Bobath Concept Structural Framework (BCSF): Positioning Partial Aspects Within a Holistic Therapeutic Concept

摘要

Background: The Bobath concept is a complex, holistic approach to neurorehabilitation. This complexity presents difficulties for describing Bobath therapy in a comprehensible way. The purpose of this project was to develop an external structure to promote a better understanding of how specific therapeutic procedures are categorized, how partial aspects can be organized and how their interactions can be made more obvious. Method: A scoping review of the literature was undertaken and clustered for keywords. These data were assigned to four levels of a framework model: Conceptual level (leading thoughts), Principle level (essential characteristics of the system), Method level (systematic procedures) and Technique level (the execution tools). Drafts of the framework were presented at annual conferences of the International Bobath Instructor Training Association (IBITA). Feedback from members was sought informally and in questionnaires. Results: The BCSF was supported by 75% of IBITA members (N = 107). In the Conceptual level, three aspects were established; propositional knowledge, individual client context and professional practice knowledge. Seven components are represented in the Principle level; optimizing activity and participation, problem solving, interactive - dialogue approach, client goal oriented, identification of potential, ongoing interplay of assessment and intervention and 24 hours approach. In the Methods level, three systematic procedures were identified; activation, shaping and repetition. At the Techniques level, four execution tools were described; communication, facilitation, assignment of task and environmental arrangement. Discussion: The BCSF provides a structure for further research into the Bobath concept. At a qualitative level, this structure will allow different aspects to be explored whilst still viewing a single aspect as a component of the whole. At a quantitative level, the BCSF clarifies what kind of therapy constitutes a Bobath intervention and the factors that need to be present at all levels of the framework. Conclusion: The BCSF is a useful tool where partial aspects of the Bobath concept can be categorized into a comprehensive classification system. This classification makes it possible to focus on specific items without losing the "big picture" and to identify partial aspects and their interactions more clearly. Specific procedures can be presented in a structured and transparent manner and well documented core elements for rehabilitation of people with CNS disorders can be demonstrated.