Nová definice Bobath konceptu 2021

Evropská asociace Bobath terapeutů (EBTA) uveřejnila v červenci 2021 novou definici Bobath konceptu. Zde je originální anglická verze. Překlad do češtiny připravujeme.

Definition of the Bobath Concept
The Bobath Concept* is a clinical reasoning framework for intervention and management strategies for any individual with cerebral palsy or other neurodevelopmental conditions across the lifespan.
It consists of dialogue with individuals and families, observation, critical analysis and interpretation of the individual’s current participation, activity, body function and structure together with understanding of the potential impact of these on future functional abilities.

It is underpinned by an in-depth understanding of current scientific principles that govern child development, motor control (including the influence of muscle tone and patterns of co-ordination that underlie optimal task performance) motor learning, neuroplasticity and neuropathological processes, thereby promoting clinical reasoning that addresses both neurological and developmental perspectives.
Intervention and management strategies include training of activity related tasks that are meaningful to the child and family, and modification of the environment, including therapeutic handling. Strategies are individualised and specifically selected to optimise self-initiated activity. 
This definition continues to be representative of the work conceptualised by the Bobaths in the 1950s, reiterated in 2008 (Mayston M) and continues to provide the opportunity for the sharing of in-depth clinical reasoning skills across disciplines (e.g., PT, OT, & SLT), enabling transdisciplinary intervention in the achievement of meaningful participation goals.
*The Bobath Concept is also used with individuals who have neurological conditions acquired in adulthood.
 
Explanation of terms
Concept - an approach (a way of thinking) which guides clinical reasoning and intervention, rather than a therapy intervention or prescriptive regime.
 
Cerebral palsy – ‘a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing foetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, and behaviour; by epilepsy, and by secondary musculoskeletal problems.’ (Rosenbaum et al. 2007).
 
Neurodevelopmental Conditions
Neurodevelopmental conditions are a group of conditions in which the development of the central nervous system is disturbed. This can include developmental brain dysfunction, which can manifest as impaired motor function, learning ability, self-control, emotion, memory, language or non-verbal communication neuropsychiatric problems. “
Rutter, Michael; Cooper, Miriam; Thapar, Anita (2017-04-01). "Neurodevelopmental disorders". The Lancet Psychiatry. 4 (4): 339–346
 
Muscle tone – "Amount of background activity and tension in a muscle. The mechanical and elastic characteristics of muscle and the degree of motor unit activity contribute to muscle tone.” (Haley & Inacio, 1990).
 
"Resting skeletal muscle tone = intrinsic visco-elastic tension and is CNS independent; CNS actions generate far greater tensions” (Masi & Hanon, 2008).


Thus, both a neural component: relating to the central nervous system (brain and spinal cord) and/or peripheral nervous system (nerves);
And a non-neural component: related to changes in the physical properties of muscles and other soft tissues (resulting in either limited or excessive soft tissue extensibility).
 
 
Patterns of co-ordination – describe the relationship of joints during a motor task, according to the dynamic combination of flexion, extension and rotation throughout the body. Patterns of co-ordination underlie functional tasks. During infancy and through-out life, skills are learnt, mastered and refined in relatively predictable ways. Patterns of co-ordination learnt in one context influence and enable performance in others. Continuously increasing complexity of coordination enables a greater variety of functional activities. Altered tone impacts patterns of co-ordination by reducing complexity and variety which affect an individual’s refinement of postural control and may affect growth, activity and participation.
 
Motor control - the integration of sensory, motor, perceptive and cognitive systems for the performance of motor skills.
Motor control is defined as the ability to regulate or direct the mechanism essential to movement that is produced by the central nervous system (CNS) that purposeful, coordinated movements in its interaction with the rest of the body and with the environment “
Shumway-Cook, A., & Woollacott, M. H. (2007). Motor control: translating research into clinical practice. Lippincott Williams & Wilkins.
Latash, M. L., Levin, M. F., Scholz, J. P., & Schöner, G. (2010). Motor control theories and their applications. Medicina, 46(6), 382.
 
Postural control - is a complex motor skill based on the interaction of dynamic sensor-motor and cognitive processes to control body position for orientation and stabilization in space and is the ability to maintain the centre of body mass within the limits of stability and to organize the continuity of balance and includes resistance to gravitational forces and mechanical support throughout movement.
Shumway-Cook, A., & Woollacott, M. H. (2007). Motor control: translating research into clinical practice. Lippincott Williams & Wilkins.
Horak, F. B. (2006). Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age and ageing, 35(suppl_2), ii7-ii11.
 
Neuropathological processes – the impact of an impaired central nervous system on body, structure and function over the life course. This may include muscle structure and function, skeletal changes, hyper/hypo tonicity, pain, fatigue, cardiovascular, digestive and respiratory factors.
 
Transdisciplinary intervention - refers to: “the sharing of roles across disciplinary boundaries so that communication, interaction, and cooperation are maximized among team members.”
King, G Strachan, D., Tucker, M., Duwyn, B., Desserud, S., & Shillington, M. (2009). The application of a transdisciplinary model for early intervention services. Infants & Young Children, 22(3), 211-223.
 
Environment- (International Classification of Functioning Disability and Health (ICF) Definition) The physical, social and attitudinal environment in which people live and conduct their lives. (WCPT 2019). Examples: Landscape, design and construction of buildings, equipment and technology, family, health care professionals and societal attitudes.
For ICF definition of all terms - see link below.


References
Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, Dan B, Jacobsson B. A report: the definition and classification of cerebral palsy April 2006 Dev Med Child Neurol Suppl. 2007 109:8-14
Mayston M. Editorial: Bobath Concept: Bobath @50 mid-life crisis- what of the future: Physiother. Res. Int. 2008 13(3) 131–136


The ICF: An Overview. Available at: https://www.wcpt.org/sites/wcpt.org/files/files/GH-ICF_overview_FINAL_for_WHO.pdf accessed 29/11/2019
Originally formulated by the therapists of Cerebral Palsy Cymru formerly Bobath Children’s Therapy Centre Wales) and Cerebral Palsy Scotland (formerly Bobath Scotland) discussed and agreed by the UK Bobath Tutors group.


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