Re: [xmca] Bobath method

If it's helpful, I can clarify a bit about the Bobaths (Berta and Karel), their work, and how it impacts physical, occupational and speech therapy practices today around the world, and if it relates to Vygotsky.

The quick and dirty history is that Berta, a dancer, noticed that children with cerebral palsy exhibited stereotypical patterned movements and talked about this with her husband Karel, a doctor. Based on the idea that these movements and patterns of high muscle tone and spasticity were due to primitive basic reflexes the damaged brain was unable to override, they devised an approach to inhibit these reflexes, thus allowing more natural movement.

This became known as the neurodevelopmental treatment approach (NDT), which is what most therapists around the world today call this method. For quite a while the Bobaths' name was dropped altogether and not mentioned in conjunction with NDT other than as an historical footnote. Recently, however, there has been a split in the US training and practice of NDT, with another group developing procedures with a slightly different grounding, but still referring to the method by the acronym NDT. So, to clarify which NDT they mean, some therapists in the US have recently begun referring to traditional NDT as the Bobath approach.

This approach is most often used today with individuals with hemiplegic stroke and children with cerebral palsy. What Andy noticed, the tactile cueing for voluntary movement, can only take place after "inappropriate" reflexes and postures are inhibited. The inhibiting takes place through careful hand placement at various points on the body (not necessary right at the area where the focus of treatment is taking place) and tactile cueing. It may or may not be apparent to the lay observer. The idea is not that you make the patient's limb move in a particular direction but that through careful posture adjustment and touch, one suppresses the reflex and enables the possibility of voluntary movement, and helps to develop motor memory of that posture and the voluntary movement.

I am not NDT certified (nor are most therapists), but like most therapists around the world, I did learn about the general principles and approaches used in this method and a number of others as part of my basic training as an occupational therapist. So, while Mike's therapists may not refer to the Bobath's by name, they certainly learned at least some of the basics of the NDT approach in their schooling. Though it is one of the most accepted rehab approaches, there has not yet been enough outcomes research to establish NDT as a more effective method than any other approach, by the way.

As for the Vygotsky question, I am sure that the Bobath's would have been aware of his work but I do not recall any mention of a direct influence in the history and literature on the method that I have read.

Finally, a topic I can contribute on :-)

Cristine Carrier PhD(C), OTR/L
Department of Occupational Science and Occupational Therapy
University of Southern California

----- Original Message -----
From: Mike Cole <lchcmike@gmail.com>
Date: Tuesday, July 31, 2007 4:54 pm
Subject: Re: [xmca] Bobath method
To: "eXtended Mind, Culture, Activity" <xmca@weber.ucsd.edu>

> Andy-- I am in Brasilia where people do not use the term bobath
> and only some have heard of Vygotsky, but they adopt the same
> philosophy-in-practice. (Gimple was no fool, as David ke has
> eloquentlyreminded us).
>
> I hope to write about this in more detail but one brief (perhaps too
> brief) example. I am at a rehabilitation center for (mostly) children
> who exhibit some form of cerebral palsey ( a very hazy concept),
> or have experienced traumatic brain injury (not so hazy, but always
> ambiguous in detail). It is amazing for implementing at an
> institutionallevel what I would consider a zone of proximal
> development (being a relative
> of Gimple~s and not nearly so wise).
>
> Among the many fascinating features of this place is a pathway in
> the middle of an amazing rehabilitation center. Gorgeously
> organized down to
> the tiniest detail. But the pathway is not smooth. About every 3-4
> meters it
> changes its texture with small ruts or cobblestones. Why? Because
> once a
> patient has learned to move along a smooth surface (with whatever
> prostheticdevices and what ever bobathian assistance) in the
> future are the regular
> sidewalks and streets of Brasilia. And, not unlike the sidewalks
> of San
> Diego or London or....... they are uneven and one must make constant
> adjustments to their texture and uneveness,even if one is still
> temporarily unimpaired.
>
> The sidewalk, thought of by a wizardess who works at this center,
> is an
> ^"actant" organizing to help people in the present to confront
> their likely
> if not inevitable future so that when that future crashes down on
> them they
> are not crushed by its weight.
>
> Bom Nioche, or G'day, whatever it is where you are
> mike
>
>
> On 7/31/07, Andy Blunden <ablunden@mira.net> wrote:
> >
> > I have spent a lot of time recently watching my partner Vonney
> receiving> physiotherapy treatment following her stroke.
> >
> > I noticed that the physios used a Vygotskyist approach, in this
> respect.> If
> > for example, if Vonney was doing facilitated walking, and her
> left hip was
> > lazily trailing and needed to be activated and moved forward,
> instead of
> > pushing it forward from the back, which would be the common
> sense thing to
> > do, they would lightly touch her on the front. In my
> interpretation, this
> > touch creates a "psychological tool" in drawing Vonney's
> attention to the
> > part of her body which needs to be activated and she naturally
> responds in
> > that way and reacts against the light push.
> >
> > Yesterday I Googled the name of the method the physios used,
> "Bobath", and
> > found in the opening paragraph of the definition of this method the
> > following:
> >
> >
> > " the client's potential, which was
> considered to be
> > that task or those
> > activities which could be performed by the
> person with
> > a little help,
> > and therefore possible for that person to
> achieve> independently where possible. "
> >
> > This is a straightforward definition of out beloved ZPD.
> >
> > Is this a case of "great minds think alike" or is there an
> historical> connection between CHAT and Bobath?
> >
> > Andy
> >
> > _______________________________________________
> > xmca mailing list
> > xmca@weber.ucsd.edu
> > http://dss.ucsd.edu/mailman/listinfo/xmca
> >
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Received on Tue Jul 31 18:06 PDT 2007