Неврологиялық реабилитациядағы Бобат әдісінің тиімділігі және дамуы

Approach to neurological rehabilitation

The Bobath concept is an approach to neurological rehabilitation that is applied in patient assessment and treatment (such as with adults after stroke The Bobath concept was focused on regaining regular movements through re education at its earliest inception. Since then, it has evolved to incorporate new information on neuroplasticity, motor learning, and motor control. The strategies and techniques utilized in Bobath therapy encompass therapeutic handling, facilitation, and activation of pivotal control points. Therapeutic handling is a method applied to influence movement quality, combining both facilitation and inhibition approaches.

Paci (2003) conducted an extensive critical appraisal of studies to determine the effectiveness of the Bobath concept for adults with hemiplegia following a stroke. Selected trials showed no evidence proving the effectiveness of the Bobath Concept as the optimal type of treatment. it offers certification in NDT for managing adults with stroke or brain trauma and for managing and treating children with cerebral palsy and other neuromotor disorders. People who have this certification sometimes are called "neurodevelopmentalists".

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). Furthermore, a 2020 review of lower limb rehabilitation following stroke concluded that Bobath therapy was inferior to task specific training and that prioritising Bobath therapy over other interventions is not supported by current evidence. 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 is effective, while 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". See also an interesting exchange of letters between the above authors and Bobath tutors. National evidence based guidelines for stroke rehabilitation have been published for England, Netherlands, Canada, Australia, and New Zealand; yet in none of these is the Bobath approach recommended. Conversely, in 2016 the American Stroke Association concluded that although the effectiveness of NDT/Bobath (compared with other treatment approaches) had not been established that it still “may be considered” as a treatment option for mobility. This, however, was their lowest classification of acceptable treatment. Their two highest recommendation groups (“should be performed” and “reasonable to perform”) contained a variety of treatments for which there was much better evidence. NDT/Bobath was not listed as an option for arm/hand rehabilitation. Also, in 2016, the revised RCP guidelines for stroke made no mention of Bobath/NDT, whilst many alternatives were recommended. Importantly they stated that if a treatment was not mentioned, then it was not recommended and need not be funded. They also stated that therapists using such methods must objectively review their options in light of the evidence supporting the recommended alternatives. Furthermore, patients receiving such interventions should be informed that it was outside mainstream practice. A highly significant 2021 “position paper” by the Academy of Neurologic Physical Therapy of the American Physical Therapy Association concluded that, despite its lack of an evidence base, NDT/Bobath methods were still favoured by some therapist in the USA. To overcome this problem, they described a range of strategies that will be implemented to encourage best evidence based practices and de implement traditional (NDT/Bobath) methods of working at both an individual and organizational level. 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. 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 neurorehabilitation. Yet, the British Bobath Tutors Association website does quote the minority of RCTs that support their approach.