: Experiencias con el concepto Bobath / Experiences with the Bobath concept: Fundamentos, tratamientos y casos / Fundamentals, Treatment. Experiencias con el Concepto Bobath, fundamentos, tratamientos y casos DE LA REHABILITACIÓN NEUROLÓGICA SEGÚN EL CONCEPTO BOBATH. Pelissier JY. Burtner. D. Navarro historical perspective. Experiencias con el concepto Bobath: fundamentos. Mottet D. Mayston M () An overview of the.

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You imply that the Novak paper is just one piece of research and that it can fundamenyos be a balancing by another contradictory piece of research. This is not the case, the Novak paper is a review of ALL the high quality evidence for and against Bobath ; it therefore represents best evidence. As therapists we do not have time to read and study all the individual research publications, but we conceppto study the major reviews that summarise all the best current fundzmentos.

We cannot be selective in which evidence we chose to use and which we bobaty to ignore. When robust evidence such as the Novak review comes along we need to sit up, listen and modify practice.

How long must we wait for high quality evidence supporting Bobath? As HCPC registered physiotherapists we are duty bound to offer the best evidence based treatment to our patients. I do wonder where one stands on the matter of professional registration for those who refuse to set aside their Bobath treatment strategies in the knowledge that better evidenced practise exists elsewhere.

For those therapists unwilling to part with Bobath, is it time for them to part company with Physiotherapy? Picking up on the notion of levels of evidence. I, of course, was agog to find out more about this new evidence that should not be underestimated, so I had a good look at the case studies on the website.

There are dle, and they were submitted as the assignment for a Basic Bobath Course and were uploaded between and Their number and the beneficial impact they appear to demonstrate does not overcome the poor quality evidence they provide. The good news is that all the reports should positive results — Yes, every single one and dell literally incredibly positive results.

So it works, right? Having a blinded assessor who is unaware of and has no vested interest in the treatment received would reduce this. The reporting is selective. How many of them reported less spectacular results?

For any treatment to be useful the effects need to be sustained. The sample of patients involved is highly fumdamentos — most are young, do not have serious co-morbidities, were previously fit and well, are positive and motivated and have motor-sensory impairments only.

So there is a lot of cherry picking fundamenhos on. Most of the assignments have attempted to use objective measurement tools to demonstrate effect but many are not used effectively.

They are just one-off measures. The strength of their argument could be increased if multiple measurements had been taken and mean values presented one or two folk tried this. Or they could use a single case design and take fundamenros measurements over time before, during and after the intervention. If the treatment is effective then it should show an improvement clearly above the variability of baseline that is sustained once treatment has finished. There is nothing that indicates any changes observed were down to the Bobath treatment received as there no control.

They are designed to ensure the participants are representative of the clinical case load and have broad and inclusive recruitment strategies a so called pragmatic trial — so they include the complex, diverse population of potential patients. They have also included a sample size calculation which works out how many participants is needed to show fundamentox effect if one exists, so the trials is done on just enough participants— not too many and not too few.

So that is why one should fundamebtos note of the good quality, unbiased trials when it exists — rather than the low quality evidence. The only time one can justify relying on such low quality evidence is when nothing stronger exists, which is not the case in this situation.


Eel is a fair body of lower level research which does reflect positive outcomes for Dl. They recognise that level 1 RCTs are not the only way forward. With respect, this suggests a misunderstanding of fundamenros levels of evidence. The whole idea of a systematic review is that one excludes low levels of evidence, because they are inherently open to scientific bias and therefore the conclusions drawn from that deo cannot be relied on.

Evidence-based practice is a matter of taking funeamentos objective view of the quality of the evidence available, selecting the strongest ie with the least risk of bias and summarising that. It is not a matter of cherry-picking and promoting the type that of evidence that give one the answers one wants. Randomised controlled trials of interventions for people ufndamentos cerebral palsy as with other complex, multi-faceted long-term conditions are entirely fkndamentos, as demonstrated by Novak in her review, and many other reviews and reports of good trials.

The discussion on icsp fundamfntos off in February Yes really! GRADE is a well-respected method to pragmatically overview the state of evidence on a topic so that clinical practice can be informed.

It demonstrates that task specific strength training, exercise, orthoses, casting, aquatic therapy, biofeedback, CIMT, treadmill and Botox are effective and should be used. And that Bobath along with cranio-sacral therapy and some others is not effective and should not be used. They called for more research and particularly research into alternatives to NDT.

This is very much my point, we have come since when there was insufficient evidence to categorically recommend or disprove the efficacy of particular treatments; there has been much more research. In general this recommended list is similar regardless of who writes it …. More recently the level of evidence has increased and reviewers now bobaty that they can state that Bobath is ineffective.

Novaks conclusions are an extension of this, they may be disputed but they are part of a similar trend in stroke rehabilitation research. As a fundamenros we could go on for ever swapping references and arguing the toss. But the inconvenient truth is that there is now a strong body of evidence that some specific interventions such as Botox, exercise, intensive practice of functional tasks are effective for neurological rehabilitation in adults and children, while there is a growing body of evidence that Bobath is not.

Now then, [the easily shocked and indignant may want to get some smelling salts at this point] — muscles are muscles. A muscle contracts when there is sufficient drive from the fundamenhos neurones to exceed the contraction threshold, and whether that contraction produces movement depends on whether sufficient force is produced by the contraction to overcome any forces acting against it like gravity or resistance.

What one actually needs to assess is how strong the muscle is ie how much force it produces. This is done nobath and simply using the MRC Oxford scale. It takes 5 minutes, max. I am confident that I get good early conccepto and that I work evidence based. However, I have since realised that providing this walking practice is not as easy as I make it look. Several of my colleagues have had a go with the same bobwth as they ffundamentos the principles and in theory it sounds straight forward.

What would they do with a patient instead? Maybe walking practice with assistance of more than 1 person? How to treat walking without a treadmill or gait-trainer? But what do the patients do once you let go of them? Then they would be able to walk, even if they have to make do with your less skilled colleagues. If using EBP, one would then get the patient practising walking a lot plus other mobility tasks such as STS, transfers, balance activities, bed mobility.

All the time the task and environment need to be manipulated to enable safe function, build motor skill, strength, endurance, efficiency, and confidence but not fretting about quality of movement.


They also need to exercise and the choice of exercise depends on the strength, which you know from the results of the Motricity Index to build up their strength, endurance, range. The skill of the therapist lies in being able to tailor the practice conditions by manipulating task and environment to promote motor learning and enable safe function. No magic handling skills required beyond what, I would hope, students learn while training and 1 st qualified.

Obviously one gets better at it with time and experience but the advanced skill is in the brain, not the hands. Jose Lopez has kindly offered to translated these blogs in to Boath so that it can be conceptp by a wider audience. Here is the 1st one. He intentado hacer esto tan abierto y manejable como he podido.

Siempre se puede volver al hilo original de la icsp para compararlo. In the last blog I promised more on the professionalism thing, so here it is. But some sort of moniker is needed so other readers can distinguish between all the different Anonymouses or should that be Anonymi.

Ho um, each to their own, I bobafh. Anyway up, conccepto to the professionalism thing. It now nearly 25 years since Bobath fans accused me of being unprofessional.

I had published the results of my MSc which provided objective evidence contradicting the Bobath dogma of the concepgo that walking aids are Bad and should not be used. Folk were so incensed by this shocking impertinence that a petition was started calling for the CSP should discipline me for bringing the profession in to disrepute. I was later made a fellow of the Chartered Society for my contribution to the fundamenfos and advancing neurological physiotherapy, so not that unprofessional then, eh?

Tag: Bobath

Now, as on previous occasions, I have asked folk to explain what they find unprofessional, I am would fundaemntos quite happy to apologise and retract whatever is unprofessional, if my actions can be shown to be so. As fundaments have noted before in these discussions, it probably human nature to hit out at those who do not support what an individual holds dear and it is challenging to acknowledge that practise is no longer fit for purpose and needs to change, especially when one has invested and gained much from the old practice.

But that is what professional practise is all about. Levels of evidence Picking up on the notion of levels of evidence.

Método Bobath by Carolina Calderón Suárez on Prezi

Reporting bias The reporting is bobatth. Selection bias The sample of patients involved is highly selective — most are young, do not have serious co-morbidities, were previously fit and well, are positive and motivated and have motor-sensory impairments only. Ineffective use of outcome measures Most of the assignments have attempted to use objective measurement tools to demonstrate effect but many are not used effectively. If the treatment is effective then it should show an improvement clearly above the variability of baseline that is sustained once treatment has finished Lack of control There is nothing that indicates any changes observed were down conceto the Bobath treatment received as there no control.

When should bobayh change practice? Part 1 Change over time The discussion on icsp kicked off in February Yes really! Ho um, each to their own, I guess Anyway up, back to the professionalism thing. When EBP meets neurological physiotherapy …. Create a free website or blog at WordPress.

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