The Bobath (NDT) concept in adult neurological rehabilitation: what is the state of the knowledge? A scoping review. Part I: conceptual perspectives

Abstract

Knowledge derived from review of the conceptual literature provides clinicians with an updated Bobath clinical framework as well as identifying aspects of Bobath clinical practice that require careful consideration in future effectiveness studies. Implications for Rehabilitation The integration of posture and movement with respect to the quality of task performance remains a cornerstone of the redefined Bobath concept. A key fundamental principle of the clinical application of the Bobath concept since its inception is the selective manipulation of sensory information, namely, facilitation, to positively affect motor control and perception in persons post-central nervous system lesion. This is an aspect of Bobath clinical practice that requires further investigation. Study and treatment fidelity issues such as therapist expertise, the use of treatment logs to document individualized clinical practice, as well as therapist supervision and evaluation require careful consideration in the implementation of Bobath effectiveness studies such that causality can be determined.

Phronesis: practical wisdom the role of professional practice knowledge in the clinical reasoning of Bobath instructors

“…The purpose of this qualitative study was to gain a greater depth of understanding of the critical aspects of tacit knowledge informing and extending the cognitive processing used in the clinical reasoning of expert neuro‐rehabilitation therapists, specifically, IBITA instructors. Although the effectiveness of the Bobath concept has been widely investigated, clear descriptions of Bobath interventions are lacking and the clinical reasoning process is undocumented . Understanding how therapists conceptualize clinical reasoning and make decisions in clinical practice is essential for the development of substantive theory on how therapists decide to do what they do …”

“…Neurological conditions have significant personal, financial, and economic costs with stroke and traumatic brain injury being major global health problems of disability and socioeconomic burden . The Bobath concept, referred to as “NeuroDevelopmental Therapy” in the American literature, is one of the most widely used neuro‐rehabilitation approaches . A hallmark of the Bobath concept is its interaction between assessment and treatment with an emphasis on the complex clinical reasoning process enabling a continuously evolving treatment, response‐based to the client and context .…”

Hemorrhagic versus ischemic stroke: Who can best benefit from blended conventional physiotherapy with robotic-assisted gait therapy?

“…Strategies utilized in these sessions emphasized general bilateral and tri-dimensional movements required for turning, rolling, kneeling, sitting, standing, and so on, as well as integration of the selective movement in functional activity and exercise for improving balance. The key aspects of clinical practice of the Bobath approach are related to the identification of movement deficits, the analysis of movement and its quality, the use of afferent sensory information from multiple sources and facilitation, and minimizing motor solutions that incorporate motor compensations [55]. …”

Functional strength training and movement performance therapy produce analogous improvement in sit-to-stand early after stroke: early-phase randomised controlled trial

“…conventional physical therapy focused on movement performance (CPT + MPT), that had greater benefit for walking recovery than additional FST (CPT + FST) [8]. This may simply have been the result of the study being statistically underpowered; however, it is also possible that the MPT investigated was more beneficial than FST because it emphasised therapeutic techniques that focus on enhancing the quality of movement through use of sensory stimulation and muscle/joint preparation for functional movement [10]. Indeed, there is evidence that both therapeutic approaches are beneficial [11].…”