Friday, May 24, 2013

Bobath: The more you move, the worse you'll get

I've made my position on Bobath/NDT pretty clear (hint, I'm not a devotee). One of the many things Bobath was clearly wrong about was the effect of effort on spasticity. Bobath weirdly believed that using spastic muscles would increase spasticity. The way she put it in her book Adult Hemiplegia was, "Effort leads to an increase in spasticity." This is the way the thinking goes: Since movement poststroke requires effort, movement increases spasticity. Distilled, the philosophy was pretty clear: The more you move, the worse you'll get. Later in her book she doubled down on this concept. "The use of effort... will only reinforce the existing released tonic reflexes and, with it, increase spasticity."
 Wrong. Wrong. Wrong.  
(Here are the references...)
Note: CIT requires a lot of effort.
And it's more than just wrong, it obfuscates the issue for clinicians trying to find answers. I'm guessing, but at least 80% of all seminars for stroke recovery revolve around the Bobath/NDT. So clinicians learn it. And it wastes researcher's time, effort and funding. Because clinicians learn and believe it, researchers often have to go and "prove the negative." Researchers have successfully debunked the concept that effort increases spasticity. Because effort reestablishes cortical control over spastic muscles, spasticity is actually reduced. 

"This evidence is not compatible with the underlying assumptions of the Bobath approach." 
(From the 3rd article referenced, above) 

  ©Stronger After Stroke Blog 


oc1dean said...

I got that from my main OT and she was planning on going on to become an NDT trainer. I'm no longer in contact with her so I can't correct her.

Peter G Levine said...

Some ndt therapists have their hearts in the right place. And they'll offer arguments like "That's not what we believe any more; ndt has changed." I just think ndt should come very clean about mistakes, do a ton more research to prove/disprove efficacy, and be honest about the 30 some odd years of claiming ndt was the best and any therapist who didn't learn it was the lesser therapist. Dean!

oc1dean said...

Of course I didn't help matters any when I moved to another clinic and left a voicemail to my PT that I was going because I wanted a NDT trained PT. I heard later that he got NDT training because of me. Sorry, I know better now, my recovery was spontaneous and not NDT-driven.

Kadima said...

Our therapist has us splint the arm as much as possible especially when walking and do shoulder stretch 2-3 times a day all to reduce tone. Then there are monthly intensive sessions with lots of strertching preceeding attempts to get some movement. Does spliniting reduce tone?

Judy B. said...

I have cramping in my left foot. My doctors have not told me if this is spasticity, but I suspect it is. It feels better if I remember to stretch out my legs and calves after doing my daily walking. Better enough that I can fall asleep at night without being bothered by the cramping.

Judy B. said...

I have some spasticity in my left foot. It feels better if I remember to stretch out my legs and calves after my daily walk. Otherwise it aches and bothers me while I try to fall asleep. I had my stroke 1.2 years ago.

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