Definiti on
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Its method is based on hands-on from assessing to treatment of individuals with disturbance of function, movement and postural control due to lesion to the CNS
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It was first developed to improve motor behavior in individuals with CP, while decreasing secondary contractures such as deformity. The theories of Bobath technique is that by giving typical movement patterns to child with 4/22/12 their CP brain would
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Neglect the affected side of hemiplegic in functional role. Passive stretching and exercise only address problem of abnormal tone and co-ordination. Neglect the Brunnstrom technique.
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and muscular synergies are group of muscles that respond together to create total flexion or extension of limb.
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Postural reflexes and reactions is involuntary, stereotyped responses to a stimulus related to the position of the head or body to gravity. Muscle tone is the slight degree of contraction that muscle maintain when 4/22/12 inactive.
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Normal moveme nt
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Retrain normal movement responses on the patients hemiplegic side. Avoid activities and exercises that increase abnormal tone or movement. Use treatment activities and exercises that encourage or 4/22/12 strengthen normal movement
Principl es
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4) Help patient use existing motor control on hemiplegic side for occupational performance. 5) Develop compensations and adaptations that encourage use of the affected side and decrease development of abnormal movements and asymmetrical postures.
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Evaluation
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Muscle tone Postural reflexes and reaction Motor patterns and synergies
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Done through:
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patient will actively assists during passive movement when movement control is present. If therapist stop the movement briefly 4/22/12
2) Associated Reaction: involuntary, nonfunctional changes in limb position and muscles. also occurs during yawn or sneezes. for hemiplegic patient, their hemiplegic arm is in a flexed position when the patient walks It is linked to postural control, 4/22/12 once balance is regained it will
2) Postural Reaction
For hemiplegic patient, motor patterns are poor because synergistic muscle are weak to contribute the movement.
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They need to pay full attention and effort to produce movement on affected side.
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- Normal movement can be achieved when: - normal muscle tone is present - normal postural reaction and reflexes are present - normal motor patterns and synergies.
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4) Functional Performance
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Treatment To determine abnormal patterns such as Goals posture, and hypertone, asymmetrical
weak synergistic movements. (INHIBITION technique) To decide normal movements components such as coordinated movement at the involved and two side of the body. (FACILITATION technique) To improve functional use of involved side to decrease compensation and adaptive equipment.
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Function of inhibition technique: - To correct alignment - To lengthen or shorten muscle - Decrease abnormal muscle4/22/12 tone
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Reflex-inhibiting patterns (RIP) Scapula mobilization Trunk rotation Weight bearing Lengthen muscles and realign joint
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Reflex-inhibiting patterns (RIP): Flexor spasticity in the arm is located in the shoulder elevators and internal rotators and elbow, wrist, and finger flexors.
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It is inhibited with RIP that includes, shoulder girdle depression and shoulder external rotation, elbow and wrist extension, and open hand.
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Lengthen Muscles and Realign Joint: Therapist places hemiplegic arm in extended position that maintain passive length in flexor muscle of the arm and hold position while facilitating normal movement response.
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The arm will not resist moving into RIP if there is no or little spasticity.
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Scapula mobilization: Used to reposition the scapula. -Lengthen tight muscle around shoulder girdle.
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Weight Bearing: Used to elongate soft tissue structures and minimize flexion or extension synergies in 4/22/12
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Facilitation Technique
It is used to:
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Provide sensation of normal movement on hemiplegic side Train normal movement pattern. Activate normal postural response and trunk control. Teach ways to incorporate involved side into functional task and 4/22/12
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-The therapist use light contact with correct key point of control and manually assist the patients movement pattern. -This will minimize the learning of abnormal movement by allowing patient practice normal 4/22/12
Weight-Bearing: Patient is taught to activate muscle in trunk by moving body weight over stable arm .
This will produce changes in the position of hemiplegic arm, actively lengthening and shortening muscles.
It begins with first, teaching patient to accept weight on the hemiplegic arm with forearms on a table.
Extended elbow weight bearing is more difficult because it requires control of the elbow and wrist joints as well as control of the trunk and shoulder girdle.
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Selective Arm Movements: Used to: i) Give patient sensation of normal movement ii) teach normal patterns of initiation and sequencing iii) reeducate and strengthen normal movement for function.
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Move the patients arm in normal pattern. Patient is encouraged to assist with the movement.
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Distal Key Point: - Located away from source of problem such as the hand and foot. - It is used to allow client to engage in activities with minimal control of therapist.
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-When patient cannot move hemiplegic side, clasped-hand grip are used.
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Wrist in extension
Patient who have difficulty may grasp 4/22/12 the ulnar side of the hemiplegic wrist
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Motor learning theorist has critized that handling technique in NDT is too passive and lacking in opportunities for independent practice.
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Limitatio n
B. Bobath emphasis on movement quality has resulted a perception where, patients should not be encouraged to move independently until they are able to use normal patterns of muscle activation.
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Referen Crepeau, E. B., Cohn, E. S., & Schell, B. A. (2003). ce Willard & Spackman's Occupational Therapy.
Pennsylvania: Lippincott Williams & Wilkins. Kielhofner, G. (2004). Conceptual Foundations of Occupational Therapy 3rd Edition. Philadelphia: F. A. Davis Company. Pendleton, H. M., & Schultz-Krohn, W. (2006). PEDRETTI"S OCCUPATIONAL THERAPY: Practice Skills for Physical Dysfunction 6th Edition. Missouri: MOSBY ELSEVIER. Reed, L. R., & Sanderson, S. N. (1999). Concepts of Occupational Therapy Fourth Edition. Maryland: 4/22/12 Lippincott Williams & Wilkins.
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