The Bobath Concept in Adult Neurology

249 Pages·2016·7.47 MB·English

by  Bente Elisabeth Bassøe Gjelsvik

The Bobath Concept
in Adult Neurology
Bente E. Bassøe Gjelsvik
Physiotherapist
Advanced Bobath Instructor IBITA
Bergen, Norway
241 Illustrations
Thieme
Stuttgart · New York
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StructureoftheBook V
Preface
About the Author
x enablingthereaderto formhypotheses
throughclinicalreasoningintreatmentsitua-
tionsbasedonaconceptualunderstanding
I trained as a physiotherapist at the School of oftheinteractionbetweenhumansandthe
Physiotherapy, Royal Victoria Infirmary, New- environment,andbetweentheCNS,themus-
castle-upon-Tyne, England, in 1978. For a short culoskeletalsystems,movement,andfunction.
time I worked in a newly opened hospital in Clinical reasoning cannot be learned through
Newcastle, before I moved back to Norway with readingabook:itisdevelopedthroughcontinu-
my husband. Since July 1978 I have worked in ous critical evaluation of one’s own practice, by
Haukeland University Hospital in Bergen; for pursuing answers through experimenting and
the first 7 years in medical wards, from 1985 to by improving one’s evidence-based knowledge. I
1996 in the Neurology Department, and since hope that this book may help the reader in this
then in the Department of Physical Medicine process.
andRehabilitation.Ihavebeeninvolvedindiffer- The book is written for physiotherapists and
ent projects, one of which was the development occupational therapists, students, and qualified
of a rehabilitation network in Norway. This led professionals. It is mainly aimed at the clinician
to the opening of what is now the Department working with neurologically impaired indivi-
ofPhysicalMedicineandRehabilitationin1996. duals.
I have taken part in many research projects
andIhaveco-authoredseveralarticles.
ItrainedasaBobathInstructorwiththe Brit-
ish Bobath Tutor Association (BBTA). I was ap- Structure of the Book
proved by the International Bobath Instructors
Training Association (IBITA) as a Bobath Instruc-
torin1991,andasanAdvancedBobath Instruc- The book is meant to be read in the way it is
tor in 2004. I am a specialist in neurorehabilita- structured. The chapters build on each other,
tion and have been a member of the Norwegian and the reader may miss important information
Physiotherapist Association since 1995. I have and discussions if it is primarily used as a refer-
extensive teaching experience and have taught encebook.Idohope,however,thatitwillbeuse-
courses in many countries in Europe. Currently, fulasareferenceonce readthrough.
IamtheChairpersonofIBITA. Chapter1,AppliedNeurophysiology,isdivided
intothreeparts:
x 1.1SystemsControl:Thisdealswith some
systemsandstructuresconcernedwith
Aims of This Book
movementandsensorimotorintegration.This
parttakesabrieflookatthestructureand
functionofpartsoftheCNS,anddescribesthe
To improve the therapist’s competency in the interactionbetweenCNSfunction,muscle
treatment of individuals with neurologic condi- function,function,andmovement.Conse-
tionsby: quencesofCNSlesionsandclinicalreflections
x building bridgesbetween: arediscussedthroughout.
– thestructureandfunctionofthecentral x 1.2Plasticity:Thispartoutlineschangesinthe
nervoussystem(CNS),theneuromuscu- CNSasaresultofnatureandnurtureand
loskeletalsystems,andtheabilityfor asaconsequenceofCNSlesions.These
change(plasticity); changesformthebasisforlearningandare
– posturalcontrolandmovement;andthe thereforeimportantto understand.Implica-
– treatmentofneurologicconditions. tionsfortherapyarediscussed.
VI Preface
x 1.3ConsequencesofandReorganizationafter Chapter 2, Physiotherapy, discusses normal
CNSLesions:Thispartattemptstoputthe balanceandmovement,anddeviationsfromnor-
consequencesofCNSlesionsandplasticity malmovementaswellaschoicestherapistsmay
intoaclinicalcontext.Thispartdiscussesand haveforinterventions.
formulateshypothesesaboutthecauseand Chapter 3, Assessment, looks at the Interna-
effectoflesions andthesensorimotorprob- tional Classification of Functioning, Disability,
lemsthatpatientsexperience.Clinicalsymp- and Health as a basis for assessment. Some out-
tomssuchasspasticityandassociatedreac- comemeasuresarealsobrieflydescribed.
tionsarediscussed. Chapter 4, Case Histories, presents the case
studiesoftwoindividuals,SisselandLisa.
I have used the pronoun “he” for the patient
and “she” for the therapist except where photos
show differently, although in real life the situa-
tion isoftenreversed.
Foreword VII
Foreword
At this time we know more about the central Bobath Concept and its current interpretation of
nervous system than ever before, but to bring movement control. The basis of the text is to
about the reality of a functional recovery after a understand thestructureand function of the or-
lesion is still a very serious clinical challenge to ganism, which is expressed through an under-
both patients and therapists. In this book Bente standing of posture and movement control. It is
Gjelsvik, an acknowledged Bobath Instructor a clinically oriented text concluding with two
and Clinical Specialist in Neurology, brings all detailed case histories that will be of significant
herskillstoexplainaconceptwhichhasevolved interest to all professions involved in the man-
over decades to address the complexities of agementofneurologicdisability.
neuro-disability. She adopts a problem-solving
approach consistent with the definition of the MaryLynch-Ellerington
VIII Acknowledgments
Acknowledgments
The first book that I published with Thieme was MyhusbandOlavGjelsvikisacloseandcriti-
in German: Form und Funktion. It is thanks to calcolleague.HeisaphysiotherapistandBobath
my German editor, Eva Maria Gr(cid:1)newald, that Instructorandhasgivenmevaluablesupport,en-
her colleague Angelika-M. Findgott at Thieme couragement,andinputthroughoutthisprocess.
Publishers, the English branch of Thieme Verlag, MygreatfriendandmentorMaryLynch-Eller-
became interested in publishing an English edi- ington is a Senior Bobath Instructor and the
tion—the book you are holding in your hands professional leader of BBTA. She has, over many
now.Mythanksgotobothmyeditors. years, given me the basis for my conceptual
This English edition is based on the German understanding of the Bobath Concept. She is an
one, but it has been revised and updated. A sec- extremely generous person, sharing her insight
ond German version with the same updates and andknowledgewithcolleaguesandcourseparti-
revisions has already been published. I have cipantsallover theworld.
done the revision and translation (from Nor- Last but not least, a special thank you to the
wegian) into English myself, with great help patients and colleagues who were willing to be
frommyEnglishcolleaguesattheBritishBobath includedinthisbook.
TutorsAssociation(BBTA):LynneFletcher,Janice
Champion,andLinziSmith. BenteEBassøeGjelsvik
Contents IX
Contents
Introduction.................. 1 ActiveMovement;LearnedNonuse;
The Bobaths: AHistorical Overview.. 1 Neglect;PassiveMovement......... 125
The International BobathInstructors ControlofAssociatedReactions...... 127
Training Association—IBITA......... 1 Feedback ....................... 128
IBITA’sTheoretical Assumptions Carry-over ...................... 130
andClinical Practice .............. 3 2.3 OtherInterventions:SomeKeyPoints 132
StrengthTraining................. 132
1 Applied Neurophysiology...... 5 TreadmillTraining ................ 133
1.1 Systems Control: Systems and MultidisciplinaryTeamwork ........ 135
StructuresConcernedwithMovement AssistiveDevices ................. 135
andSensorimotor Integration ...... 6 MedicalInterventionfortheTreatment
TheNeuromuscularSystem......... 6 ofSpasticity ..................... 141
TheSomatosensorySystem,Vision,
andBalance ..................... 14 3 Assessment................... 145
TheBrainandSpinalCord.......... 23 3.1 The International Classification of
1.2 Plasticity ....................... 47 Functioning, Disability, andHealth .. 145
Neuroplasticity................... 49 3.2 Physiotherapy Assessment ......... 147
1.3 Consequences of andReorganization History ......................... 148
after CNS Lesions................. 56 Functional Activity................ 149
UpperMotorNeuronLesions........ 58 Body FunctionsandStructures ...... 151
TheComplexProblemoftheUpper Sensation,Perception,and
MotoneuronSyndrome ............ 60 LearnedNonuse .................. 154
Pain ........................... 156
2 Physiotherapy ................ 67 ClinicalReasoning ................ 157
2.1 Balance andMovement ........... 68 TheAimofAssessment ............ 158
HumanMovementControl ......... 68 3.3 OutcomeMeasures ............... 163
Balance......................... 69 BodyStructureandFunctionMeasures 163
DeviationsfromNormalMovement ActivityMeasures ................ 164
andBalance Control............... 81 Self-ReportMeasures.............. 165
2.2 Intervention—Considerations and ObjectiveGoalSetting ............. 165
Choices......................... 90 AssessmentDiagram .............. 165
PosturalSets .................... 90 EvaluationandDocumentation ...... 166
AnalysisofBasicPostures Conclusion ...................... 166
andPosturalSets ................. 91
KeyAreas ....................... 108 4 Case Histories ................ 169
SelectiveMovementandFunctional 4.1 CaseHistory: Sissel ............... 169
Activity......................... 110 PastMedicalHistory,SocialHistory,
TheRelationshipbetweenAutomatic Activities,andParticipation......... 169
andVoluntaryMovement .......... 112 HistoryofPresentIllness........... 169
Handling........................ 116 Assessment...................... 170
ClinicalReasoningandHypothesis ... 175