The Bobath concept (NDT) in adult neurorehabilitation: a scoping review of conceptual literature.

PURPOSE: This scoping review aims to describe how Bobath concept is conceptualized, operationalized, and studied in adult neurorehabilitation. METHODS: The Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) guidelines were adopted. Non-scientific and research articles were searched in electronic databases PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science, ScienceDirect, and Physiotherapy Evidence Database (PEDro), with the keywords "Bobath" or "Neurodevelopmental Treatment", published in English, Spanish, and Portuguese, between 2013 and 2023. RESULTS: Of the 78 publications identified, 31 articles addressed the conceptual underpinnings of Bobath concept (seven theoretical papers, seven Delphi/surveys/mixed methods studies, four qualitative studies, one scoping review, 10 letters to the editor, and two editorials), comprising five themes: (a) theoretical principles; (b) clinical principles; (c) clinical reasoning; (d) conceptualizing movement; and, current (e) evidence debate. The revised definition and the Model of Bobath Clinical Practice provide a clarification of the unique aspects of Bobath concept. A new clinical skill was identified beyond facilitation - visuospatial kinesthetic perception - as well as how Bobath experts conceptualize movement, which are all integral to clinical reasoning. CONCLUSIONS: This review provides an updated Bobath clinical framework that gathers the theoretical foundations and clinical practice principles that require careful consideration in the design of future intervention studies.Implications for rehabilitationThis scoping review consolidates the clinical and theoretical principles of contemporary Bobath practice, providing a clear framework for clinicians.The Model of Bobath Clinical Practice (MBCP) framework enables detailed documentation of movement analysis and movement diagnosis, guiding clinical reasoning and interventions.This review identifies fundamental principles and practices to inform future Bobath intervention studies, ensuring their clinical relevance.A framework with specific recommendations has been developed to guide Bobath intervention studies, enhancing the integration of clinical practice, education, and research.

Sensory training combined with motor training improves trunk proprioception in stroke patients: a single-blinded randomized controlled trial.

OBJECTIVES: Inadequate trunk function is the underlying cause of many problems such as impaired balance and mobility. Although there have been trunk-based physiotherapy approaches in recent years, almost all of these approaches focus on motor problems. This study aims to investigate the effects of sensory training combined with trunk-centered Bobath exercises on trunk control and proprioception, balance, gait, and the activity of daily living (ADL). MATERIALS AND METHODS: This study is a randomized controlled trial included with twenty-seven stroke patients. Participants were separated into two groups, Group 1; 'sensory training combined with trunk-centered Bobath exercises' and Group 2; 'trunk-centered Bobath exercises'. Trunk-centered Bobath exercises were used for motor training. Sensory training included transcutaneous electric nerve stimulation and a set of exercises that provide tactile and proprioceptive stimulation. Trunk Impairment Scale, Trunk Reposition Error, Berg Balance Scale, 2-minute walk test, and Barthel Index were used to assess trunk control, trunk proprioception, balance, gait, and ADL respectively. RESULTS: Intra-group analysis results showed that trunk control, trunk proprioception, balance, gait, and ADL improved in both groups after treatment (p < 0.05). The changes in the Trunk Reposition Error values of the participants in Group 1 before and after treatment was found to be significantly higher than Group 2 (p < 0.05). CONCLUSIONS: The findings indicated that the application of trunk-centered motor training is effective in improving trunk proprioception and trunk control, balance, gait, and ADL in stroke patients. Also, sensory training combined with trunk-centered motor training was found more effective in improving trunk proprioception than solely motor training.

O exercício físico resistido em pacientes com paralisia cerebral / Strength training in cerebral palsy

Neste trabalho e apresentada uma revisão bibliográfica de artigos que pesquisaram os efeitos do exercício físico resistido como abordagem de tratamento ao portador de Paralisia Cerebral com espasticidade. A avaliação preliminar das condições do paciente quanto a real força muscular, à espasticidade, as limitações articulares e ao condicionamento cárdio-respiratório e necessária, a fim de eleger esta abordagem como forma mais apropriada de tratamento com resposta direta sobre a funcionalidade. As razões para a fraqueza muscular, juntamente com a perda de controle motor seletivo, a fatigabilidade, o reduzido equilíbrio e os déficits sensoriais, todos fatores determinantes do prognóstico locomotor, tem implicações diretas no tratamento. O treino de força com exercícios em cadeia cinética fechada com peso corporal ou num grupo que tem A disposição estações de trabalho que incluam atividades funcionais com equilíbrio e treinamento isocinético com enfoque em membros inferiores promove efeitos benéficos as condições gerais do paciente desde que seja mantida boa postura durante a execução das atividades e inibidas as reações associadas, conforme o Conceito Bobath.

The purpose of this paper is to present a research about strength training effect as a management technique in spastic cerebral palsy. A preliminary evaluation of the patient's conditions regarding muscle strength, spasticity, joint limitations and cardiorespiratory fitness is necessary to elect this technique as the most appropriate with direct response for functionality. The causes of muscle weakness, loss of selective motor control, fatigability, reduced balance and sensorial deficit, all determining factors to the locomotor prognosis, have direct implications in the treatment. Strength training with closed-kinetic-chain exercises and with body weight or in a group that has acess to workstations including functional activities with balance and isokinetic training in lower limb produces gains in general conditions provided that a good posture during activities is kept and the associated reactions are inhibited as prescribed by the Bobath Concept. Physical fitness in cerebral palsy should be aimed always taking into consideration the functional conditions of each patient.