bobath approach
DESCRIPTION
Introduction, Theory, Principles and TechniquesNo pictures or diagrams.TRANSCRIPT
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BOBATH APPROACH
By Cedric Fernandez
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IntroductionBobath therapy is an interdisciplinary approach to the management of cerebral palsy involving occupational therapy, physiotherapy and speech and language therapy. Bobath therapy is a holistic approach pioneered by Dr and Mrs. Bobath. The basis of the approach is to give children an experience of normal movement by enabling the child to respond actively to specialized handling.
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The Pioneers –Mrs.Berta and Dr.Karel Bobath
Berta Bobath was a physiotherapist, who had initially trained in remedial gymnastics. She understood normal movement and posture, and together with her husband Karel, who was a pediatric neurologist, Berta developed an approach to the treatment of cerebral palsy that would encourage a child to move and function as normally as possible, while Karel researched the neurological implications of the Bobath approach.
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Fundamental theory
HIERARCHICAL THEORY which described the nervous system as hierarchial in nature
-Based on the works of Jackson, Sherrington, and Magnus
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Hypothesis
A neurologic insult will lead to a release of the lower-level centers from higher-level center inhibitory control, resulting in stereotypical postures, primitive movement patterns and predominant reflex activity
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Treatment for…
At its inception the Bobath Approach was specifically used only for children suffering from Cerebral Palsy
Treatment approach was later on expanded to include the rehabilitation of adults with motor problems, particularly CVA
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Treatment Approach Main problem: the abnormal
coordination of movement patterns combined with abnormal postural tonus (Bernstein, 1967)
Secondary problem: muscle strength and muscle activity
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The Bobath Approach…. has undergone changes in its theoretical
base to accommodate developments in the fields of neurophysiology, biomechanics, and typical development
involves the whole patient, his sensory, perceptual and adaptive behavior, and motor problems
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Principles
Normalize muscle toneInhibit primitive reflexesFacilitate normal postural reactionsTreatment should be developmental
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TechniquesHandlingWeight bearing over the affected limbUtilize positions that allow use of the
affected limbsAvoidance of sensory input that affect
muscle tone
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Techniques of treatment
Initial flaccid stage Stage of spasticity Stage of relative recovery
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Physiotherapy in First Stage Turning over from supine to side-lying- Clasped hands raised and moved side to side- External rotation of arm in horizontal abduction- Alternate flexion and extension of the elbow Preparing the patient for sitting up and standing Working for control of the leg- Flexion and passive and slow extension with
control of patient in supine position- Lateral border of foot raised more than medial
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Physiotherapy in First Stage Extension in preparation for weight
bearing- Alternate knee flexion/extension in
dorsiflexed foot Preparing for walking without
circumduction- Flexion of knee with hip extended- Extension of hip with knee flexed- Moving foot up and down against a wall
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Physiotherapy in First Stage Control of adduction and abduction at
the hip in supine Sitting up from supine and side-lying Trunk balance in sitting Working for extended arm support in
sitting Control of the arm at the shoulder Mobilizing the shoulder girdle
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Physiotherapy in Second Stage Treatment in sitting and standing up- Shifting chair to chair- Sitting with crossed legs- Controlled lowering of flexed affected
limb- Moving dorsiflexed foot backward before
standing up
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Physiotherapy in Second Stage Treatment for standing up and standing- Weight bearing on affected leg while
starting to stand up- Extension of hip and knee with foot on
ground - Stepping forward with affected leg with
control by therapist
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Physiotherapy in Second Stage Treatment for walking The stance phase- Weight bearing and balancing of affected
leg with unaffected foot in front The swing phase- Knee flexion with hips extended without
pulling pelvis upwards- Alternating movements of flexion/extension- Dorsiflexion of spastic foot before step
forward- Knee flexion when foot is backwards
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Physiotherapy in Second Stage Treatment in prone lying and kneeling- Patient kneeling forward and asked to lift
unaffected arm- Rocking backwards and forwards
balancing on affected knee- Kneel standing with weight on affected
side- Extension of hip with flexed knee on
stool
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Physiotherapy in Second Stage Treatment for control of movements of
the arm- Moving trunk in all directions Working for independent and controlled
movements of the elbow- While arm is flexed/abducted at
shoulder- Moving clasped hands to face
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Physiotherapy in Second Stage Exercises the patient should do at home- Elevation of arms with clasped hands- Then turn palms upwards and outwards- Same movements with arms forward- Walking backward with palms on table- Standing with palms flat and raised
against the wall
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Physiotherapy in Third Stage Treatment to improve the patients gait- working for dorsiflexion- Moving trolley with affected leg- Standing with legs crossed- Step backwards on affected leg- Walking with arms in extension- Rotation of pelvis while walking
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Thank you!!!!