Why hasn't Bobath been shitcanned since 2003? This research in 2009 just shows you how fucking out-of-date the mentors and senior researchers are. They should be allowed nowhere near stroke research after approving this to go ahead.
My best therapist supposedly used it but I really
think her competence came from her knowledge of anatomy.
The latest waste of time here:
What is the Evidence?
Abstract
Background and Purpose—
In the Western world, the Bobath Concept or neurodevelopmental
treatment is the most popular treatment approach used in stroke
rehabilitation, yet the superiority of the Bobath Concept as the optimal
type of treatment has not been established. This systematic review of
randomized, controlled trials aimed to evaluate the available evidence
for the effectiveness of the Bobath Concept in stroke rehabilitation.
Method—
A systematic literature search was conducted in the bibliographic
databases MEDLINE and CENTRAL (March 2008) and by screening the
references of selected publications (including reviews). Studies in
which the effects of the Bobath Concept were investigated were
classified into the following domains: sensorimotor control of upper and
lower limb; sitting and standing, balance control, and dexterity;
mobility; activities of daily living; health-related quality of life;
and cost-effectiveness. Due to methodological heterogeneity within the
selected studies, statistical pooling was not considered. Two
independent researchers rated all retrieved literature according to the
Physiotherapy Evidence Database (PEDro) scale from which a best evidence
synthesis was derived to determine the strength of the evidence for
both effectiveness of the Bobath Concept and for its superiority over
other approaches.
Results— The search
strategy initially identified 2263 studies. After selection based on
predetermined criteria, finally, 16 studies involving 813 patients with
stroke were included for further analysis. There was no evidence of
superiority of Bobath on sensorimotor control of upper and lower limb,
dexterity, mobility, activities of daily living, health-related quality
of life, and cost-effectiveness. Only limited evidence was found for
balance control in favor of Bobath. Because of the limited evidence
available, no best evidence synthesis was applied for the health-related
quality-of-life domain and cost-effectiveness.
Conclusions—
This systematic review confirms that overall the Bobath Concept is not
superior to other approaches. Based on best evidence synthesis, no
evidence is available for the superiority of any approach. This review
has highlighted many methodological shortcomings in the studies
reviewed; further high-quality trials need to be published.
Evidence-based guidelines rather than therapist preference should serve
as a framework from which therapists should derive the most effective
treatment.
Before the
introduction of neurophysiological approaches to rehabilitation,
patients with central nervous system damage were re-educated using both a
compensatory and an orthopedic approach consisting of stretching,
bracing, and strengthening the affected side and teaching the patient to
rely more heavily on the unaffected side to become as independent as
possible.1
Concomitant with advances in motor control and neurosciences of the
last decades went the development of new innovative interventions for
neurologically impaired patients. One of these approaches is the Bobath
Concept, which was last published by Bertha and Karl Bobath in 1990.2
Bobath explained movement dysfunction in hemiplegia from a
neurophysiological perspective stating that the patient must be active
while the therapist assists the patient to move using key points of
control and reflex-inhibiting patterns.2
Since 1984, the Bobaths conceded that reflexes were not primitive
responses, but essential reactions to support movement; as a
consequence, the missing components of the normal developmental sequence
were no longer facilitated during Bobath therapy in either adults or
children.3
It is thus unfortunate that the Bobath Concept is still referred to as
NeuroDevelopmental Treatment (NDT) in the American literature because it
was originally based on facilitating the missing components of the
normal developmental sequence in children with cerebral palsy. More than
50 years later, this treatment approach that is based on their
revolutionary ideas has become the most popular approach for the
treatment of neurologically impaired patients in the Western world.4
In the past 2 decades, a better understanding has developed of the underlying mechanisms that are responsible for motor learning5 and functional recovery after stroke.6
Recent studies suggest that different mechanisms are involved in
generating the nonlinear pattern of neurological recovery after stroke.
These mechanisms include: (1) salvation of penumbral tissue surrounding
the infarcted area; (2) elevation of cerebral shock (ie, “elevation of
diaschisis”); and (3) the ability of the brain to adapt by
neuroplasticity. These mechanisms are not independent from each other,
but are likely highly interrelated. For example, neurons that are
anatomically related to the infarcted area, that is in the process of
recovering from a suppressive state, can restore their function by
inducing plastic changes such as receptor hypersensitivity and dendritic
growth of new interneuronal pathways. Recent studies also suggest that
mechanisms of experience-dependent plasticity are further enhanced by
exercise training.7 This relationship is subject to a dose-response increase, ie, more intense training leads to a better response.8
However, there is also a growing body of evidence that functional
recovery entails more than just the restitution of body functions. In
particular, recent longitudinal studies that examined human kinematics
showed that improvement in dexterity and gait is to a large extent based
on the use of compensatory movement strategies by which patients learn
to deal with existing deficits.6
As
a result of this gradual accumulation of scientific knowledge, the
Bobath Concept has evolved into its current form by selectively
incorporating this knowledge.9–12
The International Bobath Instructors Training Association (IBITA)
defines the current Bobath Concept as a problem-solving approach to the
assessment and treatment of individuals with disturbances of function,
movement, and postural control due to a lesion of the central nervous
system; the association clearly states that the Bobath Concept aims to
identify and analyze problems within functional activities and
participation in everyday life as well as the analysis of movement
components and underlying impairments.12
The British Bobath Tutors’ Association (BBTA) supports this view that
although the Bobath Concept targets both impairments and functional
activities, successful goal acquisition in a given task must be
practiced to improve efficiency of movement and promote generalization
in everyday life.11
These main adaptations to current Bobath practice concur with the
evidence base for applying exercise therapy at a functional level and
preferably in the patient’s own environment, because the effects of
impairment-focused training rarely generalize to activities that are not
directly trained in the treatment program and also that these generated
effects are context-dependent.13–15
In the past decade, the theoretical assumptions underlying the Bobath Concept have been subject to criticism1,4,16; despite its popularity, the Bobath Concept has never been proven to be superior to alternative treatment approaches.17 Although 2 systematic reviews have specifically examined the effectiveness of Bobath-based therapy reviewing papers up to 200118 and 2003,16
in light of the growing number of randomized, controlled trials, the
improved understanding of mechanisms underlying adaptive motor
relearning and mechanisms of functional recovery after stroke and the
different policies to deal with the lack of evidence for the efficacy of
Bobath therapy, we have systematically evaluated the evidence for the
effectiveness of the Bobath Concept in stroke rehabilitation when
compared with alternative approaches in terms of outcome of: (1)
sensorimotor control of the upper and lower paretic limb; (2) balance
control; (3) dexterity; (4) mobility; (5) activities of daily living
(ADLs); (6) health-related quality of life (HRQOL); and (7)
cost-effectiveness.
