The Bobath concept in stroke rehabilitation: a focus group study of the experienced physiotherapists' perspective

Purpose : The Bobath concept, usually known as neurodevelopmental treatment (NDT) in America, is one of the major approaches used to rehabilitate pati ents following stroke; however since the last publication of Bobath (1990), the concept has been taught via an oral tradition on postgraduate courses. This study therefore aimed to explore with experienced therapists firstly how the Bobath concept had changed since 1990, and secondly what they consi dered its main theoretical assumptions to be using a focus group research d esign. Method: Eight peer-nominated expert physiotherapists agreed to participate in two focus groups organized according to specialist interest in either ne urology (group A) or elderly care (group B). Therapists were asked to discu ss six topics based on a review of published literature. Data analysis invo lved several readings of verbatim transcriptions, from which key themes and concepts were developed. Results : All therapists agreed on the following core themes defining Bobat h: analysis of normal movement, control of tone and facilitation of movemen t. Neuroplasticity was described as the primary rationale for treatment wit h therapists using afferent information to target the damaged central nervo us system. In addition group A discussed motor learning, whereas group B di scussed patient focused goals and relating treatment to function. Conclusions : This study highlighted changes in theory, terminology, and te chniques. Tone remained a major problem in the rehabilitation management of the hemiplegic patient; however much attention was also directed towards t he musculoskeletal system. Both facilitation of normal movement components and task specific practice using specific manual guidance were considered c ritical elements of the Bobath concept. For Bobath therapists, physiotherap y has an important impact on both the performance components of movement an d functional outcomes. In view of the small numbers involved in this prelim inary study, further studies are now needed to determine if these themes an d concepts are congruent with the majority of physiotherapists' interpretat ion of the Bobath concept in stroke rehabilitation.