All the heads up! neurological physiotherapists follow the Bobath approach in their work, which is based on two key ideas:
- People with neurological problems can improve their movement skills and
- That it is important to treat the body holistically.
The Bobath concept was developed by Berta Bobath, MBE PhD (Hon), who came to the UK from Germany in the 1930’s with her Czech husband, who was a neurologist and psychiatrist. She specialised in neurological disorder and set up a centre for children with cerebral palsy.
At the time, the prevailing wisdom was that people with strokes couldn’t improve any of their movement skills which had been damaged. At best people were encouraged to strengthen their undamaged sides; at worst, rehabilitation wasn’t even encouraged.
Bobath’s revolutionary ideas showed that people could improve movement on their damaged side after a stroke. Her holistic approach also showed that the body functioned as a whole and that walking and balance could be improved through treatment of the arm.
Bobath explained the concept in an interview: it is ” a whole new way of thinking, observing, interpreting what the patient is doing, and then adjusting what we do in the way of techniques – to see and feel what is necessary, possible for them to achieve. We do not teach movements, we make them possible.”
The basis of the Bobath concept lies in handling patients so that the physiotherapist helps to facilitate movement by lengthening short muscles, mobilising or moving tight joints, strengthening weak muscles and helping to keep their bodies in better alignment. This can be summarised as ‘stabilising wobbly bits and mobilising stiff bits’.
It is difficult for people to learn new movement or to learn confidence in their existing movements on their own. Physiotherapists can give them the opportunity to practice movements in an atmosphere of safety.
The Bobath approach tries to help people move in the most efficient manner so that they conserve their energy, lessen the wear and tear on their bodies and reduce the strain they are feeling. The aim is to teach the body and mind how to move most easily, involving as many parts of the body as possible, using all the movement already available and trying to increase movement skills.
If one part of their body is out of balance because it’s stiff or painful, because it feels like concrete or because it’s working too hard, the physiotherapist will try to help provide balance and give all parts of the body a chance to work together.
A more detailed description of what happens in a typical treatment session can be found here.
Bobath training is mostly given at post-graduate level. Those physiotherapists specialising in neuro-physiotherapy who want to train in the Bobath concept have three levels of training:
- Introductory Modules on movement analysis
- A 3-week residential course, including a project on strokes
- A week-long advanced Bobath course, which can only be taken a year after the second course.
On completion of all these levels, a physiotherapist can use the designation ‘Bobath trained’.
All physiotherapists working at heads up! have completed the three week course and completed at least one advance course.
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