The Bobath Concept: Theory and clinical practice in neurological rehabilitation

234 Pages·2016·2.68 MB·English

by  Raine S.

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Bobath Concept
Theory and Clinical Practice in Neurological
Rehabilitation
Dedication
This book is dedicated to all of our patients and students from
whom we have learnt and through whom we have developed.
This book is dedicated to the memory of Pam Mulholland, MCSP,
Bobath Tutor, our colleague and friend.
Bobath Concept
Theory and Clinical Practice in
Neurological Rehabilitation
Edited by
Sue Raine
Linzi Meadows
Mary Lynch-Ellerington
A John Wiley & Sons, Ltd., Publication
This edition fi rst published 2009
© 2009 by Blackwell Publishing Ltd
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Library of Congress Cataloging-in-Publication Data
The Bobath Concept: Theory and clinical practice in neurological rehabilitation / edited by Sue
Raine, Linzi Meadows, Mary Lynch-Ellerington.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4051-7041-3 (pbk. : alk. paper) 1. Movement disorders—Patients—Rehabilitation.
2. Bobath, Berta. 3. Bobath, Karel. 4. Motor learning. I. Raine, Sue. II. Meadows, Linzi.
III. Lynch-Ellerington, Mary.
[DNLM: 1. Bobath, Berta. 2. Bobath, Karel. 3. Central Nervous System Diseases—
rehabilitation. 4. Physical Therapy Modalities. 5. Rehabilitation—methods. WL 300 B663 2009]
RC376.5.B63 2009
616.8’3—dc22 2008053126
A catalogue record for this book is available from the British Library.
Set in 10/12 pt Palatino by Macmillan Publishing Solutions, Chennai, India
Printed in Singapore
1 2009
Contents
Foreword viii
Preface xii
Contributors xiv
Acknowledgements xv
1. The Bobath Concept: Developments and Current
Theoretical Underpinning 1
Sue Raine
Introduction 1
The founders and development of the Bobath Concept 1
Current theory underpinning the Bobath Concept 3
Systems approach to motor control 4
Clinical application of the theory underpinning the Bobath Concept 11
Summary 16
References 17
2. An Understanding of Functional Movement as a Basis for Clinical
Reasoning 23
Linzi Meadows and Jenny Williams
Introduction 23
Normal movement versus effi cient movement 24
Compensatory strategies 25
Motor control and motor learning 26
Requirements of effi cient movement 31
Summary 37
References 39
3. Assessment and Clinical Reasoning in the Bobath Concept 43
Paul Johnson
Introduction 43
Models of clinical reasoning and the Bobath Concept 45
Key characteristics of assessment using the Bobath Concept 47
v
Contents
Basis for clinical reasoning 52
Illustrating clinical reasoning using the Bobath Concept 53
Summary 57
References 61
4. Practice Evaluation 64
Helen Lindfi eld and Debbie Strang
Introduction 64
Evaluation in the context of the International Classifi cation of Function,
Disability and Health 65
Factors infl uencing measurement selection 66
Measurement properties 68
Measures 70
Summary 78
References 79
5. Moving Between Sitting and Standing 83
Lynne Fletcher, Catherine Cornall and Sue Armstrong
Introduction 83
Clinical considerations from the literature 84
Phases of sit to stand 86
Movements from standing to sitting 89
Effects of ageing 92
Sit to walk 93
Clinical aspects 93
Movement in functional contexts 95
Clinical example 98
References 114
6. The Control of Locomotion 117
Ann Holland and Mary Lynch-Ellerington
Introduction 117
Key aspects of bipedalism 117
The gait cycle 122
Use of body weight support treadmill training in the Bobath Concept 127
Assistive devices 129
Outcome measures 147
Summary 149
References 149
7. Recovery of Upper Limb Function 154
Janice Champion, Christine Barber and Mary Lynch-Ellerington
Introduction 154
The importance of postural control in upper limb function 155
vi
Contents
The shoulder complex 157
Functional reach 162
The hand 170
Early treatment and management of the hand 170
Assessment of the hand 171
Contactual hand-orientating response 173
Selective strength training of the intrinsic muscles of the hand 173
Summary 177
References 178
8. Exploring Partnerships in the Rehabilitation Setting: The 24-Hour
Approach of the Bobath Concept 182
Clare Fraser
Partnerships in the rehabilitation environment 182
The early days 184
Overcoming sensory deprivation and stimulating body schema 190
Scheduling the day – opportunities for practice 191
Return to work 194
Summary 202
References 204
Index 208
vii
Foreword
As a physician and neurorehabilitationist whose primary professional concern has
been with adult patients, it may seem strange that I feel so deeply indebted to Karel
and Berta Bobath, who devoted much of their lives to the rehabilitation of children
with neurological problems, especially cerebral palsy. And yet, it is true. I believe
that the benefi cent infl uence of the Bobaths on our approach to neurological rehabil-
itation has been incomparable, and all of us who are involved in the care of people
struggling to overcome the impact of neurological damage owe them a debt of grat-
itude. Things that we now take for granted were regarded as heretical or eccentric
when the Bobaths started out on their careers so many years ago and developed an
approached which combined science, and a deeply humane concern for the plight of
individuals, with neurological damage with something we might call ‘clinical nous‘.
The results are plain to see for all those who have long enough memories. When
I began my career as a doctor in the 1970s, stroke patients were not welcomed on
medical wards and rehabilitation services were poorly developed. The nihilism of
Hughlings Jackson, the father of British neurology – encapsulated in his observa-
tion that ‘You can’t treat a hole in the brain’ – summarised the prevailing attitude.
The physiotherapy these patients received was often misguided, having an ortho-
paedic bias, as Sue Raine notes in her contribution: massage, heat, passive and
active movement techniques such as the use of pulleys, suspension and weights.
The results were dreadful: stroke patients routinely ended up with severe fl exion
of the upper limbs (with the fi ngers curled over so tightly that hygiene was almost
impossible), extension of the lower limbs and foot drop, so that walking was a
perilous business – requiring circumduction at the hip – and not infrequently, the
chronic misery of severe shoulder pain. Inappropriate splints and walking aids
added to the demoralisation of the patient.
As a junior doctor, I assumed that this wretched state of affairs was an inevitable
consequence of stroke. It was not until the Bobath revolution started to gain a foot-
hold in the UK that I began to see that things might be otherwise. At the heart of
the revolution was, as the title of this book indicates, a concept. And at the heart of
this concept was an understanding that if you are going to promote recovery and
independence, then you must (to use Geoffrey Kidd’s phrase) ‘talk to the nervous
system in a language it understands’. At any rate, it meant an approach that was
viii