For many people the Bobath concept is a new idea, however it has been practised for over 80 years. It is based upon two key principles:
- People with neurological problems can improve their movement skills.
- The importance of treating the body holistically.
First developed by Berta Bobath MBE PhD (Hon), she had come to the UK from Germany in the 1930s with her Czech husband, a neurologist and psychiatrist. She specialised in neurological disorders 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 that 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 as “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 movements or to become confident in their existing movements on their own. Physiotherapists can give them the opportunity to practice movements in an atmosphere of safety.
The Bobath approach helps people to move in the most efficient manner possible, 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 is stiff or painful, feels like concrete or is working too hard, the physiotherapist will try to help by providing balance and giving all parts of the body a chance to work together.
Bobath Training programmes
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, at least one advanced course, and further training courses through the British Bobath Tutors Association (BBTA).