Neurodevelopmental Techniques (Bobath)
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Direct answer
Berta Bobath, a physiotherapist, and Karel Bobath, a physician, built their neurodevelopmental treatment approach in 1940s London around one observation: adult hemiplegia and childhood cerebral palsy share abnormal postural tone and abnormal movement patterns that block normal function. NDT does not drill movements; the therapist handles the patient at key points of control — head, trunk, scapula, pelvis — and uses reflex-inhibiting postures to normalise tone first, so more normal automatic and voluntary movement can emerge. The Bobath concept remains a living framework, explicitly "a concept, not a recipe", applied with individual goal-setting across adult neurology and paediatrics.
What you must remember
- Core premise: normal movement requires normal postural tone; spasticity, abnormal co-contraction and obligatory synergies are the obstacles, so tone is prepared before strength or task practice.
- Reflex-inhibiting patterns (RIPs) position the body opposite to the dominant abnormal pattern — for the hemiplegic arm's flexor synergy: scapular protraction with shoulder abduction, external rotation and extension, forearm supination, fingers open; for the leg's extensor pattern: hip abduction and external rotation with knee flexion and ankle dorsiflexion.
- Key points of control are where the therapist's hands work — proximal (head, shoulders, trunk, pelvis) for global tone, distal (hand, foot) for refinement; each hand contact changes tone throughout the linked chains.
- Weight-bearing on the affected side — sitting or standing shifted onto the hemiplegic buttock or leg — provides extensor tone input and sensory awareness that passive movement cannot.
- The comparison set every exam expects: Brunnstrom trains movement within synergies, Rood drives tone through sensory stimulation, PNF facilitates via diagonals and resistance, and Carr and Shepherd's motor relearning programme practises tasks directly.
- In paediatric practice, handling inhibits persistent primitive reflexes (asymmetric tonic neck reflex, symmetric tonic neck reflex, Moro), promotes head control and symmetrical posture, and is taught to families for use during feeding, dressing and play.
- Modern Bobath teaching has moved beyond reflex-hierarchy theory, integrating task-specific training and strength work; the concept explicitly invites this evolution.
Handling a hemiplegic arm the Bobath way
Begin proximally, because an arm cannot relax while the scapula sits retracted and elevated. Side-lying with the affected side uppermost, the therapist mobilises the scapula into protraction and depression — gentle rhythmic lengthening until the guarding melts. Tone changes at the key point flow distally: the shoulder, previously pinned into adduction and internal rotation, begins to accept external rotation.
Now the reflex-inhibiting posture: scapula protracted, shoulder abducted and externally rotated, elbow extended, forearm supinated, wrist and fingers extended over the therapist's thigh — held without pain, breathing allowed to settle. This is preparation, not treatment in itself.
From preparation into activation: weight-bearing through the lengthened arm on a mat table while the therapist grades the load, then reaching activities in which trunk rotation carries the arm, with the therapist's proximal hand preventing the flexor synergy from stealing the movement. Finally, standing and weight-shifting onto the affected leg while the arm bears weight on a table — the whole body now organised around the once-neglected side. Each step embodies the sequence: inhibit, elongate, weight-bear, activate, integrate.
How the exam frames it
"Who developed it and when" opens the viva, and the answer — the Bobaths, in London, in the 1940s — is free marks. The quotation-style MCQ tests "NDT is a concept, not a set of techniques". Matching questions sort Bobath from Brunnstrom, Rood and motor relearning by their signature logic, and one scenario always asks the direction of a reflex-inhibiting pattern — opposite to the abnormal posture, never with it.
Frequently asked questions
Who developed the Bobath concept, and when?
Berta Bobath (physiotherapist) and Karel Bobath (physician), in London in the 1940s.
What are reflex-inhibiting patterns?
Sustained positions opposite to the patient's dominant abnormal tone pattern, used to reduce spasticity before functional movement is trained.
What is a key point of control?
A handling location — head, scapula, trunk or pelvis — where the therapist's input modulates tone and alignment throughout connected body segments.
How does Brunnstrom's approach differ from Bobath's?
Brunnstrom deliberately trains the synergies as stages of recovery; Bobath works to inhibit synergies so selective movement can return.
Which primitive reflexes complicate handling in cerebral palsy?
Persistence of the asymmetric and symmetric tonic neck reflexes and the Moro reflex disturbs symmetry, head control and hand function.