Introduction to the Bobath Concept of Normal Human Movement

1. Introduction to the Bobath Concept of Normal Human Movement Presented By: Marianne Lawton, B.Sc.PT. NDT/Bobath Instructor, IBITA

2. Practical Sessions • Facilitation of Gait and Scapula • Using Household Items for therapy • Functional Exercises in Therapy

3. What is Movement? “Movement can be defined as the result of a flexible system, continuously interacting with the environment, a system where motor sensory and cognitive processes interact to find the most optimal solutions to problems.” Mulder, Th. Hochstenback J. Motor Control and Learning Implications for Neurological Rehabilitation 1998

4. How is Movement Created?

6. Normal Movement Implies • Variability • Not Static • Individual to each person • Works in conjunction with Postural Support • Based on Exposure to various situations (development of one’s phenotype)

7. Central Postural Control Mechanism • Based on Phenotypical Expression • Comprised of muscle tone, reciprocal innervation, patterns of movement and their sense of sensory and proprioceptive controls that influence their behaviour. (BBTA 1997) • Allows us to move up and down against gravity, have good head control and free up all four limbs for function and communication

8. Central Postural Control Mechanism

9. Tone • Tone is an adaptable muscle activity responsive to a variety of controls.

10. Normal Postural Tone • The state of readiness of the body in preparation for the maintenance of posture or the performance of a movement. Bernstein 1967

11. Normal Postural Tone • Enables individual to: • maintain an upright posture within force of gravity • adapt to a varying and often changing BOS • acquire selective movements to attain functional goals. Postural tone is adaptable and varies throughout different parts of the body in response to desired goals. (Edwards 1996)

12. Reciprocal Innervation Agonists/ Antagonists and Synergists are pitted against each other in a finely graded way to allow interplay of muscle groups for fixation with mobility and optimal mechanical conditions for muscle power. Bobath 1990

13. Reciprocal Innervation • Occurs at all levels of organization • Is variable to allow for an infinite variety of movements. Many things can interfere with Reciprocal Innervation, including spasticity, rigidity, ataxia, spasm and over use of a body part (form function).

14. Patterns of Movement • Are sequences of selective movement in an appropriate alignment for the achievement of a goal. • The brain knows nothing of the muscles only of the patterns of movement experienced in gaining motor goals. (BBTA 1997)

15. Sensory and Proprioceptive Control • Is the ability to selectively receive, integrate and respond to the environment through adaptivity of the individual’s motor behavior to achieve a successful outcome. (BBTA 1997)

16. Proprioceptive Controls RANGECOMPRESSION DISTRACTION STRETCH c ROTATION TIMING,SPEED,RANGE BOS v GRAVITY AUTOMATIC/VOLITIONAL KEY POINT ALIGNMENT MOTIVATION, GOAL VOICE VISION

17. Postural Control vs Balance • Postural control works in conjunction with movement to create balance

19. Balance Reactions • Automatic responses to the displacement of the body’s centre of gravity over a base of support. They consist of gross movements of the limbs trunk and/or head and barely perceptible changes in postural tone.

20. Gravity • It is a constant downward force with which man must develop the ability to interact in order to move selectively. • Balance and selective control of movement is developed through exposure to gravity.

21. Base of Support • The supporting surface of the body parts are in contact with if they and the rest of the body are interacting appropriately with it. • Reference point within the posture and between postures.

22. Righting Reactions Sequences of selective movements in pattern in response to displacement. Functionally, Righting Reactions allow the loss and regaining of midline through: • trunk righting • head righting • stepping/hopping reactions • protective reactions Components of righting reactions can be performed voluntarily. (Edwards 1996)

23. Equilibrium Reactions • Automatic adaptations of postural tone in response to gravity and displacement. Functionally they maintain a postural alignment. • They cannot be performed voluntarily. BBTA 1997

24. In Normal activity, righting and equilibrium reactions work together to allow both feed back adjustments in movement and feed forward elements to minimize the postural disruption that would be associated with movement.

25. Therapeutic Handling • The individual is encouraged guided and facilitated to move in order to regain postural control and selective movement and learn functional motor skills.

26. Assessment for Positioning • Is the body surface in contact with BOS • How does the posture relate to midline • Are the patterns of the limbs appropriate • Does the patient look and feel comfortable. • Can the patient function

27. Assess and Treat • Assess posture and balance • Assess muscle tone, strength and selective movement • Increase exercise tolerance

28. Thank you Marianne Lawton 905 469 2935 mlawtonphysio@outlook.ca