The Bobath Concept helps us analyse the child’s present level of activity and participation – what the child’s activity and activity limitations are. To achieve this, we analyse the daily activities of the child and note how their patterns of movement and postural tone present when the child wants or needs to do something. Postural/muscle tone is described as the amount of muscle activity needed in order to maintain a posture or to support an activity.
The Concept also allows us to understand how other factors related to CP such as sensory impairments may have an important effect on performing every day tasks. We look at what happens when the child moves or is moved in a variety of activities throughout their day, so we can see which elements are missing or used in a less than ideal way, affecting all areas of development. Our assessment and therapy will be based on what the child, parents and carers would like to be able to achieve during therapy (goal directed).
We use specific handling to modify the child’s tone and patterns of movement, so that activities are easier for them to do, and analyse the components of the activity and give opportunities to practice these step by step. We will also consider the use of equipment and will advise about making changes to the environment to affect the child’s posture and movement so that they can more easily be successful in daily activities. Other forms of treatment, such as Botulinum Toxin injections, lycra garments etc. can be recommended parts of intervention, dictated by the needs of the child.
What is unique about the Concept is that we might use our hands to help the child to learn to move in a more beneficial way and show parents and carers how they can work to achieve this throughout the child’s day e.g. during un/dressing, play, mealtimes etc. In doing so, we create multiple opportunities for long term change. The aim is that the child’s own activity will take over, on the basis of activities that are more beneficial in the long term. We use hands-on only to achieve hands-off.
The need to consider the future, while intervening at the present time, is driven by our knowledge of neuroscience and the way the brain learns, and of the effect that activity limitations and impairments may have on the child’s body over a lifetime into adulthood. We can then help the child, parents and carers understand what we can do today to modify what happens tomorrow and enable optimal functioning for the present and future.