Neurological Physiotherapy

I am an advanced Bobath practitioner and have been studying the Bobath concept for over 10 years. I have been practicing in neurology for most of my career and have found that the Bobath method has given me tools to problem solve and adapt to a wide variety of clinical presentations.

In preparation for starting to write blogs I dug around the web to see what was on the minds of those who were already doing this, as I am not super tuned in to social media. As I am interested in neurology, that’s where I started. It turns out that that the Bobath concept is somewhat controversial. I knew of some of the controversy from courses I had taken, but I had not experienced first hand the state of the debate that was going on. Some individuals are clearly against the Bobath concept, but it seems some of their issues may be due to ignorance around it, and many of their concerns could be answered. Perhaps some can not be.

I was reading from an Indian mystic recently who said he believed all religions were correct as they all brought people a path to a better Life. Perhaps the same is true with therapeutic techniques and frameworks? Having one will inform and guide one’s practice to hopefully be more efficient and helpful. Therapists are drawn to what they are interested in as well as the availability of education.

As physiotherapy is done to humans by humans, there will always be an individualistic nature inherent to practice. So learning a framework, or practicing within a conceptual model, will never mean that that model is the same regardless of who is practicing. Treatments need to be adapted to fit the individual client, always. I have yet to find any therapists who work exactly the same way, regardless of their area of practice. Perhaps there are several approaches that all work on their own, or more importantly, together? Efficient and successful therapeutic concepts may indeed be as diverse as those they have been designed to aid.

Neurology is a complicated, many-faceted area that often has challenges beyond the body. Although it would be great to have one method that was the best that we could all follow, my hope in this thread is to discuss some therapies used in neurological physiotherapy, and hopefully come up with some ideas as to how to choose which type of therapy is the best fit for someone, whether it is a patient looking for therapy, or a practitioner deciding how to go about treatment, and also to look at therapy not as a bunch of competing models of practice, but as a diverse set of tools that help different people at different times in their rehabilitation.

There are several concepts out there right now. Exercise based, repetitive task, technological, constraint therapy, NDT, and Bobath to name a few.

Now time for a short bit about why I am writing about this...

I had an excellent teacher during my physiotherapy program who was a Bobath practitioner and now is a certified advanced instructor. She was inspiring and her passion was infectious. The longer I have followed this path, the more teachers and therapists I have come across with the same enthusiasm for their craft and compassion for those they serve. What endeared me to the Bobath concept was its open and creative nature based on this focused and intense moment by moment interaction between the patient and the therapist, the never-ending quest into the central and peripheral systems, and then the magic of putting these together through one’s hands in specified environments and settings to change the nervous system, in order to change the patient’s abilities. It was brain farming in real time! And I was awestruck when I saw it in action.

I am also a musician, currently involved in largely improvised music. Players have typically studied their instruments for years and have played countless hours on their own and with ensembles. Only once they have mastered their instrument and the process of musical creation, can they truly express themselves in an improvised context. Perhaps this is why I was drawn to the Bobath concept? I like to listen and explore - with a purpose, a direction – but knowing that the end result is going to be related to the combination of many factors. It is improvisation. It is a dance. It also has science behind it, just like music. One has to adapt to, and thus be receptive to the subtleties that happen during treatment. One has to have the theory and the neuroscience engrained. Then one has to be able to make decisions for both the short and long term, which requires what we call patient mileage as well as creativity, critical thinking and reflection.

So, neither making music on the spot with someone you’ve never met, nor helping to repair nervous systems with one’s hands is easy. It takes time to learn how to do it and there are many pathways people take to get there.