HandFun Meeting 2013

Bobath Concept

q  Assessment and rehabilitation of persons with disorders of function, movement and postural control.

q  Current Neurophysiology.

q  Science movement (motor control, motor learning).

q  Biomechanics and sensory components, perceptual, cognitive, adaptive and motor. q  Normal movement.

Where does our hand begin?

Hand as the organ that explores and interacts with the world.

Tallis, 2008

Hand evaluation q  Psychological / Cognitive / Emotional (Physiotherapist, Occupational Therapists, Neuropsychologist…)

q  Sensitive / proprioceptive and perceptive.

q  Motor. Standardized Tests: - Rivermead - Fugl-Meyer Scale - Motor Activity Log (MAL) - …etc

Specific work of the hand

Patterns of movement and behavior

Individual C.

Task Environment

Specific work of the hand 1. Individual characteristics

q  Stability precedes mobility. q  Postural Control ßà Hand

q  Active participation by the patient. q  Learning organization and integration.

Specific work of the hand 2.Environment

Specific work of the hand 3.Task

Visual input Somesthetic input

Parietal cortex Premotor cortex

Primary motor

cortex

Movement

The patients Motivation participation Cognitive processes/Planning Cortical organization/Learning

Movement Search normal patterns of movement facilitation Task success by physiotherapist Reinforce feedback and help feedforward

Cognitive

Sensitive

Motor

Components to make an

EFFICIENT MOVEMENT

Biomechanical

Perceptual

Applicability to patient's daily life

FUNCTIONALITY

Specific work of the hand

Mayston, 1999

Environment and contact with the space

Patient Gives meaning to the task. Physiotherapist Gives the preparation of the hand (form, size …).

CONCLUSIONS

q  It’s a concept, not a technique or a method. q  It kept in mind postural control and motor learning. q  Component cognitive, sensory, proprioceptive, motor and integration

into daily life. q  Three factors to consider: individual, task and environment.

q  Collaboration with other professionals, therapies and approaches.

q  Mirror Therapy, forced use therapy, new technologies, splints and

other assistance.

Bobath, B.; Hemiplejia del adulto: Evaluación y Tratamiento; 1999; Editorial Médica Panamericana De Diego C, Puig S, Navarro X. A sensorimotor stimulation program for rehabilitation of chronic stroke patients. Restor Neurol Neurosci. 2013; 31(4):361-71 Majnemer, A., Bourbonnais, D., Frak, V., (2008). The role of sensation for hand function in children with cerebral palsy. Clinics in Developmental Medicine: Improving hand function in cerebral palsy: theory, evidence and intervention . A-C Eliasson, and P. Burtner. Eds, MacKeith Press. Mayston M (1999) An overview of the central nervous system. Workshop, SA Neurodevelopmental therapy Association, Johannesburg , 1999. Ertelt D, Hemmelmann C, Dettmers C, Ziegler A, Binkofski F.; Observation and execution of upper-limb movements as a tool for rehabilitation of motor deficits in paretic stroke patients: protocol pf a randomized clinical trial. BMC Neurology 2012, 12:42 Oujamaa L, Relave I, Froger J, Mottet D, Pelissier JY. Rehabilitation of arm function after stroke. Literature review. Ann Phys Rehabil Med. 2009; 52(3):269-93. Paeth, B.; Experiencias con el concepto Bobath: fundamentos, tratamiento, casos; 2006; Editorial Médica Panamericana Partridge CJ.; Physiotherapy approaches to the treatment of neurological conditions - an historical perspective. In: Edwards S, editor(s). Neurological physiotherapy. A problem-solving approach. Edinburgh: Churchill Livingstone, 1996:3-14.

BIBLIOGRAPHY

Paci M. Physiotherapy based on the Bobath concept for adults with post-stroke hemiplegia: a review of effectiveness studies. J Rehabil Med 2003; 35:2-7. Scalha TB, Miyasaki E et al; Correlations between motor and sensory functions in upper limb chronic hemiparetics after stroke. Arquivos de Neuro-Psiquiatria 2011; 69 (4), 624-9 Schabrun S, Hillier SL; Evidence for the retraining of sensation after stroke: a systematic review. Clinical Rehabilitation 2009; 23; 27-39 Shumway-Cook A, Woollacott MH. Motor control: translating research into clinical practice. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2007Tallis, R.; The Hand; 2008 Smania N, Montagnana B, Faccioli S, Fiaschi A, et al. Rehabilitation of somatic sensation and related deficit of motor control in patients with pure sensory stroke. Archives of Physical Medicine and Rehabilitation 2003; 84(11):1692-702. Waller, SM.; Prettyman, MG; Arm training in standing also improves postural control in participants with chronic stroke. Gait & Posture, Volume 36, Issue 3, 2012: 419-42 Winges, SA., Weber, D J., Santello, M. The role of vision on hand preshaping during reach to grasp. Experimental Brain Research, 2003; 152(4):489-98. Wolf, S.L., Winstein, C.J., Taub, E., Uswatte, G., Morris, D., Giuliani, C., Light, K.E., and Nicholas-Larsen, D. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: The EXCITE randomized clinical trial. JAMA : The Journal of the American Medical Association. 2006, 296(17), 2095-2104. Wolf, S. L., Winstein, C. J., Miller, P., Thompson, P. A., Taub, E., Uswatte, G., Morris, D., Blanton, S., Nicols-Larsen, D., and Clark, P. Retention of upper limb function in stroke survivors who have received constraint-induced movement therapy: the EXCITE randomized trial. Lancet Neurological 2008; 7:33-40.

BIBLIOGRAPHY

¡ THANKS !