The Bobath Concept (NDT) as rehabilitation in stroke patients: A systematic review

Abhishek Pathak, Vyom Gyanpuri, Priya Dev, Neetu Rani Dhiman, Abhishek Pathak, Vyom Gyanpuri, Priya Dev, Neetu Rani Dhiman

Abstract

Background and objectives: The Bobath approach, also known as neurodevelopmental treatment (NDT), is a widely used concept in the rehabilitation of stroke patients with hemiparesis in many countries. This technique is being used since years all over the world; however, strong evidence of its usefulness is still not present. This review is aimed to find out its effectiveness based on the randomized controlled trials in the rehabilitation of stroke patients with motor disability and to compare it with other therapeutic techniques.

Materials and methods: A systematic literature search on PubMed Central, Science-Direct, Cochrane, Scopus, Clinical Trial Database, and Indian Clinical Trial Registry in English till 31st July 2021 was undertaken. The review is published in Prospective Register of Systematic Reviews (PROSPERO) with registration number "CRD42019125400." Physiotherapy Evidence-based Database (PEDro) score has been used for the quality assessment of the studies. Randomized clinical trials that studied the comparative effect of the NDT/Bobath concept on motor activity outcomes and cognition/behavior in stroke patients in comparison with other rehabilitative techniques were included.

Results: No strong documentation describing the effectiveness of this neuro-developmental treatment or its supporting neuro-developmental treatment in comparison with other advanced neuro-physiotherapeutic techniques has been found so as to consider it as the recommended treatment for post-stroke hemiplegia/hemiparesis. Methodological aspects of selected studies for further research are suggested.

Interpretation and conclusions: This study is inconclusive in determining the effectiveness of the Bobath approach for the movement rehabilitation of stroke patients. These results are similar to the results of previous reviews done on the same topic.

Keywords: Bobath Concept; rehabilitation; review; stroke.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2021 Journal of Family Medicine and Primary Care.

Figures

Figure 1
Figure 1
PRISMA flow diagram of the study process. PRISMA, Preferred Reporting Items for Systematic Review and Meta-Analysis

References

    1. Bobath B. Evaluation and treatment. 2nd ed. London: Heinemann; 1978. Adult hemiplegia.
    1. Davies PM. Steps to Follow. Heidelberg: Springer-Verlag Berlin; 1985.
    1. Bobath B. Evaluation and Treatment. London: Heinemann; 1990. Adult Hemiplegia.
    1. Paci M. Physiotherapy based on the Bobath concept for adults with post-stroke hemiplegia:A review of effectiveness studies. J Rehabil Med. 2003;35:2–7.
    1. Keshner EA. Reevaluating the theoretical model underlying the neurodevelopmental theory. A literature review. Phys Ther. 1981;61:1035–40.
    1. Lennon SM. The Bobath concept:A critical review of the theoretical assumptions that guide physiotherapy practice in stroke rehabilitation. Phys Ther Rev. 1996;1:35–45.
    1. Ernst E. A review of stroke rehabilitation and physiotherapy. Stroke. 1990;21:1081–5.
    1. Ashburn A, Partridge CJ, De Souza L. Physiotherapy in the rehabilitation of stroke:A review. Clin Rehabil. 1993;7:337–45.
    1. Vaughan-Graham J, Cott C, Virginia Wright F. The Bobath (NDT) concept in adult neurological rehabilitation:What is the state of the knowledge?A scoping review. Part II:Intervention studies perspectives. Disabil Rehabil. 2015;37:1909–28.
    1. Luke C, Dodd KJ, Brock K. Outcomes of the Bobath concept on upper limb recovery following stroke. Clin Rehabil. 2004;18:888–98.
    1. Desmeules F, Roy JS, MacDermid JC, Champagne F, Hinse O, Woodhouse LJ. Advanced practice physiotherapy in patients with musculoskeletal disorders:A systematic review. BMC Musculoskelet Disord. 2012;13:107.
    1. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83:713–21.
    1. De Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials:A demographic study. Aust J Physiother. 2009;55:129–33.
    1. Bhogal SK, Teasell RW, Foley NC, Speechley MR. The PEDro scale provides a more comprehensive measure of methodological quality than the Jadad scale in stroke rehabilitation literature. J Clin Epidemiol. 2005;58:668–73.
    1. Dickstein R, Hocherman S, Pillar T, Shaham R. Stroke rehabilitation. Three exercise therapy approaches. Phys Ther. 1986;66:1233–8.
    1. Basmajian JV, Gowland CA, Finlayson MA, Hall AL, Swanson LR, Stratford PW, et al. Stroke treatment:Comparison of integrated behavioural- physical therapy vs traditional physical therapy programs. Arch Phys Med Rehabil. 1987;68(2 Pt 1):267–72.
    1. Gelber DA, Josefczyk PB, Herman D, Good DC, Verhulst SJ. Comparison of two therapy approaches in the rehabilitation of the pure motor hemiparetic stroke patient. J Neutral Rehabil. 1995;9:191–6.
    1. Langhammer B, Stanghelle JK. Bobath or motor relearning programme?A comparison of two different approaches of physiotherapy in stroke rehabilitation:A randomized controlled study. Clin Rehabil. 2000;14:361–9.
    1. van der Lee JH, Wagenaar RC, Lankhorst GJ, Vogelaar TW, Deville WL, Bouter LM. Forced use of the upper extremity in chronic stroke patients;results from a single-blind randomized clinical trial. Stroke. 1999;30:2369–75.
    1. Lum PS, Burgar CG, Shor PC, Majmundar M, van der Loos M. Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke. Arch Phys Med Rehabil. 2002;83:952–9.
    1. Tang QP, Yang QD, Wu YH, Wang GQ, Huang ZL, Liu ZJ, et al. Effects of problem-oriented willed-movement therapy on motor abilities for people with poststroke cognitive deficits. Phys Ther. 2005;85:1020–33.
    1. Platz T, Eickhof C, van Kaick S, Engel U, Pinkowski C, Kalok S, et al. Impairment-oriented training or Bobath therapy for severe arm paresis after stroke:A single-blind, multicentre randomized controlled trial. Clin Rehabil. 2005;19:714–24.
    1. Van Vliet PM, Lincoln NB, Foxall A. Comparison of Bobath based and movement science based treatment for stroke:A randomized controlled trial. J Neurol Neurosurg Psychiatry. 2005;76:503–8.
    1. Wang RY, Chen HI, Chen CY, Yang YR. Efficacy of Bobath versus orthopaedic approach on impairment and function at different motor recovery stages after stroke:A randomized controlled study. Clin Rehabil. 2005;19:155–64.
    1. Dias D, Lains J, Pereira A, Nunes R, Caldas J, Amaral C, et al. Can we improve gait skills in chronic hemiplegics?A randomized control trial with gait trainer. Eura Medicophys. 2007;43:499–504.
    1. Thaut MH, Leins AK, Rice RR, Argstatter H, Kenyon GP, McIntosh GC, et al. Rhythmic auditory stimulation improves gait more than NDT/Bobath training in near-ambulatory patients early poststroke:A single-blind, randomized trial. Neurorehabil Neural Repair. 2007;21:455–9.
    1. Yelnik AP, Le Breton F, Colle FM, Bonan, Hugeron C, Egal V, et al. Rehabilitation of balance after stroke with multisensorial training:A single-blind randomized controlled study. Neurorehabil Neural Repair. 2008;22:468–76.
    1. Birgitta L, Johan KS. Can physiotherapy after stroke based on the Bobath concept result in improved quality of movement compared to the motor relearning programme. Physiother Res Int. 2011;16:69–80.
    1. Kim B, Gerlinde H, Gerhard R, Susan C. Does physiotherapy based on the Bobath concept, in conjunction with a task practice, achieve greater improvement in walking ability in people with stroke compared to physiotherapy focused on structured task practice alone?:A pilot randomized controlled trial. Clin Rehabil. 2011;25:903–12.
    1. Huseyinsinoglu BE, Ozdincler AR, Krespi Y. Bobath Concept versus constraint-induced movement therapy to improve arm functional recovery in stroke patients:A randomized controlled trial. Clin Rehabil. 2012;26:705–15.
    1. Arya KN, Verma R, Garg RK. Meaningful Task-Specific Training (MTST) for stroke rehabilitation:A randomized controlled trial. Top Stroke Rehabil. 2012;19:193–211.
    1. Muhammed K, Fatma A, Ozge O, Ayvat E, Savcun Demirci C, Aksu Yildirim S. The effects of Bobath-based trunk exercises on trunk control, functional capacity, balance, and gait:A pilot randomized controlled trial. Top Stroke Rehabil. 2015;23:50–8.
    1. Jolanta K, Marcin B, Monika S, Jan C. The influence of NDT-Bobath and PNF methods on the field support and total path length measure foot pressure (COP) in patients after stroke. Neurol Neurochir Pol. 2016;50:449–54.
    1. Kollen BJ, Lennon S, Lyons B. The effectiveness of the Bobath Concept in stroke rehabilitation:What is the evidence? Stroke. 2009;40:e89–97.
    1. Díaz-Arribas MJ, Martín-Casas P, Cano-de-la-Cuerda R, Plaza-Manzano G. Effectiveness of the Bobath concept in the treatment of stroke:A systematic review. Disabil Rehabil. 2019;42:1636–49.
    1. Scrivener K, Dorsch S, McCluskey A, Schurr K, Graham PL, Cao Z, et al. Bobath therapy is inferior to task-specific training and not superior to other interventions in improving lower limb activities after stroke:A systematic review. J Physiother. 2020;66:225–35.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe