Parents with children with congenital malformations put all their energy and give all the time to overcome the problems faced by the family. Even without hope of a complete deliverance of the descendant from defects, they strive to make his life easier and give him a chance at least for partial rehabilitation. For many children, Bobat therapy provides an opportunity to begin to lead a more or less full life. However, in order for them to take this chance, parents should at least find out what it is.
Origin history
Bobat therapy was named (and became known by it) by the name of its developers, a London couple - physiotherapist Berthe Bobat and her husband, neurophysiologist Karl Bobat. In the 40s of the last century, in a number of works, Berta proposed a radically new, unexpected approach to the issue of recovery of patients, whose disease is accompanied by spastic muscle lesions. It was based on many years of observation and the personal experience of a physiotherapist. The main idea was the interaction of the psyche with the body, as a result of which the body as a whole was treated not as a separate organ. The pursued goal is the development of controlled, appropriate and conscious movements with a parallel decrease in muscle cramps and tension.
The invaluable practical experience was later systematized, summarized and substantiated from a theoretical point of view by the spouse of Berta. The high efficiency of the methodology contributed to its rapid and wide distribution throughout the world. In medical circles, Bobat therapy is known as neurodynamic rehabilitation.
Scope of the technique
The most widely and successfully used bobat therapy in cerebral palsy, and of any severity, both with affecting higher nervous activity, and only with impaired motor functions. However, it is effective in other diseases. These include:
- Various kinds of defects that occurred during the development of the spinal canal.
- Scoliosis of varying severity.
- Motor development disorders: spasticity, coordination problems, hyperkinesis, impaired motor control.
- Hip dislocations congenital and acquired at an early age.
- The consequences of injuries (in particular postpartum), operations or diseases that led to the child losing control of the body. These include strokes and side effects of brain inflammation.
Of course, Bobath therapy cannot always help; the results, however, it gives much more successful than many methods preceding it.
Who should not use Bobat therapy
There are few restrictions on the use of neurodynamic recovery, but they are.
- Bobath therapy for the treatment of schizophrenics is strictly prohibited.
- It can be used very carefully with epilepsy. In a light or latent form of flow, constant monitoring and a softer style of occupation are required; in severe - bobath therapy should be excluded from the list of acceptable therapeutic measures.
- Convulsive readiness in expressed form: certain actions of the method can provoke convulsions.
It is also recommended to suspend classes if chronic diseases are in the acute stage.
Directions of exposure
All actions of Bobath therapy are focused on achieving one of three goals.
- Prohibitory Retention. In this case, the therapist (or parents) inhibit the convulsive, pathological, involuntary movements of the child. This stage is called inhibition.
- Guiding movements. They are preceded by a variety of stretch marks, designed to relieve tonus muscle tension and remove its fixation (physical memory of the body). Further, the therapist moves the individual limbs of the child in the right, right rhythm and direction. The body must remember the correct movement in order to automatically use it in the future in a similar situation. This stage is called phacilitation.
- Stimulating the child to achieve the desired result. Usually, all classes include familiar and beloved by the child games or service items that eventually become self-service.
All activities should be carried out in a team, with the participation of not only a therapist and a child, but also with the involvement of parents, who will eventually replace a doctor-instructor, and under the supervision of a number of narrow specialists - from an ENT specialist and a speech therapist to a neurologist with an orthopedist. In this case, treatment primarily focuses on the adaptation of the baby to normal life.
Basics of Bobath Therapy
First of all, neurodynamic rehabilitation should not follow any exact schemes and dogmatic approaches. For each patient, Bobat therapy forms an individual approach. The methodology is based on motion treatment, called kinesitherapy. The specialist controls the movements of the child, while simultaneously controlling his reactions at three levels: head - shoulder girdle - pelvic girdle. When one of these zones is passively moved (by the therapist’s hands), rectification, equilibrium or the so-called labyrinth reactions are activated. With normal development, these reflexes are laid and fixed between the first six and eight months of life, and the simplest ones begin at all from one month. Bobath therapy helps the child to master all positions that are natural, without pathological, irregular movements. The constant repetition of postures - lying, standing on all fours, sitting or squatting - strengthens the correct movement and simplifies the stabilization of the vertical position.
Over time, the correct positions begin to prevail, displacing pathological ones and moving to the level of unconditioned reflexes.
Initiation of therapy
You can embark on a course of neurodynamic rehabilitation at any age, from infants to adulthood. But, like any other treatment, the sooner you start, the more successful Bobat therapy will be. Reviews say that many movements by the age of three are so strongly prescribed on the baby's cortex that it becomes very difficult to rid him of pathologies and convulsive stresses.
At the first visit, the therapist must determine with what movements the baby has the greatest difficulties, which are easier for him and require only adjustment. A set of stretch marks, exercises and positions that need to be given maximum attention will depend on this.
It is equally important for the therapist to be able to determine how persistent the parents will be in therapy, and to be able to teach them the initial necessary minimum. Each Bobat specialist should have good pedagogical qualities and a good understanding of psychology.
Basic movements
We have already mentioned the individual approach on which Bobat therapy is based. Exercises are developed based on the level of development of the child and the degree of damage to his body. However, we list the most commonly used movements below.
- Extension of the limbs and neck in a supine position.
- In the supine position with bent arms (all joints are involved) - raising the head, extending the arms forward with their preliminary shaking and shaking. A roller is placed under the chest.
- Roll-up stimulation: segmental rotation of the legs, pelvis and trunk as a whole.
- Crawling on all fours: moving arms and legs in the correct sequence, without any unnecessary intermediate movements, with correction of the arms setting and control of the firmness of the emphasis.
- Developing a proper fit: a roller between the hips, holding the child by the hands, observing the correct fit and placement (without flipping over on the side).
- Working out the transition from a sitting position (on the couch) to a standing position.
Over time, more complex exercises are introduced, aimed at strengthening vertical resistance and proper movement when walking. The latter is a rather complex physiological complex of movements, so constant monitoring of the fidelity of the position of all components of the body, from legs to head, is required.
Positive Results and Benefits
Despite the painstakingness and duration that Bobat therapy requires, it is enthusiastically used throughout the world, as it has a number of undeniable advantages.
- Stability achieved. All motor skills acquired during therapy are irreversible and are built directly into the patient’s personality.
- Safety of the technique: the risks of injury or infection are excluded.
- The absence of any drug load on the body.
- The absence of any side effects.
An additional advantage can be considered the game form in which the therapy is conducted: the child willingly takes part in it, not perceiving it as a treatment.
Bobat therapy and cerebral palsy: reviews of mothers
Neurodynamic rehabilitation, according to parents, cannot be called a course of treatment. Rather, it becomes a way of life - daily and year-round. She needs to be given attention constantly, and the more, the better. However, most mothers and fathers are very willing to do this, since the first results become noticeable after a month or two of regular classes. Moreover, these results are so impressive that the enthusiasm of parents increases significantly.
If you are interested in Bobath therapy, a book entitled “Bobath Concept”, compiled by experienced specialists in this field, Sue Rain, Lensi Meadows and Mary Lynch-Ellerington, published in 2013 in Russian, can give you a detailed idea of the fundamental principles and treatment approaches. However, experts say it’s unlikely to master it independently: basic skills and deep understanding can be mastered only by observing the actions of a professional therapist and listening to his recommendations. However, when Bobath therapy is involved, teaching parents how to use it is part of the therapist's task.