptors

12. ● Therapists should have the knowledge of the principles of motor learning:
a. active participation,
b. opportunities for practice, and
c. meaningful goals.
● Bobath concept demands training in different real-life situations rather than just practicing in the
therapy department.
● Task-specific muscle activation patterns and sensory input enables successful completion of the task in
different contexts and environments, taking in to account the perceptual and cognitive demands.
● Therapy addresses abnormal, stereotypical movement patterns that interfere with function.
● It is aimed at preventing development of spasticity and improving residual function. Therapists can
influence hypertonia at a non-neural level by influencing muscle length and range.

13. ● Therapists work on tone to improve movement, not to normalise tone. Tone can be reduced by:
a. mobilisation of muscles and stiff joints,
b. muscle stretch,
c. practice of more normal movement patterns, and
d. through a more efficient, less effortful performance of functional tasks
e. weight-bearing.
● Sensory integration and musculoskeletal system also plays an important role.

14. STAGES OF HEMIPLEGIA & BOBATH APPROACH
★ Initial flaccid stage
★ Stage of spasticity
★ Stage of relative recovery

15. BRUNNSTROM
BOBATH
VS

16. CONCLUSION
Bobath Concept Structural Framework

17. THANK YOU