{{Short description|Approach to neurological rehabilitation}} {{Multiple issues|{{format footnotes|date=August 2019}} {{tone|date=October 2012}}}} {{Infobox medical intervention | name = Bobath concept | specialty = neurological }}
The '''Bobath concept''' is an approach to [[Neurology|neurological]] rehabilitation that is applied in patient assessment and treatment (such as with adults after [[stroke]]<ref name="bobath1" /> or children with [[cerebral palsy]]<ref name="Knox & Evans 2002"/>). The goal of applying the Bobath concept is to promote [[motor learning]] for efficient [[motor control]] in various environments, thereby improving participation and function. This is done through specific [[patient]] handling skills to guide patients through the initiation and completing of intended tasks.<ref name="bobath3" /> This approach to neurological rehabilitation is multidisciplinary, primarily involving [[Physical therapy|physiotherapists]], [[occupational therapist]]s, and speech and language therapists. In the United States, the Bobath concept is also known as ''''neuro-developmental treatment'''' (NDT).<ref name="bobath1" />
The concept and its international tutors / instructors have embraced [[neuroscience]] and the developments in understanding motor control, motor learning, [[neuroplasticity]] and human movement science. They believe that this approach continues to develop.
The Bobath concept is named after its inventors: [[Berta Bobath]] ([[Physical therapy|physiotherapist]]) and Karel Bobath (a psychiatrist/neurophysiologist). Their work focused mainly on patients with cerebral palsy and stroke. The main problems of these patient groups resulted in a loss of the standard postural reflex mechanism and regular movements.<ref name="Schmitz">{{cite book|last=O'Sullivan|first=Susan B|title=Physical Rehabilitation, Fifth Edition|author2=Schmitz, Thomas J|publisher=F.A. Davis Company|year=2007|location=Philadelphia, PA|pages=490}}</ref> The Bobath concept was focused on regaining regular movements through re-education at its earliest inception. Since then, it has evolved to incorporate new information on [[neuroplasticity]], [[motor learning]], and [[motor control]].<ref name="bobath1" /><ref name="Graham Eustace Brock 2009"/> [[Therapy|Therapists]] that practice the Bobath concept today also embrace the goal of developing optimal movement patterns through the use of [[orthotics]] and appropriate compensations instead of aiming for ultimately "normal" movement patterns.<ref name="bobath1" /><ref name="Graham Eustace Brock 2009"/>
The [[Bobath Centre]] in Watford, UK is a specialist therapy, treatment & training facility and the home of the Bobath Concept.
== Stroke rehabilitation == In the Bobath Concept, postural control is the foundation on which patients begin to develop their skills. Patients undergoing this treatment typically learn how to control postures and movements and then progress to more difficult ones. Therapists analyze [[Posture correction|postures]] and movements and look for any abnormalities that may be present when asked to perform them. Examples of common abnormal movement patterns include obligatory synergy patterns. These patterns can be described as the process of trying to perform isolated movement of a particular limb but triggering the use of other typically uninvolved muscles (when compared to normal movement) in order to achieve movement. Obligatory synergy patterns can be further subdivided into [[Anatomical terms of motion|flexion]] and extension synergy components for both the upper and lower extremities. This approach requires active participation from both the patient and the therapist.<ref name="O'Sullivan" /> Depending on the patient, rehabilitation goals may work to improve any or all of the following: postural control, coordination of movement sequences, movement initiation, optimal body alignment, abnormal tone or [[muscle weakness]].<ref name="bobath1" /><ref name="Graham Eustace Brock 2009"/> Treatment will therefore address both negative signs such as impaired postural control, and positive signs such as [[spasticity]].<ref>{{cite book|last=O'Sullivan|first=Susan B|title=Physical Rehabilitation, Fifth Edition|author2=Schmitz, Thomas J|publisher=F.A. Davis Company|year=2007|location=Philadelphia, PA|pages=512}}</ref>
Intervention strategies and techniques for Bobath consist of therapeutic handling, facilitation, and activation of key points of control. Therapeutic handling is used in order to influence the quality of the patients' movements and incorporates both facilitation and inhibition.<ref name="O'Sullivan" /> Facilitation is a key technique used by Bobath practitioners to promote motor learning. It is the use of sensory information (tactile cues through manual contacts, verbal directions) to reinforce weak movement patterns and discourage overactive ones. The appropriate provision of facilitation during the motor task is regulated in time, modality, intensity and withdrawal, all of which affect the outcome of motor learning.<ref name="Graham Eustace Brock 2009"/> Inhibition can be described as reducing parts of movement/posture that are abnormal and interfere with normal performance. Key points of control generally refer to parts of the body that are advantageous when facilitating or inhibiting movement/posture.<ref name="O'Sullivan" />
Activities assigned by a [[Physical therapy|physical therapist]] or [[occupational therapist]] to an individual who has suffered from a stroke are selected based on functional relevance and are varied in terms of difficulty and the environment in which they are performed. The use of the individual's less involved segments, also known as compensatory training strategies, are avoided. Carryover of functional activities in the home and community setting is largely attributed to patient, family and caregiver education.<ref name="Schmitz" />
==History== The Bobath Concepts' theoretical underpinning and practice is clearly documented in a contemporary book published by Wiley Blackman in 2009: ''Bobath Concept: Theory and Clinical Practice in Neurological Rehabilitation' written by the British Bobath Tutors Association (BBTA) and edited by Raine, Meadows, and Lynch-Ellerington. ''The chair of ACPIN (Association of Chartered Physiotherapists in Neurology) reviewed this book and concluded:- “I am not really sure that it is clear from the book what the Bobath approach actually is”, “often the prose turns into jargon” and “this book will do little to quell the critics; in fact, it will no doubt give them more fuel for the fire”.<ref>Mayston (2010) Review of “The Bobath Concept: Theory and clinical practice in neurological rehabilitation”. Synapse Spring 2010.{{page needed|date=January 2022}}</ref>
== Research == Paci (2003) conducted an extensive critical appraisal of studies to determine the effectiveness of the Bobath concept for adults with [[Hemiparesis|hemiplegia]] following a stroke. Selected trials showed no evidence proving the effectiveness of the Bobath Concept as the optimal type of treatment.<ref name=Paci2003/> Paci (2003) recommended that standardized guidelines for treatment be identified and described and that further investigations are necessary to develop outcome measures concerning goals of the Bobath approach such as quality of motor performance.<ref name=Paci2003/>
Bobath therapy is nonstandardized as it responds, through clinical reasoning and the development of a clinical hypothesis, to the individual patient and their movement control problems. The decisions about specific treatment techniques are collaboratively made with the patient and are guided by the therapist through the use of [[goal setting]] and the development of close communication and interaction. Working to develop improved [[muscle tone]] appropriate to the task, the individual and the environment, will enable better alignment, and activation of movement, and allow for the recruitment of, for example, arm activity in functional situations within various positions.<ref name="Platz Eickhof van Kaick et al 2005"/>
A study by Lennon et al.<ref name="Lennon Ashburn Baxter 2006"/> concluded that even under idealized conditions (patients with optimal rehabilitation potential, advanced trained therapists, unlimited therapy input, and a movement analysis laboratory) the Bobath approach had no effect on the quality of gait for patients with a stroke.
==Institutions== The Neuro-Developmental Treatment Association (NDTA) was founded to carry on the Bobath's work;<ref>{{cite book|last1=Howle|first1=Janet M|title=Encyclopedia of disability|date=2006|publisher=Sage Publications|isbn=9781452265209|editor1-last=Albrecht|editor1-first=Gary L.|location=Thousand Oaks, Calif.|pages=193–194|chapter=Bobath, Berta and Karel|chapter-url=https://books.google.com/books?id=LwxzAwAAQBAJ&pg=PA2069}}</ref> it offers certification in NDT for managing adults with stroke or [[Traumatic brain injury|brain trauma]] and for managing and treating children with cerebral palsy and other neuromotor disorders.<ref>{{cite web|url=https://www.ndta.org/certificate_courses.php|title=Certificate Courses|publisher=Neuro-Developmental Treatment Association|url-status=dead|archive-url=https://web.archive.org/web/20170110161155/https://www.ndta.org/certificate_courses.php|archive-date=10 January 2017|access-date=10 January 2017}}</ref> People who have this certification sometimes are called "neurodevelopmentalists".<ref>{{cite news|url=https://www.voanews.com/a/sociallyassitverobots08dec2009-78761362/416256.html|title=Robot Helps Children with Disabilities|date=December 11, 2009|work=VOA}}</ref><ref>{{cite book|last1=Pierson|first1=Susan H.|title=Clinical Evaluation and Management of Spasticity|url=https://archive.org/details/clinicalevaluati00gelb|url-access=limited|date=2002|publisher=Humana Press|isbn=978-1-59259-092-6|editor1-last=Gelber|editor1-first=David A.|location=Totowa, NJ|page=[https://archive.org/details/clinicalevaluati00gelb/page/n62 52]|chapter=4. Physical and Occupational Approaches|editor2-last=Jeffery|editor2-first=Douglas R.}}</ref>
==Criticism==
The concept that Bobath can “evolve” and still be called Bobath has been challenged by the president of the American Academy of Cerebral Palsy and Developmental Medicine and the chair of the UK Association of Chartered Physiotherapists in Neurology (ACPIN).<ref name=Damiano2007/><ref name=Mayston2006/> These eminent physiotherapists believe that several of the key original teachings of the founders have now been abandoned, whilst the ideas/concepts of others (non Bobath therapists & scientists) have unjustifiably been given the name of Bobath.
There is a widespread use of the Bobath concept amongst therapists in stroke rehabilitation. Yet, a large review of randomized controlled trials (RCTs) of Bobath for stroke rehabilitation found only three instances of significant differences in favour of Bobath, yet 11 in favour of alternatives.<ref name="Kollen Lennon Lyons et al 2009"/> The authors concluded that therapists should base their treatment methods on “evidence-based guidelines, accepted rules of motor learning, and [[Mechanism (biology)|biological mechanisms]] of functional recovery, rather than therapist preference for any named therapy approach”. This review pointed out that the approach is now regarded as “obsolete” in some European countries and it is therefore no longer taught.
In 2018, a major review of [[upper limb]] interventions following stroke found significant positive effects for constraint and task specific-therapies and the supplementary use of [[biofeedback]] and electrical stimulation. However, they concluded that the use of Bobath therapy was not supported.<ref>{{cite journal |last1=Wattchow |first1=Kimberley A. |last2=McDonnell |first2=Michelle N. |last3=Hillier |first3=Susan L. |title=Rehabilitation Interventions for Upper Limb Function in the First Four Weeks Following Stroke: A Systematic Review and Meta-Analysis of the Evidence |journal=Archives of Physical Medicine and Rehabilitation |date=February 2018 |volume=99 |issue=2 |pages=367–382 |doi=10.1016/j.apmr.2017.06.014 |doi-broken-date=18 November 2025 |pmid=28734936 |url=https://unisa.alma.exlibrisgroup.com/view/delivery/61USOUTHAUS_INST/12150077710001831 |url-access=subscription }}</ref> Furthermore, a 2020 review of [[Human leg|lower limb]] rehabilitation following stroke<ref>{{cite journal |last1=Scrivener |first1=Katharine |last2=Dorsch |first2=Simone |last3=McCluskey |first3=Annie |last4=Schurr |first4=Karl |last5=Graham |first5=Petra L |last6=Cao |first6=Zheng |last7=Shepherd |first7=Roberta |last8=Tyson |first8=Sarah |title=Bobath therapy is inferior to task-specific training and not superior to other interventions in improving lower limb activities after stroke: a systematic review |journal=Journal of Physiotherapy |date=1 October 2020 |volume=66 |issue=4 |pages=225–235 |doi=10.1016/j.jphys.2020.09.008 |doi-broken-date=18 November 2025 |pmid=33069609 |s2cid=224783899 |doi-access=free }}</ref> concluded that Bobath therapy was inferior to task specific training and that prioritising Bobath therapy over other interventions is not supported by current evidence.
In the UK, an NHS review of stroke rehabilitation by Professor Tyson concluded that "the strength of evidence that task-specific [[functional training]] and [[strength training]] is effective, while Bobath is not, indicates that a [[paradigm shift]] is needed in UK stroke physiotherapy..... it is increasingly difficult to justify the continued use of the Bobath concept or its associated techniques".<ref name=Tyson2009/> More recently Professor Tyson and Dr Mepsted have both written comprehensive and critical reviews of Bobath/NDT methods, theory and effectiveness.<ref>{{Cite web |last=Tyson |first=Sarah |date=2023-07-13 |title=Sarah Tyson |url=http://sarahtphysioblog.wordpress.com/ |access-date=2025-12-29 |website=When EBP meets neurological physiotherapy ... |language=en}}</ref><ref>{{Cite web |title=Bobath physiotherapy. evidence based or habit based. |url=https://www.slideshare.net/slideshow/bobath-physiotherapy-evidence-based-or-habit-based/82037030 |access-date=2025-09-26 |website=Slideshare |language=en}}</ref> See also an interesting exchange of letters between the above authors and Bobath tutors.<ref>{{cite journal |last1=Mepsted |first1=Roger |last2=Tyson |first2=Sarah |title=The Bobath concept. A guru-led set of teachings unsupported by emerging evidence |journal=Journal of Evaluation in Clinical Practice |date=October 2017 |volume=23 |issue=5 |pages=1127–1128 |doi=10.1111/jep.12791 |doi-broken-date=18 November 2025 |pmid=28726254 }}</ref>
National evidence-based guidelines for stroke rehabilitation have been published for England, Netherlands, Canada, Australia, and New Zealand; yet in none of these is the Bobath approach recommended. Conversely, in 2016 the [[American Heart Association|American Stroke Association]] concluded that although the effectiveness of NDT/Bobath (compared with other treatment approaches) had not been established that it still “may be considered” as a treatment option for mobility. This, however, was their lowest classification of acceptable treatment. Their two highest recommendation groups (“should be performed” and “reasonable to perform”) contained a variety of treatments for which there was much better evidence. NDT/Bobath was not listed as an option for arm/hand rehabilitation.<ref>{{cite journal |last1=Winstein |first1=Carolee J. |last2=Stein |first2=Joel |last3=Arena |first3=Ross |last4=Bates |first4=Barbara |last5=Cherney |first5=Leora R. |last6=Cramer |first6=Steven C. |last7=Deruyter |first7=Frank |last8=Eng |first8=Janice J. |last9=Fisher |first9=Beth |last10=Harvey |first10=Richard L. |last11=Lang |first11=Catherine E. |last12=MacKay-Lyons |first12=Marilyn |last13=Ottenbacher |first13=Kenneth J. |last14=Pugh |first14=Sue |last15=Reeves |first15=Mathew J. |last16=Richards |first16=Lorie G. |last17=Stiers |first17=William |last18=Zorowitz |first18=Richard D. |title=Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association |journal=Stroke |date=June 2016 |volume=47 |issue=6 |pages=e98–e169 |doi=10.1161/STR.0000000000000098 |doi-broken-date=18 November 2025 |pmid=27145936 |s2cid=4967333 |doi-access=free }}</ref>
Also, in 2016, the revised RCP guidelines for stroke made no mention of Bobath/NDT, whilst many alternatives were recommended. Importantly they stated that if a treatment was not mentioned, then it was not recommended and need not be funded. They also stated that therapists using such methods must objectively review their options in light of the evidence supporting the recommended alternatives. Furthermore, patients receiving such interventions should be informed that it was outside mainstream practice.<ref>{{Cite web |date=2016 |title=National clinical guideline for stroke |url=https://www.strokeaudit.org/SupportFiles/Documents/Guidelines/2016-National-Clinical-Guideline-for-Stroke-5t-(1).aspx |archive-url=https://web.archive.org/web/20221008123853/https://www.strokeaudit.org/SupportFiles/Documents/Guidelines/2016-National-Clinical-Guideline-for-Stroke-5t-(1).aspx |archive-date=2022-10-08 |access-date=2025-09-26 |website=www.strokeaudit.org |edition=5th}}</ref>
A highly significant 2021 “position paper” by the Academy of Neurologic Physical Therapy of the [[American Physical Therapy Association]]<ref>{{cite journal |last1=Scheets |first1=Patricia L. |last2=Hornby |first2=T. George |last3=Perry |first3=Susan B. |last4=Sparto |first4=Patrick |last5=Riley |first5=Nora |last6=Romney |first6=Wendy |last7=Fell |first7=Dennis |last8=Kugler |first8=Katherine |last9=Nordahl |first9=Timothy |title=Moving Forward |journal=Journal of Neurologic Physical Therapy |date=January 2021 |volume=45 |issue=1 |pages=46–49 |doi=10.1097/NPT.0000000000000337 |doi-broken-date=18 November 2025 |pmid=33315836 |s2cid=229176139 |doi-access=free }}</ref> concluded that, despite its lack of an evidence base, NDT/Bobath methods were still favoured by some therapist in the USA. To overcome this problem, they described a range of strategies that will be implemented to encourage best evidence-based practices and de-implement traditional (NDT/Bobath) methods of working at both an individual and organizational level.
The Bobath (NDT) approach is also widely used on children with cerebral palsy (CP). However, when the effectiveness of interventions for the treatment of CP was reviewed by Novak et al.<ref>{{cite journal |last1=Novak |first1=Iona |last2=Mcintyre |first2=Sarah |last3=Morgan |first3=Catherine |last4=Campbell |first4=Lanie |last5=Dark |first5=Leigha |last6=Morton |first6=Natalie |last7=Stumbles |first7=Elise |last8=Wilson |first8=Salli-Ann |last9=Goldsmith |first9=Shona |title=A systematic review of interventions for children with cerebral palsy: state of the evidence |journal=Developmental Medicine & Child Neurology |date=October 2013 |volume=55 |issue=10 |pages=885–910 |doi=10.1111/dmcn.12246 |doi-broken-date=18 November 2025 |pmid=23962350 |s2cid=1658072 |doi-access=free }}</ref> they concluded, “Consequently, there are no circumstances where any of the aims of NDT could not be achieved by a more effective treatment. Thus, on the grounds of wanting to do the best for children with CP, it is hard to rationalize a continued place for traditional NDT within clinical care”. They consequently recommended “ceasing provision of the ever-popular NDT”.{{Citation needed|date=November 2025}}
The dichotomy between the popularity and institutional funding of this approach versus the negative findings of most RCTs has been excused on the grounds that RCTs may not be suitable for neurorehabilitation. Yet, the British Bobath Tutors Association website does quote the minority of RCTs that support their approach.
==See also== *[[Occupational therapy]] *[[Physical therapy]] *[[Speech and language pathology]] *[[Brunnstrom Approach]] *[[Frenkel exercises]]
==References== {{Reflist|refs= <ref name="bobath1">{{cite journal|last1=Lennon|first1=S|last2=Ashburn|first2=A|title=The Bobath concept in stroke rehabilitation: a focus group study of the experienced physiotherapists' perspective|journal=Disability and Rehabilitation|date=October 2000|volume=22|issue=15|pages=665–674|pmid=11087062|doi=10.1080/096382800445461|doi-broken-date=18 November 2025|s2cid=19478077}}</ref> <ref name="Graham Eustace Brock 2009">{{cite journal |last1=Graham |first1=Julie Vaughan |last2=Eustace |first2=Catherine |last3=Brock |first3=Kim |last4=Swain |first4=Elizabeth |last5=Irwin-Carruthers |first5=Sheena |title=The Bobath Concept in Contemporary Clinical Practice |journal=Topics in Stroke Rehabilitation |date=January 2009 |volume=16 |issue=1 |pages=57–68 |doi=10.1310/tsr1601-57 |doi-broken-date=18 November 2025 |pmid=19443348 |s2cid=14241433 }}</ref> <ref name="bobath3">{{cite web|website=International Bobath Instructors Training Association|title=Theoretical assumptions and clinical practice|date=September 2008|access-date=May 10, 2011|url=http://ibita.org/pdf/assumptions-EN.pdf|url-status=unfit|archive-url=https://web.archive.org/web/20110818062216/http://ibita.org/pdf/assumptions-EN.pdf|archive-date=August 18, 2011}}</ref> <ref name="Kollen Lennon Lyons et al 2009">{{cite journal |last1=Kollen |first1=Boudewijn J. |last2=Lennon |first2=Sheila |last3=Lyons |first3=Bernadette |last4=Wheatley-Smith |first4=Laura |last5=Scheper |first5=Mark |last6=Buurke |first6=Jaap H. |last7=Halfens |first7=Jos |last8=Geurts |first8=Alexander C.H. |last9=Kwakkel |first9=Gert |title=The Effectiveness of the Bobath Concept in Stroke Rehabilitation: What is the Evidence? |journal=Stroke |date=April 2009 |volume=40 |issue=4 |pages=e89-97 |doi=10.1161/STROKEAHA.108.533828 |doi-broken-date=18 November 2025 |pmid=19182079 |doi-access=free |hdl=2066/81271 |hdl-access=free }}</ref> <ref name="Knox & Evans 2002">{{cite journal |last1=Knox |first1=Virginia |last2=Evans |first2=Andrew Lloyd |title=Evaluation of the functional effects of a course of Bobath therapy in children with cerebral palsy: a preliminary study |journal=Developmental Medicine & Child Neurology |date=July 2002 |volume=44 |issue=7 |pages=447–460 |doi=10.1017/s0012162201002353 |doi-broken-date=20 October 2025 |pmid=12162382 |doi-access= }}</ref> <ref name="O'Sullivan">{{cite book|last=O'Sullivan|first=Susan|date=2007|title=Physical Rehabilitation|url=https://archive.org/details/physicalrehabili00osul|url-access=limited|pages=[https://archive.org/details/physicalrehabili00osul/page/n63 60], 512, 720|publisher=F.A. Davis|location=Philadelphia|isbn=978-0-8036-1247-1}}</ref> <ref name=Paci2003>{{cite journal |last1=Paci |first1=Matteo |title=Physiotherapy based on the Bobath concept for adults with post-stroke hemiplegia: A review of effectiveness studies |journal=Journal of Rehabilitation Medicine |date=1 January 2003 |volume=35 |issue=1 |pages=2–7 |doi=10.1080/16501970306106 |doi-broken-date=18 November 2025 |pmid=12610841 |doi-access=free }}</ref> <ref name="Platz Eickhof van Kaick et al 2005">{{cite journal |last1=Platz |first1=T |last2=Eickhof |first2=C |last3=van Kaick |first3=S |last4=Engel |first4=U |last5=Pinkowski |first5=C |last6=Kalok |first6=S |last7=Pause |first7=M |title=Impairment-oriented training or Bobath therapy for severe arm paresis after stroke: a single-blind, multicentre randomized controlled trial |journal=Clinical Rehabilitation |date=November 2005 |volume=19 |issue=7 |pages=714–724 |doi=10.1191/0269215505cr904oa |doi-broken-date=18 November 2025 |pmid=16250190 |citeseerx=10.1.1.1023.3059 |s2cid=36998550 }}</ref> <ref name=Damiano2007>{{cite journal |last1=Damiano |first1=Diane |title=Pass the torch, please! |journal=Developmental Medicine & Child Neurology |date=October 2007 |volume=49 |issue=10 |pages=723 |doi=10.1111/j.1469-8749.2007.00723.x |doi-broken-date=18 November 2025 |pmid=17880637 |s2cid=41659576 }}</ref>
<ref name=Mayston2006>{{cite journal |last1=Mayston |first1=Margaret |title=Letter to the editor |journal=Physiotherapy Research International |date=September 2006 |volume=11 |issue=3 |pages=183–186 |doi=10.1002/pri.343 |doi-broken-date=18 November 2025 |pmid=17019949 }}</ref>
<ref name=Tyson2009>Tyson, S. (2009) 2009 Annual Evidence Update on Stroke rehabilitation – Mobility, NHS Evidence. Available at :-http://arms.evidence.nhs.uk/resources/hub/37914/attachment or https://salford-repository.worktribe.com/output/1465090/2009-annual-evidence-update-on-stroke-rehabilitation-mobility</ref>
<ref name="Lennon Ashburn Baxter 2006">{{cite journal |last1=Lennon |first1=Sheila |last2=Ashburn |first2=Ann |last3=Baxter |first3=David |title=Gait outcome following outpatient physiotherapy based on the Bobath concept in people post stroke |journal=Disability and Rehabilitation |date=January 2006 |volume=28 |issue=13–14 |pages=873–881 |doi=10.1080/09638280500535132 |doi-broken-date=18 November 2025 |pmid=16777775 |s2cid=30776966 }}</ref> }}
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[[Category:Occupational therapy]] [[Category:Physical therapy]] [[Category:Rehabilitation medicine]]