Balance and gait improved in patients with MS after physiotherapy based on the Bobath concept

Background and Purpose . Patients with multiple sclerosis (MS) tend to have movement difficulties, and the effect of physiotherapy for this group of patients has been subjected to limited systematic research. In the present study physiotherapy based on the Bobath concept, applied to MS patients with balance and gait problems, was evaluated. The ability of different functional tests to demonstrate change was evaluated. Method . A single‐subject experimental study design with ABAA phases was used, and two patients with relapsing–remitting MS in stable phase were treated. Tests were performed 12 times, three at each phase: A (at baseline); B (during treatment); A (immediately after treatment); and A (after two months). The key feature of treatment was facilitation of postural activity and selective control of movement. Several performance and self‐report measures and interviews were used. Results . After intervention, improved balance was shown by the Berg Balance Scale (BBS) in both patients, and improved quality of gait was indicated by the Rivermead Visual Gait Assessment (RVGA). The patients also reported improved balance and gait function in the interviews and scored their condition as ‘much improved’. Gait parameters, recorded by an electronic walkway, changed, but differently in the two patients. Among the physical performance tests the BBS and the RVGA demonstrated the highest change, while no or minimal change was demonstrated by the Rivermead Mobility Index (RMI) and Ratings of Perceived Exertion (RPE). Conclusion . The findings indicate that balance and gait can be improved after physiotherapy based on the Bobath concept, but this should be further evaluated in larger controlled trials of patients with MS. Copyright © 2006 John Wiley & Sons, Ltd.     

Defining a Bobath clinical framework – A modified e-Delphi study

Objective: To gain consensus within the expert International Bobath Instructors Training Association (IBITA) on a Bobath clinical framework on which future efficacy studies can be based. Methods: A three-round modified e-Delphi approach was used with 204 full members of the IBITA. Twenty-one initial statements were generated from the literature. Consensus was defined a priori as at least 80% of the respondents with a level of agreement on a Likert scale of 4 or 5. The Delphi questionnaire for each round was available online for two weeks. Summary reports and subsequent questionnaires were posted within four weeks. Results: Ninety-four IBITA members responded, forming the Delphi panel, of which 68 and 66 responded to Rounds Two and Three, respectively. The 21 initial statements were revised to 17 statements and five new statements in Round Two in which eight statements were accepted and two statements were eliminated. Round Three presented 12 revised statements, all reaching consensus. Conclusion: The Delphi was successful in gaining consensus on a Bobath clinical framework in a geographically diverse expert association, identifying the unique components of Bobath clinical practice. Discussion throughout all three Rounds revolved primarily around the terminology of atypical and compensatory motor behavior and balance.     

Bobath球训练对脑卒中偏瘫患者平衡和步行能力的影响

目的:探讨用Bobath球训练偏瘫患者躯干、骨盆及下肢,对其改善运动功能、平衡、日常生活活动能力及步行能力的影响。方法:将48例偏瘫患者随机分为对照组和观察组各24例,2组均进行常规康复治疗,而观察组则在常规训练基础上增加Bobath球训练患者的躯干、骨盆及下肢。治疗前后分别采用简化Fugle mayer评定法（FMA）、Berg平衡量表(BBS)、10m步行时间(10MWT)、6min内步行距离测定(6MWT)、Holden步行功能评定(FAC),以及改良Barthel指数(MBI)进行评定。结果：治疗4周后,2组患者FMA、BBS、MBI、FAC与6MWT评分均较治疗前明显提高（P＜0.01）,且观察组更高于对照组（P＜0.05）,2组10MWT较治疗前明显减少（P＜0.01）,且观察组更低于对照组（P＜0.05）。结论：在常规康复训练的基础上进行Bobath球训练偏瘫患者,可以改善其运动功能、平衡功能和日常生活活动能力,提高其步行能力。     

易-和康复技术改善缺血性中风痉挛性偏瘫随机对照研究

目的 观察易-和康复技术改善缺血性中风后痉挛性偏瘫的临床疗效.方法 将171例缺血性中风后痉挛性偏瘫的患者,通过中央随机系统按2:1比例将患者随机分为治疗组114例、对照组57例.其中,治疗组脱落17例,完成病例观察97例,脱落率为14.9％;对照组脱落8例,完成病例观察49例,脱落率为14.0％.治疗组采用易-和康复...     

The reliability of the Leeds Movement Performance Index (LMPI): a new tool for neurological physiotherapy

Abstract

Background: Measuring movement performance in people with neurological damage requires a tool that reflects physiotherapy assessment and clinical reasoning. The Leeds Movement Performance Index (LMPI) was previously developed by a group of neurological physiotherapists to fulfill these requirements. Objective: To assess the reliability of the LMPI for use in neurological physiotherapy practice. Methods: Twelve senior neurological physiotherapists were trained to use the LMPI and then asked to measure the movement performance of five patients whose movement had been previously video-recorded for this purpose. A retest session was completed after two weeks. Data were analysed to establish internal and external reliability. Results: Internal reliability was assessed using Cronbach's alpha coefficient, applied to the entire scale (0.862) and to each item (range 0.795–0.892). External (inter-rater) reliability was assessed by a calculation of the intraclass correlation coefficient for scores awarded by multiple raters (0.959), with individual item reliability ranging from 0.874 to 0.968. External (test–retest) reliability was assessed by calculating the Spearman's rank correlation coefficient between scores obtained on two testing occasions (0.792) with values of individual items ranging from 0.397 to 0.674. A variance components analysis partitioned variance into components arising from between-patient variability (55.2%) between-therapist variability (7.8%) and between-testing variability (2.8%). Conclusions: Results indicate that the LMPI is a reliable measurement tool when used by senior neurological physiotherapists.     

新 Bobath 技术治疗脑卒中偏瘫患者的应用价值

〔摘 要〕 目的：分析在脑卒中偏瘫患者运动治疗基础上结合新 Bobath 技术治疗促进上肢功能康复的作用。方法：选取 东莞市第八人民医院 2019 年 5 月至 2020 年 5 月收治的 48 例脑卒中偏瘫患者,根据康复治疗方法分为对照组与观察组,各 24 例。对照组接受常规康复治疗,观察组行新 Bobath 技术治疗。比较分析两组患者治疗前后运动功能评分与日常生活自理 能力,统计上肢功能康复效果。结果：经治疗后,两组患者的 Fugl–Meyer 上肢运动功能评定量表（FMA–UE）评分与改良 barthel 指数（MBI）评分均较治疗前升高,且观察组高于对照组,差异均具有统计学意义（P ＜ 0.05）。观察组患者的康 复有效率为 95.83 %,明显高于对照组的 83.33 %,差异具有统计学意义（P ＜ 0.05）。结论：新 Bobath 技术治疗用于脑卒 中偏瘫的效果理想,可有效改善患者的肢体功能。     

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。     

Bobath理论与历史的变迁

Bobath理论是为中枢神经系统疾病患者开发的治疗与康复技术,可应用于成人及儿童。它最初源于Berta与Karel Bo-bath的临床经验以及当时的运动控制理论模型。这种整体性治疗技术经历了50多年的发展,今天已经以新的运动控制和运动学习理论模型为指导。它的理论框架将随着运动科学知识的更新而不断丰富、发展。