|
The Bobath concept is an approach to neurological rehabilitation that is applied in patient assessment and treatment (such as with adults after stroke,〔 or children with cerebral palsy〔). The goal of applying the Bobath concept is to promote motor learning for efficient motor control in various environments, thereby improving participation and function. This is done through specific patient handling skills to guide patients through initiation and completion of intended tasks.〔 This approach to neurological rehabilitation is multidisciplinary, primarily involving physiotherapists, but may also include occupational therapists and speech and language therapists. In the United States, the Bobath concept is also known as 'neuro-developmental treatment' (NDT).〔 The concept and its international tutors / instructors, have embraced neuroscience and the developments in understanding motor control, motor learning, neuroplasticity and human movement science. They believe that this approach continues to develop. ==Recent Criticism of the Bobath Appoach== The concept that Bobath can “evolve” and still be called Bobath has been challenged by the president of the American Academy of Cerebral Palsy and Developmental Medicine and the chair of the UK Association of Chartered Physiotherapists in Neurology (ACPIN).〔Damiano (2007) Pass the torch, please! Developmental Medicine & Child Neurology 49 723–723.〕〔Mayston (2006) Letter to the editor RAINE: A RESPONSE. Physiotherapy Research International 11 183-186.〕 These eminent physiotherapists believe that several of the key original teachings of the founders have now been abandoned, whilst the ideas / concepts of others (non Bobath therapists & scientists) have unjustifiably been given the name of Bobath. There is widespread use of the Bobath concept amongst therapists in stroke rehabilitation. Yet, a large review of randomized controlled trials (RCTs) of Bobath for stroke rehabilitation found only three instances of significant differences in favour of Bobath, yet 11 in favour of alternatives.〔 The authors concluded:- “evidence-based guidelines, accepted rules of motor learning, and biological mechanisms of functional recovery, rather than therapist preference for any named therapy approach should serve as a framework from which therapists should derive the most effective treatment”. National evidence based guidelines for stroke rehabilitation have been published for England, Netherlands, USA, Canada, Australia and New Zealand; yet in none of these is the Bobath approach recommended. The above international review pointed out that the approach is now regarded as “obsolete” in some European countries and it is therefore no longer taught. In the UK, an NHS review of stroke rehabilitation by Professor Tyson concluded that "the strength of evidence that task specific functional training and strength training are effective, whilst Bobath is not, indicates that a paradigm shift is needed in UK stroke physiotherapy..... it is increasingly difficult to justify the continued use of the Bobath concept or its associated techniques".〔 The Bobath (NDT) approach is also widely used on children with cerebral palsy (CP). However when the effectiveness of interventions for the treatment of CP was reviewed by Novak et al.〔Novak et al. (2013) 55 885-910. A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev. Med. Child Neurol. Available at :- http://onlinelibrary.wiley.com/doi/10.1111/dmcn.12246/pdf.〕 they concluded “Consequently, there are no circumstances where any of the aims of NDT could not be achieved by a more effective treatment. Thus, on the grounds of wanting to do the best for children with CP, it is hard to rationalize a continued place for traditional NDT within clinical care”. They consequently recommended “ceasing provision of the ever-popular NDT”. The dichotomy between the popularity and institutional funding of this approach versus the negative findings of most RCTs has been excused on the grounds that RCTs may not be suitable for neurorehabilitaion. Yet, the British Bobath Tutors Association website does quote the minority of RCTs that support their approach. More recently Professor Tyson has written a comprehensive and critical review of Bobath/NDT methods, theory and effectiveness.〔Tyson (2015) When evidence based practice meets neurological physiotherapy, available at https://sarahtphysioblog.wordpress.com/〕 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Bobath concept」の詳細全文を読む スポンサード リンク
|