Bobath concept

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Bobath concept
Specialty neurological

The Bobath concept is an approach to neurological rehabilitation that is applied in patient assessment and treatment (such as with adults after stroke [1] or children with cerebral palsy [2] ). The goal of applying the Bobath concept is to promote motor learning for efficient motor control in various environments, thereby improving participation and function. This is done through specific patient handling skills to guide patients through the initiation and completing of intended tasks. [3] This approach to neurological rehabilitation is multidisciplinary, primarily involving physiotherapists, occupational therapists, and speech and language therapists. In the United States, the Bobath concept is also known as 'neuro-developmental treatment' (NDT). [1]

Contents

The concept and its international tutors / instructors have embraced neuroscience and the developments in understanding motor control, motor learning, neuroplasticity and human movement science. They believe that this approach continues to develop.

The Bobath concept is named after its inventors: Berta Bobath (physiotherapist) and Karel Bobath (a psychiatrist/neurophysiologist). Their work focused mainly on patients with cerebral palsy and stroke. The main problems of these patient groups resulted in a loss of the standard postural reflex mechanism and regular movements. [4] The Bobath concept was focused on regaining regular movements through re-education at its earliest inception. Since then, it has evolved to incorporate new information on neuroplasticity, motor learning, and motor control. [1] [5] Therapists that practice the Bobath concept today also embrace the goal of developing optimal movement patterns through the use of orthotics and appropriate compensations instead of aiming for ultimately "normal" movement patterns. [1] [5]

The Bobath Centre in Watford, UK is a specialist therapy, treatment & training facility and the home of the Bobath Concept.

Stroke rehabilitation

In the Bobath Concept, postural control is the foundation on which patients begin to develop their skills. Patients undergoing this treatment typically learn how to control postures and movements and then progress to more difficult ones. Therapists analyze postures and movements and look for any abnormalities that may be present when asked to perform them. Examples of common abnormal movement patterns include obligatory synergy patterns. These patterns can be described as the process of trying to perform isolated movement of a particular limb but triggering the use of other typically uninvolved muscles (when compared to normal movement) in order to achieve movement. Obligatory synergy patterns can be further subdivided into flexion and extension synergy components for both the upper and lower extremities. This approach requires active participation from both the patient and the therapist. [6] Depending on the patient, rehabilitation goals may work to improve any or all of the following: postural control, coordination of movement sequences, movement initiation, optimal body alignment, abnormal tone or muscle weakness. [1] [5] Treatment will therefore address both negative signs such as impaired postural control, and positive signs such as spasticity. [7]

The strategies and techniques utilized in Bobath therapy encompass therapeutic handling, facilitation, and activation of pivotal control points. Therapeutic handling is a method applied to influence movement quality, combining both facilitation and inhibition approaches. [6] Facilitation plays a central role in Bobath therapy, fostering motor learning by utilizing sensory cues (such as tactile contact and verbal guidance) to reinforce weak movement patterns and discourage excessive ones. The precise application of facilitation during motor tasks involves considerations of timing, modality, intensity, and withdrawal, all of which impact the outcome of motor learning. [5] Inhibition entails diminishing abnormal movement or posture elements that hinder normal functioning. Key control points often denote advantageous areas of the body for facilitating or inhibiting movement and posture. [6]

Activities assigned by a Physical Therapist or Occupational Therapist to an individual who has suffered from a stroke are selected based on functional relevance and are varied in terms of difficulty and the environment in which they are performed. The use of the individual's less involved segments, also known as compensatory training strategies, are avoided. Carryover of functional activities in the home and community setting is largely attributed to patient, family and caregiver education. [4]

History

The Bobath Concepts' theoretical underpinning and practice is clearly documented in a contemporary book published by Wiley Blackman in 2009: Bobath Concept: Theory and Clinical Practice in Neurological Rehabilitation' written by the British Bobath Tutors Association (BBTA) and edited by Raine, Meadows, and Lynch-Ellerington. The chair of ACPIN (Association of Chartered Physiotherapists in Neurology) reviewed this book and concluded :- “I am not really sure that it is clear from the book what the Bobath approach actually is”, “often the prose turns into jargon” and “this book will do little to quell the critics; in fact, it will no doubt give them more fuel for the fire”. [8]

Research

Paci (2003) conducted an extensive critical appraisal of studies to determine the effectiveness of the Bobath concept for adults with hemiplegia following a stroke. Selected trials showed no evidence proving the effectiveness of the Bobath Concept as the optimal type of treatment. [9] Paci (2003) recommended that standardized guidelines for treatment be identified and described and that further investigations are necessary to develop outcome measures concerning goals of the Bobath approach such as quality of motor performance. [9]

Bobath therapy is nonstandardized as it responds, through clinical reasoning and the development of a clinical hypothesis, to the individual patient and their movement control problems. The decisions about specific treatment techniques are collaboratively made with the patient and are guided by the therapist through the use of goal setting and the development of close communication and interaction. Working to develop improved muscle tone appropriate to the task, the individual and the environment, will enable better alignment, and activation of movement, and allow for the recruitment of, for example, arm activity in functional situations within various positions. [10]

A study by Lennon et al. [11] concluded that even under idealized conditions (patients with optimal rehabilitation potential, advanced trained therapists, unlimited therapy input, and a movement analysis laboratory) the Bobath approach had no effect on the quality of gait for patients with a stroke.

Institutions

The Neuro-Developmental Treatment Association (NDTA) was founded to carry on the Bobath's work; [12] it offers certification in NDT for managing adults with stroke or brain trauma and for managing and treating children with cerebral palsy and other neuromotor disorders. [13] People who have this certification sometimes are called "neurodevelopmentalists". [14] [15]

Criticism

The concept that Bobath can “evolve” and still be called Bobath has been challenged by the president of the American Academy of Cerebral Palsy and Developmental Medicine and the chair of the UK Association of Chartered Physiotherapists in Neurology (ACPIN). [16] [17] These eminent physiotherapists believe that several of the key original teachings of the founders have now been abandoned, whilst the ideas/concepts of others (non Bobath therapists & scientists) have unjustifiably been given the name of Bobath.

There is a widespread use of the Bobath concept amongst therapists in stroke rehabilitation. Yet, a large review of randomized controlled trials (RCTs) of Bobath for stroke rehabilitation found only three instances of significant differences in favour of Bobath, yet 11 in favour of alternatives. [18] The authors concluded that therapists should base their treatment methods on “evidence-based guidelines, accepted rules of motor learning, and biological mechanisms of functional recovery, rather than therapist preference for any named therapy approach”. This review pointed out that the approach is now regarded as “obsolete” in some European countries and it is therefore no longer taught.

In 2018, a major review of upper limb interventions following stroke found significant positive effects for constraint and task specific-therapies and the supplementary use of biofeedback and electrical stimulation. However, they concluded that the use of Bobath therapy was not supported. [19] Furthermore, a 2020 review of lower limb rehabilitation following stroke [20] concluded that Bobath therapy was inferior to task specific training and that prioritising Bobath therapy over other interventions is not supported by current evidence.

In the UK, an NHS review of stroke rehabilitation by Professor Tyson concluded that "the strength of evidence that task-specific functional training and strength training is effective, while Bobath is not, indicates that a paradigm shift is needed in UK stroke physiotherapy..... it is increasingly difficult to justify the continued use of the Bobath concept or its associated techniques". [21] More recently Professor Tyson and Dr Mepsted have both written comprehensive and critical reviews of Bobath/NDT methods, theory and effectiveness. [22] [23] See also an interesting exchange of letters between the above authors and Bobath tutors. [24]

National evidence-based guidelines for stroke rehabilitation have been published for England, Netherlands, Canada, Australia, and New Zealand; yet in none of these is the Bobath approach recommended. Conversely, in 2016 the American Stroke Association concluded that although the effectiveness of NDT/Bobath (compared with other treatment approaches) had not been established that it still “may be considered” as a treatment option for mobility. This, however, was their lowest classification of acceptable treatment. Their two highest recommendation groups (“should be performed” and “reasonable to perform”) contained a variety of treatments for which there was much better evidence. NDT/Bobath was not listed as an option for arm/hand rehabilitation. [25] Also, in 2016, the revised RCP guidelines for stroke made no mention of Bobath/NDT, whilst many alternatives were recommended. Importantly they stated that if a treatment was not mentioned, then it was not recommended and need not be funded. They also stated that therapists using such methods must objectively review their options in light of the evidence supporting the recommended alternatives. Furthermore, patients receiving such interventions should be informed that it was outside mainstream practice. [26] A highly significant 2021 “position paper” by the Academy of Neurologic Physical Therapy of the American Physical Therapy Association [27] concluded that, despite its lack of an evidence base, NDT/Bobath methods were still favoured by some therapist in the USA. To overcome this problem, they described a range of strategies that will be implemented to encourage best evidence-based practices and de-implement traditional (NDT/Bobath) methods of working at both an individual and organizational level.

The Bobath (NDT) approach is also widely used on children with cerebral palsy (CP). However, when the effectiveness of interventions for the treatment of CP was reviewed by Novak et al. [28] they concluded, “Consequently, there are no circumstances where any of the aims of NDT could not be achieved by a more effective treatment. Thus, on the grounds of wanting to do the best for children with CP, it is hard to rationalize a continued place for traditional NDT within clinical care”. They consequently recommended “ceasing provision of the ever-popular NDT”.

The dichotomy between the popularity and institutional funding of this approach versus the negative findings of most RCTs has been excused on the grounds that RCTs may not be suitable for neurorehabilitation. Yet, the British Bobath Tutors Association website does quote the minority of RCTs that support their approach.

See also

Related Research Articles

Hemiparesis, or unilateral paresis, is weakness of one entire side of the body. Hemiplegia is, in its most severe form, complete paralysis of half of the body. Hemiparesis and hemiplegia can be caused by different medical conditions, including congenital causes, trauma, tumors, or stroke.

<span class="mw-page-title-main">Physical therapy</span> Profession that helps a disabled person function in everyday life

Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, patient education, physical intervention, rehabilitation, disease prevention, and health promotion. Physical therapists are known as physiotherapists in many countries.

<span class="mw-page-title-main">Cerebral palsy</span> Group of movement disorders that appear in early childhood

Cerebral palsy (CP) is a group of movement disorders that appear in early childhood. Signs and symptoms vary among people and over time, but include poor coordination, stiff muscles, weak muscles, and tremors. There may be problems with sensation, vision, hearing, and speaking. Often, babies with cerebral palsy do not roll over, sit, crawl or walk as early as other children of their age. Other symptoms include seizures and problems with thinking or reasoning, each of which occur in about one-third of people with CP. While symptoms may get more noticeable over the first few years of life, underlying problems do not worsen over time.

Spasticity is a feature of altered skeletal muscle performance with a combination of paralysis, increased tendon reflex activity, and hypertonia. It is also colloquially referred to as an unusual "tightness", stiffness, or "pull" of muscles.

Hypotonia is a state of low muscle tone, often involving reduced muscle strength. Hypotonia is not a specific medical disorder, but a potential manifestation of many different diseases and disorders that affect motor nerve control by the brain or muscle strength. Hypotonia is a lack of resistance to passive movement, whereas muscle weakness results in impaired active movement. Central hypotonia originates from the central nervous system, while peripheral hypotonia is related to problems within the spinal cord, peripheral nerves and/or skeletal muscles. Severe hypotonia in infancy is commonly known as floppy baby syndrome. Recognizing hypotonia, even in early infancy, is usually relatively straightforward, but diagnosing the underlying cause can be difficult and often unsuccessful. The long-term effects of hypotonia on a child's development and later life depend primarily on the severity of the muscle weakness and the nature of the cause. Some disorders have a specific treatment but the principal treatment for most hypotonia of idiopathic or neurologic cause is physical therapy and/or occupational therapy for remediation.

The primary goals of stroke management are to reduce brain injury and promote maximum patient recovery. Rapid detection and appropriate emergency medical care are essential for optimizing health outcomes. When available, patients are admitted to an acute stroke unit for treatment. These units specialize in providing medical and surgical care aimed at stabilizing the patient's medical status. Standardized assessments are also performed to aid in the development of an appropriate care plan. Current research suggests that stroke units may be effective in reducing in-hospital fatality rates and the length of hospital stays.

Monoplegia is paralysis of a single limb, usually an arm. Common symptoms associated with monoplegic patients are weakness, numbness, and pain in the affected limb. Monoplegia is a type of paralysis that falls under hemiplegia. While hemiplegia is paralysis of half of the body, monoplegia is localized to a single limb or to a specific region of the body. Monoplegia of the upper limb is sometimes referred to as brachial monoplegia, and that of the lower limb is called crural monoplegia. Monoplegia in the lower extremities is not as common of an occurrence as in the upper extremities. Monoparesis is a similar, but less severe, condition because one limb is very weak, not paralyzed. For more information, see paresis.

Hypertonia is a term sometimes used synonymously with spasticity and rigidity in the literature surrounding damage to the central nervous system, namely upper motor neuron lesions. Impaired ability of damaged motor neurons to regulate descending pathways gives rise to disordered spinal reflexes, increased excitability of muscle spindles, and decreased synaptic inhibition. These consequences result in abnormally increased muscle tone of symptomatic muscles. Some authors suggest that the current definition for spasticity, the velocity-dependent over-activity of the stretch reflex, is not sufficient as it fails to take into account patients exhibiting increased muscle tone in the absence of stretch reflex over-activity. They instead suggest that "reversible hypertonia" is more appropriate and represents a treatable condition that is responsive to various therapy modalities like drug or physical therapy.

<span class="mw-page-title-main">Equine-assisted therapy</span> Physical or mental therapy using horses

Equine-assisted therapy (EAT) encompasses a range of treatments that involve activities with horses and other equines to promote human physical and mental health. The use of EAT has roots in antiquity, and EAT applies to physical health issues in modern form dates to the 1960s. Modern use of horses for mental health treatment dates to the 1990s. Systematic review of studies of EAT as applied to physical health date only to about 2007, and a lack of common terminology and standardization has caused problems with meta-analysis. Due to a lack of high-quality studies assessing the efficacy of equine-assisted therapies for mental health treatment, concerns have been raised that these therapies should not replace or divert resources from other evidence-based mental health therapies.

Neurorehabilitation is a complex medical process which aims to aid recovery from a nervous system injury, and to minimize and/or compensate for any functional alterations resulting from it.

Constraint-induced movement therapy is a form of rehabilitation therapy that improves upper extremity function in stroke and other central nervous system damage patients by increasing the use of their affected upper limb. Due to its high duration of treatment, the therapy has been found to frequently be infeasible when attempts have been made to apply it to clinical situations, and both patients and treating clinicians have reported poor compliance and concerns with patient safety. In the United States, the high duration of the therapy has also made the therapy not able to get reimbursed in most clinical environments.

Aquatic therapy refers to treatments and exercises performed in water for relaxation, fitness, physical rehabilitation, and other therapeutic benefit. Typically a qualified aquatic therapist gives constant attendance to a person receiving treatment in a heated therapy pool. Aquatic therapy techniques include Ai Chi, Aqua Running, Bad Ragaz Ring Method, Burdenko Method, Halliwick, Watsu, and other aquatic bodywork forms. Therapeutic applications include neurological disorders, spine pain, musculoskeletal pain, postoperative orthopedic rehabilitation, pediatric disabilities, and pressure ulcers.

<span class="mw-page-title-main">Management of cerebral palsy</span>

Over time, the approach to cerebral palsy management has shifted away from narrow attempts to fix individual physical problems – such as spasticity in a particular limb – to making such treatments part of a larger goal of maximizing the person's independence and community engagement. Much of childhood therapy is aimed at improving gait and walking. Approximately 60% of people with CP are able to walk independently or with aids at adulthood. However, the evidence base for the effectiveness of intervention programs reflecting the philosophy of independence has not yet caught up: effective interventions for body structures and functions have a strong evidence base, but evidence is lacking for effective interventions targeted toward participation, environment, or personal factors. There is also no good evidence to show that an intervention that is effective at the body-specific level will result in an improvement at the activity level, or vice versa. Although such cross-over benefit might happen, not enough high-quality studies have been done to demonstrate it.

Dyskinetic cerebral palsy (DCP) is a subtype of cerebral palsy (CP) and is characterized by impaired muscle tone regulation, coordination and movement control. Dystonia and choreoathetosis are the two most dominant movement disorders in patients with DCP.

<span class="mw-page-title-main">Athetoid cerebral palsy</span> Type of cerebral palsy associated with basal ganglia damage

Athetoid cerebral palsy, or dyskinetic cerebral palsy, is a type of cerebral palsy primarily associated with damage, like other forms of CP, to the basal ganglia in the form of lesions that occur during brain development due to bilirubin encephalopathy and hypoxic–ischemic brain injury. Unlike spastic or ataxic cerebral palsies, ADCP is characterized by both hypertonia and hypotonia, due to the affected individual's inability to control muscle tone. Clinical diagnosis of ADCP typically occurs within 18 months of birth and is primarily based upon motor function and neuroimaging techniques. While there are no cures for ADCP, some drug therapies as well as speech, occupational therapy, and physical therapy have shown capacity for treating the symptoms.

A gait trainer is a wheeled device that assists a person who is unable to walk independently to learn or relearn to walk safely and efficiently as part of gait training. Gait trainers are intended for children or adults with physical disabilities, to provide the opportunity to improve walking ability. A gait trainer offers both unweighting support and postural alignment to enable gait practice. It functions as a support walker and provides more assistance for balance and weight-bearing, than does a traditional rollator walker, or a walker with platform attachments. It also provides opportunities to stand and to bear weight in a safe, supported position.

<span class="mw-page-title-main">Berta Bobath</span> German physiotherapist

Berta Bobath, MBE was a German physiotherapist who created a method of rehabilitation and therapy known as the Bobath concept in 1948. The Chartered Society of Physiotherapy believe "it is the most popular approach for treating neurologically-impaired patients in the western world."

Video game rehabilitation is a process of using common video game consoles and methodology to target and improve physical and mental weaknesses through therapeutic processes. Video games are becoming an integral part of occupational therapy practice in acute, rehabilitation, and community settings. The design for video games in rehabilitation is focused on a number of fundamental principles, such as reward, goals, challenge, and meaningful play. 'Meaningful play' emerges from the relationship between player action and system outcome, apparent to the player through, visual, physical and aural feedback. Platforms that feature motion control, notably the Nintendo Wii, Microsoft's Xbox Kinect, Sony's Eye Toy, and virtual reality have all been effective in this field of research. Methodologies have been applied to all age groups, from toddlers to the elderly. It has been used in a variety of cases ranging from stroke rehabilitation, cerebral palsy and other neurological impairments, to tendinitis and multiple sclerosis. Researchers have promoted such technology based on the personalization of gaming systems to patients, allowing for further engagement and interaction. Additionally, gaming consoles have the ability to capture real-time data and provide instant feedback to the patients using the systems. Currently, several researchers have performed case studies to demonstrate the benefits of this technology. Repeat trials and experiments have shown that outcomes are easily replicated among various groups worldwide. Additionally, the outcomes have increased interest in the field, growing experiments beyond simple case studies to experiments with a larger participant base.

Pusher syndrome is a condition observed in some people following a stroke which has left them with one side weakened due to hemiparesis. Sufferers exhibit a tendency to actively push away from the unweakened side, thus leading to a loss of postural balance. It can be a result of left or right brain damage. In contrast to most stroke patients, who typically prefer more weight-bearing on their non-hemiparetic side, this abnormal condition can vary in severity and leads to a loss of postural balance. The lesion involved in this syndrome is thought to be in the posterior thalamus on either side, or multiple areas of the right cerebral hemisphere.

<span class="mw-page-title-main">Diane Damiano</span> American biomedical scientist and physical therapist

Diane Louise Damiano is an American biomedical scientist and physical therapist specializing in physical medicine and rehabilitation approaches in children with cerebral palsy. She is chief of the functional and applied biomechanics section at the National Institutes of Health Clinical Center. Damiano has served as president of the Clinical Gait and Movement Analysis Society and the American Academy for Cerebral Palsy and Developmental Medicine.

References

  1. 1 2 3 4 5 Lennon, S; Ashburn, A (October 2000). "The Bobath concept in stroke rehabilitation: a focus group study of the experienced physiotherapists' perspective". Disability and Rehabilitation. 22 (15): 665–674. doi:10.1080/096382800445461. PMID   11087062. S2CID   19478077.
  2. ↑ Knox, Virginia; Evans, Andrew Lloyd (July 2002). "Evaluation of the functional effects of a course of Bobath therapy in children with cerebral palsy: a preliminary study". Developmental Medicine & Child Neurology. 44 (7): 447–460. doi:10.1017/s0012162201002353. PMID   12162382.
  3. ↑ "Theoretical assumptions and clinical practice" (PDF). International Bobath Instructors Training Association. September 2008. Archived from the original on August 18, 2011. Retrieved May 10, 2011.{{cite web}}: CS1 maint: unfit URL (link)
  4. 1 2 O'Sullivan, Susan B; Schmitz, Thomas J (2007). Physical Rehabilitation, Fifth Edition. Philadelphia, PA: F.A. Davis Company. p. 490.
  5. 1 2 3 4 Graham, Julie Vaughan; Eustace, Catherine; Brock, Kim; Swain, Elizabeth; Irwin-Carruthers, Sheena (January 2009). "The Bobath Concept in Contemporary Clinical Practice". Topics in Stroke Rehabilitation. 16 (1): 57–68. doi:10.1310/tsr1601-57. PMID   19443348. S2CID   14241433.
  6. 1 2 3 O'Sullivan, Susan (2007). Physical Rehabilitation . Philadelphia: F.A. Davis. pp.  60, 512, 720. ISBN   978-0-8036-1247-1.
  7. ↑ O'Sullivan, Susan B; Schmitz, Thomas J (2007). Physical Rehabilitation, Fifth Edition. Philadelphia, PA: F.A. Davis Company. p. 512.
  8. ↑ Mayston (2010) Review of “The Bobath Concept: Theory and clinical practice in neurological rehabilitation”. Synapse Spring 2010.[ page needed ]
  9. 1 2 Paci, Matteo (1 January 2003). "Physiotherapy based on the Bobath concept for adults with post-stroke hemiplegia: A review of effectiveness studies". Journal of Rehabilitation Medicine. 35 (1): 2–7. doi: 10.1080/16501970306106 . PMID   12610841.
  10. ↑ Platz, T; Eickhof, C; van Kaick, S; Engel, U; Pinkowski, C; Kalok, S; Pause, M (November 2005). "Impairment-oriented training or Bobath therapy for severe arm paresis after stroke: a single-blind, multicentre randomized controlled trial". Clinical Rehabilitation. 19 (7): 714–724. CiteSeerX   10.1.1.1023.3059 . doi:10.1191/0269215505cr904oa. PMID   16250190. S2CID   36998550.
  11. ↑ Lennon, Sheila; Ashburn, Ann; Baxter, David (January 2006). "Gait outcome following outpatient physiotherapy based on the Bobath concept in people post stroke". Disability and Rehabilitation. 28 (13–14): 873–881. doi:10.1080/09638280500535132. PMID   16777775. S2CID   30776966.
  12. ↑ Howle, Janet M (2006). "Bobath, Berta and Karel". In Albrecht, Gary L. (ed.). Encyclopedia of disability. Thousand Oaks, Calif.: Sage Publications. pp. 193–194. ISBN   9781452265209.
  13. ↑ "Certificate Courses". Neuro-Developmental Treatment Association. Archived from the original on 10 January 2017. Retrieved 10 January 2017.
  14. ↑ "Robot Helps Children with Disabilities". VOA. December 11, 2009.
  15. ↑ Pierson, Susan H. (2002). "4. Physical and Occupational Approaches". In Gelber, David A.; Jeffery, Douglas R. (eds.). Clinical Evaluation and Management of Spasticity . Totowa, NJ: Humana Press. p.  52. ISBN   978-1-59259-092-6.
  16. ↑ Damiano, Diane (October 2007). "Pass the torch, please!". Developmental Medicine & Child Neurology. 49 (10): 723. doi:10.1111/j.1469-8749.2007.00723.x. PMID   17880637. S2CID   41659576.
  17. ↑ Mayston, Margaret (September 2006). "Letter to the editor". Physiotherapy Research International. 11 (3): 183–186. doi:10.1002/pri.343. PMID   17019949.
  18. ↑ Kollen, Boudewijn J.; Lennon, Sheila; Lyons, Bernadette; Wheatley-Smith, Laura; Scheper, Mark; Buurke, Jaap H.; Halfens, Jos; Geurts, Alexander C.H.; Kwakkel, Gert (April 2009). "The Effectiveness of the Bobath Concept in Stroke Rehabilitation: What is the Evidence?". Stroke. 40 (4): e89-97. doi: 10.1161/STROKEAHA.108.533828 . PMID   19182079.
  19. ↑ Wattchow, Kimberley A.; McDonnell, Michelle N.; Hillier, Susan L. (February 2018). "Rehabilitation Interventions for Upper Limb Function in the First Four Weeks Following Stroke: A Systematic Review and Meta-Analysis of the Evidence". Archives of Physical Medicine and Rehabilitation. 99 (2): 367–382. doi:10.1016/j.apmr.2017.06.014. PMID   28734936.
  20. ↑ Scrivener, Katharine; Dorsch, Simone; McCluskey, Annie; Schurr, Karl; Graham, Petra L; Cao, Zheng; Shepherd, Roberta; Tyson, Sarah (1 October 2020). "Bobath therapy is inferior to task-specific training and not superior to other interventions in improving lower limb activities after stroke: a systematic review". Journal of Physiotherapy. 66 (4): 225–235. doi: 10.1016/j.jphys.2020.09.008 . PMID   33069609. S2CID   224783899.
  21. ↑ Tyson, S. (2009) 2009 Annual Evidence Update on Stroke rehabilitation – Mobility, NHS Evidence. Available at :-http://arms.evidence.nhs.uk/resources/hub/37914/attachment or http://usir.salford.ac.uk/2740/.
  22. ↑ Tyson (2015) When evidence based practice meets neurological physiotherapy, available at https://sarahtphysioblog.wordpress.com/%5B%5D%5B%5D
  23. ↑ Mepsted R 2018 Bobath physiotherapy. Evidence based or habit based? https://www.slideshare.net/MepstedRoger/bobath-physiotherapy-evidence-based-or-habit-based?qid=a70137d6-d8d1-4b36-be37-1957bf301af5&v=&b=&from_search=7%5B%5D
  24. ↑ Mepsted, Roger; Tyson, Sarah (October 2017). "The Bobath concept. A guru-led set of teachings unsupported by emerging evidence". Journal of Evaluation in Clinical Practice. 23 (5): 1127–1128. doi:10.1111/jep.12791. PMID   28726254.
  25. ↑ Winstein, Carolee J.; Stein, Joel; Arena, Ross; Bates, Barbara; Cherney, Leora R.; Cramer, Steven C.; Deruyter, Frank; Eng, Janice J.; Fisher, Beth; Harvey, Richard L.; Lang, Catherine E.; MacKay-Lyons, Marilyn; Ottenbacher, Kenneth J.; Pugh, Sue; Reeves, Mathew J.; Richards, Lorie G.; Stiers, William; Zorowitz, Richard D. (June 2016). "Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association". Stroke. 47 (6): e98–e169. doi: 10.1161/STR.0000000000000098 . PMID   27145936. S2CID   4967333.
  26. ↑ RCP 2016, “National Clinical Guideline for Stroke” Section 1.8
  27. ↑ Scheets, Patricia L.; Hornby, T. George; Perry, Susan B.; Sparto, Patrick; Riley, Nora; Romney, Wendy; Fell, Dennis; Kugler, Katherine; Nordahl, Timothy (January 2021). "Moving Forward". Journal of Neurologic Physical Therapy. 45 (1): 46–49. doi: 10.1097/NPT.0000000000000337 . PMID   33315836. S2CID   229176139.
  28. ↑ Novak, Iona; Mcintyre, Sarah; Morgan, Catherine; Campbell, Lanie; Dark, Leigha; Morton, Natalie; Stumbles, Elise; Wilson, Salli-Ann; Goldsmith, Shona (October 2013). "A systematic review of interventions for children with cerebral palsy: state of the evidence". Developmental Medicine & Child Neurology. 55 (10): 885–910. doi: 10.1111/dmcn.12246 . PMID   23962350. S2CID   1658072.
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