CP factsheetBobath Therapy

This factsheet provides a basic overview of Bobath Therapy and is mainly aimed at individuals with cerebral palsy and 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/adult’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/adult 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 the individual. For instance, the way the child/adult is picked up, carried, put down, or positioned when sitting, will enable parents/carers to enhance their 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/adult and/or parents, the age of the child/adult,

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severity of their condition, and their motivation. Treatment is planned for each person following assessment. Some of the areas that will be assessed are:

• the postures and patterns of movement the child/adult 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/adult may not be achieving or may find difficult and analysis of the possible reasons for the difficulties

• activities the child/adult 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/adult and/or parents

Once the child/adult 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/adult to function more effectively and therefore therapy always incorporates activities relevant to the child/adult’s age and interests while accommodating limitations.

Handling a child/adult using key points on the body allows the therapist to manipulate the child/adult 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/adult is being carried, dressed or bathed, using correct positioning and handling is considered very important, as this lets the child/adult 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/adults 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 the most time handling the child/adult. The therapist will work with the family and/or carers to teach them how to handle and position the child/adult 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/adult can participate in the therapy. Good communication by everyone involved with the child/adult is essential; this helps to ensure the child/adult is having appropriate goals identified, and to ensure that progress is considered satisfactory.

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Many children/adults 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 parents and carers or adults with cerebral palsy can initiate the referral by approaching their therapy team or consultant paediatrician to refer to Bobath Scotland. Some NHS Boards may contribute to the cost of therapy, but otherwise it is possible to self fund. You can call Bobath Scotland’s family co-ordinator to discuss therapy options.

Therapists at Bobath Scotland always contact the child/adult’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/adult’s course of treatment.

Further information

For further information on Bobath therapy, reading material, training courses and assessment, please contact:

Bobath ScotlandChildren’s Cerebral Palsy Therapy Centre10 High Craighall RoadGlasgowG4 9UDTel: 0141 352 5000Email: info@bobathscotland.org.ukWebsite: 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 one of our library partners.

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.

Due to the individual nature of cerebral palsy, some children/adults will benefit from specific

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Telephone: 0131 313 5510Textphone: 0131 346 2529Fax: 0131 346 7864Email: advice@capability-scotland.org.ukwww.capability-scotland.org.ukScottish Charity SCO11330

Capability ScotlandWesterlea11 Ellersly RoadEdinburghEH12 6HY

Our Advice ServiceAdvice 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

You can get in touch with us by calling, e-mailing, dropping in or writing a letter.

treatments and therapies, others will not. Assessment of your or your child’s individual needs is very important.

Advice Service Capability Scotland acknowledges the co-operation of SCOPE and Bobath Scotland in the preparation of this factsheet.

October 2014