Bobath Concept in the Process of Gait Rehabilitation for Post-stroke Patients with Hemiplegia (review) / 中国康复理论与实践

Bobath concept improves walking and motor function in stroke patients with hemiplegia by promoting posture control and establishing correct body mapping. The use of the Bobath concept alone or in combination with other treatments, such as knee stability training, Botulinum toxin injection, and Traditional Chinese Medicine, can effectively improve the walking ability of stroke patients. The Bobath concept has not been widely used, and its clinical effect is difficult to assess, which is the major problem at the current stage in China.

Survey on Clinical Application of 'Neurodevelopmental Treatment'

OBJECTIVE: To investigate the recognition about clinical application of "neurodevelopmental treatment (NDT)". METHOD: We surveyed on the recognition for Bobath and NDT concepts and its training programs provided by Korean Academy of Rehabilitation Medicine from Jan 2009 to Feb 2009. The survey was made for physiatrists and physical therapists (PTs), separately. One hundred twelve physiatrists and 322 PTs have participated. RESULTS: In physiatrist, interest in NDT was very high (98%), and the need for further knowledge of NDT was also high (95%). Though the NDT was mainly used techniques in neuro-rehabilitation setting, the expectation about effectiveness of it was moderate (56%) and the requirement of changing concepts of the NDT was very high (93%). PTs have carried out NDT most frequently with Bobath's concepts, but they also did not regard NDT as the best procedure. PTs emphasized the importance of their handling technique in NDT practices and also had high interest in the other maneuvers beside Bobath's. CONCLUSION: Physiatrists and PTs regard NDT as one of the most important treating method for patients with brain lesions, but it is not approved as the most effective method yet. Nowadays NDT is changing or adapting, with discarding some of the old Bobath's concepts and adding new modern scientific knowledge. Therefore we suggest that physiatrists to give PTs the revised NDT concepts and evidence based the other therapeutic methods. And the NDT needs to be verified its therapeutic efficacy with evidence based view points through proper studies.

O exercício físico resistido em pacientes com paralisia cerebral / Strength training in cerebral palsy

Neste trabalho e apresentada uma revisão bibliográfica de artigos que pesquisaram os efeitos do exercício físico resistido como abordagem de tratamento ao portador de Paralisia Cerebral com espasticidade. A avaliação preliminar das condições do paciente quanto a real força muscular, à espasticidade, as limitações articulares e ao condicionamento cárdio-respiratório e necessária, a fim de eleger esta abordagem como forma mais apropriada de tratamento com resposta direta sobre a funcionalidade. As razões para a fraqueza muscular, juntamente com a perda de controle motor seletivo, a fatigabilidade, o reduzido equilíbrio e os déficits sensoriais, todos fatores determinantes do prognóstico locomotor, tem implicações diretas no tratamento. O treino de força com exercícios em cadeia cinética fechada com peso corporal ou num grupo que tem A disposição estações de trabalho que incluam atividades funcionais com equilíbrio e treinamento isocinético com enfoque em membros inferiores promove efeitos benéficos as condições gerais do paciente desde que seja mantida boa postura durante a execução das atividades e inibidas as reações associadas, conforme o Conceito Bobath.

The purpose of this paper is to present a research about strength training effect as a management technique in spastic cerebral palsy. A preliminary evaluation of the patient's conditions regarding muscle strength, spasticity, joint limitations and cardiorespiratory fitness is necessary to elect this technique as the most appropriate with direct response for functionality. The causes of muscle weakness, loss of selective motor control, fatigability, reduced balance and sensorial deficit, all determining factors to the locomotor prognosis, have direct implications in the treatment. Strength training with closed-kinetic-chain exercises and with body weight or in a group that has acess to workstations including functional activities with balance and isokinetic training in lower limb produces gains in general conditions provided that a good posture during activities is kept and the associated reactions are inhibited as prescribed by the Bobath Concept. Physical fitness in cerebral palsy should be aimed always taking into consideration the functional conditions of each patient.