CP Factsheet Bobath Therapy This factsheet provides a basic overview of Bobath Therapy and is mainly aimed at parents and carers looking after a child with cerebral palsy. (Where children in particular are concerned, you may come across the term Neurodevelopmental Therapy (NDT) being used interchangeably with Bobath Therapy). The Bobath concept is an evolving approach to the management and treatment of children and adults with mobility difficulties caused by neurological conditions such as cerebral palsy and stroke. This therapeutic approach was originated by Berta and Karl Bobath over 50 years ago based upon their clinical experience using models of movement and neuroscience available at that time. The approach has since developed following research, evaluation, client responses and the latest knowledge on child development and neuroscience. Health professionals using the Bobath approach include physiotherapists, speech and language therapists, occupational therapists and doctors.
The Bobath approach to treatment The Bobath treatment aims to improve the child’s posture and movement. Through specialised ways of handling, stiffness can be reduced, muscle control against gravity increased and fluctuating muscle activity stabilised. Depending on the severity of the condition, the child is better able to learn how to sit up, use his/her hands, to stand up and to walk. Ideally the treatment is an integral part of the daily routine for that child. For instance, the way the child is picked up, carried, put down, or positioned when sitting, will enable parents/carers to enhance the child’s ability and function. The goals of treatment are influenced by several factors such as the functional needs in different contexts as expressed by the child and/or parents, the age of the child, severity of their condition, and their motivation. Treatment is planned for each child following assessment. Some of the areas that will be assessed are: 1
• the postures and patterns of movement the child presents with in different situations, and analysis of underlying causes of the postures and patterns of movement e.g. abnormal muscle tone, associated problems etc • age-appropriate movements that the child may not be achieving or may find difficult and analysis of the possible reasons for the difficulties • activities the child is currently capable of performing with or without assistance • analysis of possible physical reasons for restrictions in terms of participation at home, school and social contexts as expressed by the child and/or parents Once the child has been assessed, the main problems will be identified and addressed in therapy by using handling and positioning strategies based on Bobath therapy principles. The Bobath approach focuses on enabling a child to function more effectively and therefore therapy always incorporates activities relevant to the child's age and interests while accommodating limitations. Handling a child using key points on the body allows the therapist to manipulate the child to use the most effective movements whilst limiting the use of unhelpful abnormal movement patterns. Help may be given with movements like chewing, handling objects, moving about, sitting or lying down. Even when a child is being carried, dressed or bathed, using correct positioning and handling is considered very important, as this lets the child experience, as far as possible, normal movement patterns. Positioning is very important in the Bobath approach. Correct positioning helps improve movements. Experience of different positions is necessary to improve overall body control and reduce the risk of developing permanent deformity through poor posture over time. Children are seen for blocks of intensive therapy which can be repeated on an annual basis if required. The block normally consists of six weeks of therapy three times a week for an hour at a time, totalling 18 sessions. This time period may occasionally vary depending on individual needs and circumstances.
How parents, families and carers are involved Like any other therapy, Bobath requires effort and practice to achieve benefits, so input from parents and carers is essential as they spend most time handling the child. The therapist will work with the family and/or carers to teach them how to handle and position the child properly at home, so to encourage and facilitate correct movement. Brothers and sisters are also encouraged to join in. In fact, anyone involved with the child can participate in the therapy. Good communication by everyone involved with the child is essential; this helps to ensure the child is having appropriate goals identified, and to ensure that progress is considered satisfactory. 2
Many children do not like therapy in isolation, so incorporating the movements into day-to-day life and leisure activities enhances outcomes and is more acceptable and practical to the whole family.
Referral procedure The referral process differs for each of the Bobath Centres in the UK. In Scotland, the referral should come through a child’s consultant paediatrician, who should make a referral in writing, detailing full medical history and birth details to Bobath Scotland. Once Bobath Scotland has confirmation that fees will be met by the NHS, parents are contacted to set up a block of therapy for their child. If a particular health board in Scotland cannot provide financial support for a child to attend a block of therapy, Bobath Scotland will endeavour to accommodate children on a case-by-case basis. Therapists at Bobath Scotland always contact the child's local therapists before or during a block of therapy to ensure that goals are set collaboratively. The local therapists are invited to attend one or more sessions during the child’s course of treatment.
Further information For further information on Bobath therapy, reading material, training courses and assessment, please contact: Bobath Scotland Children’s Cerebral Palsy Therapy Centre 10 High Craighall Road Craighall Business Park Glasgow G4 9UD Tel: 0141 352 5000 Fax: 0141 352 5016 Email:
[email protected] www.bobathscotland.org.uk
Further reading Bobath Concept: Theory and Clinical Practice in Neurological Rehabilitation by Sue Raine, Linzi Meadows and Mary LynchEllerington (2009) Wiley Blackwell (Pub) This is available to borrow from our library partnership. The Bobath Concept in Adult Neurology by Bente E. Bassoe Gjelsvik (2007) Thieme Publishing Group (Pub) This can be purchased from www.amazon.co.uk For Bobath Therapy, as with any other therapy or treatment, we advise people with cerebral palsy, carers and parents to consult their GP, consultant or health professional before starting or paying for any treatment. 3
Due to the individual nature of cerebral palsy, some children will benefit from specific treatments and therapies, others will not. Assessment of your child’s individual needs is very important.
Our Advice Service ASCS (Advice Service Capability Scotland) is a national disability advice and information service. We specialise in information on cerebral palsy. We offer: • information on Capability Scotland services • advice on cerebral palsy • general advice on disability issues We also have a small lending library with resources about cerebral palsy and children's books about disability. You can get in touch with ASCS by calling us, e-mailing, dropping in or writing a letter. Advice Service Capability Scotland (ASCS) 11 Ellersly Road Edinburgh EH12 6HY Tel: 0131 313 5510 Textphone: 0131 346 2529 Fax: 0131 346 1681 Email:
[email protected] Web: www.capability-scotland.org.uk
This factsheet can be made available in other formats eg: tape, large print. ASCS acknowledges the co-operation of SCOPE and Bobath Scotland in the preparation of this factsheet.
March 2011 Capability Scotland, Scottish Charity SCO11330
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