APPROACH
(Neurodevelopmental Technique)
Background
Developed by Berta Bobath
Physiotherapist
Gymnast
(it is where she developed her understanding of
normal movement, exercise and relaxation)
Assisted by her husband, Karl, a neurologist
Designed to restore normal movement to children with
cerebral palsy & to those with hemiplegia
focuses on regaining postural control and selective
movement control and also works to normalize muscle
tone
involves the inhibition of abnormal movement patterns
7. Equilibrium Reactions
elicited by displacing the persons COG while he is in one of the
developmental postures and can maintain that posture against
gravity
serve to maintain & restore balance during all activities especially
when in danger of falling
involve counter movement to restore balance, tone change etc.
involve patterns of righting reaction, such as head control &
rotation of trunk & pelvis
these reactions are needed when riding on any form of transport
can be tested either by moving the body against a fixed support
(such as the ground), or by means of a moveable platform
form the first line of defense against injury
TERMINOLOGIES
8. Protective Extension or Parachute Reaction
2nd line of defense when equilibrium reaction prove to be
insufficient
the arms and hands are use to protect the face & head from
injury when falling
9. Sensory stimulation
used for hypotonic patterns and others that appear to be
weak when the abnormal tone is inhibited, or those who have
sensory disturbance
never done unless the patient is in RIP in order to shunt the
inflow into the desired channels
a. weight bearing w/ pressure & resistance
use to increase postural tone & decrease involuntary
movements
b. placing & holding
the PT moves the limbs to various pos. with help of px.;
then px.
Hold the position without help of PT
c. tapping
Treatment/ stage of recovery
1. Initial Flaccid Stage
Focus on positioning and movement in bed to
avoid typical postural patterns of hemiplegia
2. Spastic stage
Treatment is continuation of previous stage
Goal is to break down the total pattern of
spasticity by developing control of
intermediate joints
3. Relative recovery
Treatment aims at improving the quality of
gait and use of affected hand
END
NORMAL MOVEMENT
SEQUENCE & BALANCE
REACTIONS
Intro on (N) movt
Tx is a process of teaching and learning
PTs should know their subjects well
They must know what should take place (i.e.
how people move and react)
People move in basically the same pattern
i.e spontaneous w/o the need for conscious thought
Becomes automatic in adult life
Voluntary, controlled and can be inhibited
Differences in movt comes from variations of
individual and include:
Build, personality, habits, presence of stiffness or pain
Analysis of certain everyday
movement
Rolling from supine
to prone
Head Sitting leaning
Face forward to touch
Arms feet (as if picking
Legs something)
Upper
Feet
lower
head
Trunk
Analysis of certain everyday
movement
Standing from
sitting on a chair Standing up from
Feet the floor
Knee 1 ft
Back & neck Knees
Arms Weight
Head Head
Body Back
Weight is borne arms
Analysis of certain everyday
movement
Going up and down
the stairs
1 ft
Knees Walking
Weight Stride
Head Feet
Back Heel
Arms Big toes
Eyes
Balance & equilibrium
Adjustments ofreactions
our body to gravity during
everyday activities in order to maintain
balance
Normal postural reflex mechanisms
Provides background for all skilled movt
Dependent on:
1. (N) tone
-. high enough to support body against gravity (but
not too high as to impede movt)
2. Reciprocal inhibition
-. Enables us to stabilize certain parts of body while
moving the other parts selectively
Balance & equilibrium
reactions
Lying on surface Sitting on a surface that
which tilts sideways tilts sideways
Head flexion Head flexion
Trunk flexion Trunk flexion
Arms and legs Arms
Uppermost Legs
lowermost Uppermost
lowermost
Trunk rotation
Trunk rotation
* Standing on a tilting
surface (backward)
Balance & equilibrium
reactions
Standing tipped Standing on a
forwards tilting surface
Head
Supporting Foot
(sideways)
Toes Knee uppermost
Side over the weight Arms
bearing leg
Feet
Side opposite the weight
bearing leg
(B) arms
* Standing on a tilting
surface (forward)
Balance & equilibrium
Balancing on one
leg (the other leg
Steps to save
held by PT)
(protective steps)
Foot
Appears when we
As the weight is
react quickly and
transferred
economically to
further.
regain balance
- Forward
- Sideways Protective extension
- backward second line of defense if
all other balance &
equilibrium rxns fail