An evaluation of the hemiplegic subject based on the Bobath approach. Part I: The model

An evaluation, based on the Bobath approach to treatment has been developed. A model, substantiating this evaluation is presented. In this model, the three stages of motor recovery presented by Bobath have been extended to six, to better follow the progression of the patient. Six parameters have also been identified. These are the elements to be quantified so that the progress of the patient through the stages of motor recovery can be followed. Four of these parameters are borrowed from the Bobath approach, that is: postural reaction, muscle tone, reflex activity and active movement. Two have been added: sensorium and pain. An accompanying paper presents the evaluation protocol along with the operational definition of each of these parameters.     

An evaluation of the hemiplegic subject based on the Bobath approach. Part II: The evaluation protocol

A protocol of evaluation of the hemiplegic patient based on the Bobath approach to treatment is presented. Six parameters are evaluated: sensorium, muscle tone, reflex activity, active movement, postural reactions and pain. The first and last of these are included because of their possible effects on the motor recovery process of the hemiplegic patient. The other four are directly borrowed from the Bobath modality of treatment. For each of these parameters, the procedures are given for its evaluation along with its respective rating scales. These scales are of an ordinal nature ranging from 0 to 3. It is suggested that this new evaluation protocol is fully compatible with the therapeutic modality developed by Bobath and as well is adequate to quantify patient progress in the principle aspects treated by this well used rehabilitation approach.     

An evaluation of the hemiplegic subject based on the Bobath approach. Part III. A validation study

Sixty-two hemiplegic subjects were treated with the Bobath approach for a period of three months. During this time they were evaluated on three occasions. The testing battery consisted of a Bobath evaluation, the Brunnstrom scale, the Fugl-Meyer test, the Upper Extremity Functional Test (UEFT) and the Present Pain Intensity (PPI) of the McGill pain questionnaire. A Friedman analysis of variance showed that, except for pain, all the protocols used disclosed significant progress (p less than 0.001) over time in terms of motor recovery. Except for pain, the results of the Bobath evaluation were significantly correlated (Spearman's Rho, p less than 0.001) with the results of the other testing procedures. It is concluded that the new Bobath evaluation proposed in a previous paper is as sensitive in depicting progress in motor recovery over time as are the other testing procedures used. Furthermore, this new evaluation seems to be measuring similar properties to the other tests. However, pain (PPI) appears not to be an important dependent variable.     

Outcomes of the Bobath concept on upper limb recovery following stroke

OBJECTIVE: To determine the effectiveness of the Bobath concept at reducing upper limb impairments, activity limitations and participation restrictions after stroke. METHODS: Electronic databases were searched to identify relevant trials published between 1966 and 2003. Two reviewers independently assessed articles for the following inclusion criteria: population of adults with upper limb disability after stroke; stated use of the Bobath concept aimed at improving upper limb disability in isolation from other approaches; outcomes reflecting changes in upper limb impairment, activity limitation or participation restriction. RESULTS: Of the 688 articles initially identified, eight met the inclusion criteria. Five were randomized controlled trials, one used a single-group crossover design and two were single-case design studies. Five studies measured impairments including shoulder pain, tone, muscle strength and motor control. The Bobath concept was found to reduce shoulder pain better than cryotherapy, and to reduce tone compared to no intervention and compared to proprioceptive neuromuscular facilitation (PNF). However, no difference was detected for changes in tone between the Bobath concept and a functional approach. Differences did not reach significance for measures of muscle strength and motor control. Six studies measured activity limitations, none of these found the Bobath concept was superior to other therapy approaches. Two studies measured changes in participation restriction and both found equivocal results. CONCLUSIONS: Comparisons of the Bobath concept with other approaches do not demonstrate superiority of one approach over the other at improving upper limb impairment, activity or participation. However, study limitations relating to methodological quality, the outcome measures used and contextual factors investigated limit the ability to draw conclusions. Future research should use sensitive upper limb measures, trained Bobath therapists and homogeneous samples to identify the influence of patient factors on the response to therapy approaches.     

Physiotherapy based on the Bobath concept in stroke rehabilitation: a survey within the UK

Purpose: The Bobath concept is one of the most widely used approaches in stroke rehabilitation within Europe. This survey aimed to provide an expert consensus view of the theoretical beliefs underlying current Bobath practise in the UK. Method: Questionnaires (with sections related to: therapist background, physiotherapy management, theoretical beliefs and gait re-education strategies used) were posted to all senior level physiotherapists working in stroke care (n = 1022). Results: The majority of respondents had more than 10 year's experience overall and at least 5 years experience in stroke care. The Bobath concept was the preferred approach (n = 67%) followed by an 'eclectic' approach (n = 31%). Despite a high level of consensus between groups, there were 13 significant differences highlighted between Bobath and 'eclectic' groups related to recovery, control of tone, the analysis and facilitation of normal movement and function. In summary, Bobath therapists considered that patients needed to have normal tone and use normal movement patterns in order to perform functional tasks. They would delay patients from performing tasks independently if abnormal tone and movement would be reinforced by task practice. They were not opposed to the use of walking aids and orthotics. Conclusions: This survey has raised several issues for debate within physiotherapy such as the automatic translation of movement into function, carry over outside therapy, and the way in which tasks should be practiced. The dominance of the Bobath concept needs to be justified by establishing that it is both effective and efficient at achieving its treatment aims of: normalizing tone, improving intrinsic recovery of the affected side and function within everyday tasks.     

Physiotherapy based on the Bobath concept in stroke rehabilitation: a survey within the UK

Purpose : The Bobath concept is one of the most widely used approaches in stroke rehabilitation within Europe. This survey aimed to provide an expert consensus view of the theoretical beliefs underlying current Bobath practise in the UK. Method : Questionnaires (with sections related to: therapist background, physiotherapy management, theoretical beliefs and gait re-education strategies used) were posted to all senior level physiotherapists working in stroke care ( n = 1022). Results : The majority of respondents had more than 10 year's experience overall and at least 5 years experience in stroke care. The Bobath concept was the preferred approach ( n = 67%) followed by an 'eclectic' approach ( n = 31%). Despite a high level of consensus between groups, there were 13 significant differences highlighted between Bobath and 'eclectic' groups related to recovery, control of tone, the analysis and facilitation of normal movement and function. In summary, Bobath therapists considered that patients needed to have normal tone and use normal movement patterns in order to perform functional tasks. They would delay patients from performing tasks independently if abnormal tone and movement would be reinforced by task practice. They were not opposed to the use of walking aids and orthotics. Conclusions : This survey has raised several issues for debate within physiotherapy such as the automatic translation of movement into function, carry over outside therapy, and the way in which tasks should be practiced. The dominance of the Bobath concept needs to be justified by establishing that it is both effective and efficient at achieving its treatment aims of: normalizing tone, improving intrinsic recovery of the affected side and function within everyday tasks.     

Nursing application of Bobath principles in stroke care

The nursing approach in the care of stroke patients has a direct impact on functional outcome. Nursing application of Bobath principles in stroke care offers a nursing focus on involvement of the affected side; facilitation of normal tone, posture, and movement; and development of more normal function. A research study evaluating the functional gains of stroke patients demonstrated a significant level of functional improvement in those treated with Bobath principles over stroke patients treated with the traditional nursing approach. Practical methods for applying Bobath principles in patient care activities are described. These therapeutic methods provide nurses with the means to maximize stroke patients' potential and further influence their functional recovery.     

上田法与Bobath法治疗偏瘫儿童上肢痉挛期的疗效评定

目的 探讨偏瘫儿童痉挛期在临床康复训练中降低患侧上肢肌张力，促进患肢及手的功能发育的方法。方法 32例符合条件的偏瘫儿随机分为上田组和Bobath组，每组16例，并在训练前1周进行功能检查评测，然后分别用上田法与Bobath法降低患侧上肢肌张力，抑制异常姿势痉挛控制后，两组均进行有选择的、不引起痉挛的作业活动来诱发和促进患肢及手的功能恢复，疗程为3个月。以上田敏偏瘫上肢功能评价法的详细分级与Burnnstrin偏瘫手的功能评价法进行评测。结果 通过治疗前后对照，上田组患肢肌张力降低程度和患肢及手的功能提高均明显优于Bobath组。结论 上田法在降低偏瘫儿童痉挛期上肢肌张力方面具有显著疗效。     

Does electrical stimulation reduce spasticity after stroke? A randomized controlled study

OBJECTIVE: To investigate the therapeutic effect of electrical stimulation on plantarflexor spasticity in stroke patients. DESIGN: A randomized controlled clinical trial study. SETTING: Rehabilitation clinic of Semnan University of Medical Sciences. SUBJECTS: Forty stroke patients (aged from 42 to 65 years) with ankle plantarflexor spasticity. INTERVENTION: Fifteen minutes of inhibitory Bobath techniques were applied to one experimental group and a combination of 9 minutes of electrical stimulation on the dorsiflexor muscles and inhibitory Bobath techniques was applied to another group for 20 sessions daily. MAIN MEASURES: Passive ankle joint dorsiflexion range of motion, dorsiflexion strength test, plantarflexor muscle tone by Modified Ashworth Scale and soleus muscle H-reflex. RESULTS: The mean change of passive ankle joint dorsiflexion in the combination therapy group was 11.4 (SD 4.79) degrees versus 6.1 (SD 3.09) degrees, which was significantly higher (P = 0.001). The mean change of plantarflexor muscle tonicity measured by the Modified Ashworth Scale in the combination therapy group was -1.6 (SD 0.5) versus -1.1 (SD 0.31) in the Bobath group (P = 0.001). Dorsiflexor muscle strength was also increased significantly (P = 0.04) in the combination therapy group (0.7 +/- 0.37) compared with the Bobath group (0.4 +/- 0.23). However, no significant change in the amplitude of H-reflex was found between combination therapy (-0.41 +/- 0.29) and Bobath (-0.3 +/- 0.28) groups. CONCLUSION: Therapy combining Bobath inhibitory technique and electrical stimulation may help to reduce spasticity effectively in stroke patients.     

偏瘫患者肩痛的多因素分析

本文对71例偏瘫患者发生肩痛送行了回顾性分析，旨在了解中风肩痛的发生率以及肩痛的相关因素，结果显示偏瘫患者中肩痛的发生率达49．3％，多元回归分析表明：肌腱粘连、肌张力异常、肩手综合征与肩痛显著相关（P值分别为0．001，0．001，0．004），为了减轻肩痛的发生率，中风后努力改善异常肌张力，预防肌胜粘连等措施是至关重要的。     

An evaluation of the hemiplegic patient based on the Bobath approach: a reliability study.

The intra- and inter-rater reliability of a motor function evaluation of stroke patients, based on the Bobath approach, was studied. The intraclass correlation coefficient (ICC) was used to determine the degree of agreement between repeated measurements on the same patient taken by the same rater and between measurements taken by three raters on the same patient. In the intra-rater study, each of 19 patients was evaluated in three different sessions by one of 19 raters. In the inter-rater study 18 patients were each evaluated by three different raters. The intra-rater data were highly reliable, with ICCs of 0.95 and 0.97 for the upper and lower limbs respectively. For the inter-rater study, the ICCs were 0.79 and 0.77 for the upper and lower limbs respectively. It can therefore be concluded that this instrument, previously demonstrated to quantify patient progress, is also reliable both in intra- and inter-rater dimensions.     

选择性SPR及康复治疗对痉挛性脑性瘫痪运动功能的影响

目的：观察手术及康复训练对于脑性瘫痪（脑瘫）患者的关节活动度、肌力及肌张力的影响。方法：脊神经后根切断术（ＳＰＲ） 术后进行康复训练,以Ｂｏｂａｔｈ 法为基础,加上作业治疗。结果：手术前后的肌张力差值的统计结果有显著差异。手术后与康复训练后之间的肌力改变统计结果有显著差异（Ｐ＜０．０５） ;手术前、手术后与康复训练后Ｗｅｅ ＦＩＭ测量差异在统计学上有显著性（Ｐ＜ ０．０５） 。结论：手术解除痉挛,降低部分肌力,能改善一定关节活动度,但必须强调康复训练,并与之协调,才能更好地改善患者的运动功能和日常生活自理能力,促进患者重返社会。     

针刺配合Bobath法治疗痉挛型脑性瘫痪的临床观察

目的观察针刺配合Bobath法治疗痉挛型脑性瘫痪的康复效果。方法30例脑瘫患儿为针刺组,使用针刺配合Bobath法治疗。30例脑瘫患儿为运动组,采用Bobath法治疗。比较两组患儿的康复效果。结果针刺组总有效率为93%,运动组总有效率80%;两组患儿治疗后粗大运动功能测定（GMFM）评分较治疗前均有提高（P＜0.05）,针刺组评分高于运动组（P＜0.05）;两组治疗后痉挛改善针刺组总有效率76.7%,运动组总有效率50%。结论针刺配合Bobath法治疗痉挛型脑性瘫痪较单一Bobath法治疗有更好疗效。     

Influence of Forward Head Posture on Myotonometric Measurements of Superficial Neck Muscle Tone,Elasticity, and Stiffness in Asymptomatic Individuals With Sedentary Jobs

ObjectiveThe objective of the study was to assess the influence of forward head posture on the mechanical parameters and pressure pain threshold of superficial neck muscles in clinically nonsymptomatic individuals with sedentary jobs.MethodsTwenty-five office workers with forward head posture and 25 office workers with normal head posture were matched for sex, age, body mass index, and the nature and duration of their work and were compared at a single point. The study participants were divided into study groups on the basis of photometric craniovertebral angle measurements. The upper trapezius, sternocleidomastoid, and splenius capitis mechanical properties were assessed in the sitting position. Primary outcome measures were muscle stiffness (N/m), muscle tone (Hz), and muscle elasticity. The secondary variable was perceived pain threshold.ResultsNo significant differences between the groups were found for biomechanical properties and perceived pain threshold in the studied muscles.ConclusionForward head posture has no impact on muscle stiffness, tone, and elasticity, nor does it increase the pressure sensitivity of superficial neck muscles in healthy, mildly symptomatic office workers. It is most likely that not incorrect posture of the cervical spine, but probably other factors combined with forward head posture, like comorbid acute and chronic cervical pain and musculoskeletal disorders or prolonged sitting, contribute to changes in active myofascial tone and tensegrity as well as increased pressure sensitivity of neck muscles.     

SPR术及康复治疗对痉挛性脑瘫患者的姿势及行走能力的影响

为探讨选择性脊神经后根切断术及康复治疗对痉挛性脑瘫患者的姿势及行走能力的影响，将３４例痉挛性脑瘫患者分为２组。治疗组选择性切断脊神经后根术后３￣５ｄ开始康复训练，训练方法以Ｂｏｂａｔｈ法为基础，加上作业治疗。对照组术后仅对家长予以康复指导。结果：２组坐位、直跪、站立及行走４种姿势均有改善。治疗组术前与康复治疗后行走潜能评分差异有显著性（ｔ＝４．５９，Ｐ〈０．００１）；康复治疗后治疗组与对照组比较行     

新生儿疼痛对早期神经行为影响的研究

目的 研究疼痛对新生儿早期神经行为产生的影响.方法 随机选择2009年10月至2010年3月新生儿科住院的65例患儿为研究对象,采用国内鲍秀兰教授修订的新生儿神经行为检查方法(NBNA),于疼痛刺激前后进行检查,检测结果进行统计分析.结果 疼痛刺激前后NBNA总分分别为(36.49±1.73)分和(34.80±1.79)分,差异显著,其中疼痛刺激后,行为能力和主动肌张力的得分下降,差异显著,而被动肌张力、原始反射和一般反应的得分差异不显著.结论 新生儿疼痛对其早期的神经行为能力产生影响,其中主要表现在行为能力和主动肌张力两方面,应该加强新生儿专业医护人员对新生儿疼痛管理和干预的培训,尽量减少疼痛对新生儿的不良影响.

Abstract：

Objective To investigate the influences of pain on early neonatal neurobehavioral development Methods 65 newborn infants admitted to the Neonatal Intensive Care Unit( NICU )of our hospital from October,2009 to March,2010 were randomly chosen as the objects of this study.In light of Neonatal Behavioral Neurological Assessment( NBNA) revised by Professor Bao Xiulan,examinations were carried out before and after pain stimulation,and a statistical analysis of the results of the examinations was conducted.Results The total scores of NBNA before and after the pain stimulation were (36.49±1.73) vs.(34.80±1.79) respectively,demonstrating a significant difference.Specifically,after the pain stimulation,the scores of behavioral ability and active muscle tension decreased,with a very significant difference.However,there was no significant difference in terms of the scores of passive muscle tone,primitive reflexes and common reactions.Conclusions Neonatal pain exerts influences on early neurobehavioral development,particularly on behavioral ability and active muscle tension.The training of neonatal health care professionals in the management of and the intervention in neonatal pain should be strengthened in order to decrease the adverse effects of pain on neonates.