PT Critically Appraised Topics
 

Document Type

Critically Appraised Topic

Publication Date

2014

Clinical Scenario

The patient of interest was a 63 year old male who presented to the hospital with right sided weakness, dysarthria, and headache. Imaging revealed an acute ischemic cerebrovascular accident (CVA) involving the left middle cerebral artery. He received a physical therapy evaluation within 24 hours of his stroke and presented with less than 3/5 strength in his right upper extremity and 3-3+/4 strength in his right lower extremity. Prior to the stroke, the patient was independent with activities of daily living and lead an active lifestyle. He lived alone in a single level house.

Clinical Question

Does the inclusion of the Bobath/Neurodevelopmental Approach in treating hemiparetic patients post cerebrovascular accident improve gait and function more than interventions without it?

Clinical Bottom Line

Based on the results of this critically appraised topic, there is moderate evidence to suggest that for patients post CVA resulting in hemiparesis an intervention based on the Bobath approach provides similar outcomes in function to other treatment approaches. In all four articles, subjects that received Bobath based treatment initiated in an acute care setting demonstrated statistically significant increases in function. However, the increases in function were either not statistically different than the improvements noted in comparison groups or Bobath group effect sizes were slightly lower than comparison groups. In Gelber et al., there was no difference found between the Bobath approach and the Traditional Functional Retraining group in regards to gait speed or the Functional Independence Measure. Wang et al. found the Bobath group improvement on the Berg Balance Scale was no different than subjects who received an orthopedic approach. Subjects in the Bobath group did have a greater improvement on the MAS, but the fair internal validity of this study slightly limited its usefulness. Van Vliet et al. had good internal validity and provided moderate evidence that the Bobath approach was similar to a Movement Science Based approach because there was no difference between group improvement on the Rivermead Motor Scale, Motor Assessment Scale, or gait speed. Lastly, Langhammer et al provided moderate evidence that the Bobath approach was slightly less favorable when compared to a Motor Relearning Program (MRP) on the Sodring Motor Evaluation Scale and Motor Assessment Scale. Between group analysis revealed a small effect size favoring the MRP group, but the lower end of the confidence interval crossed zero indicating that in future trials the Bobath approach could have been more effective. The MRP group did have a statistically significant shorter length of hospital stay. Therefore, the inclusion of a Bobath approach did not provide any additional increases in patient function than comparison treatments did.

As mentioned previously, the Bobath approach now includes task specific practice with a focus on normalizing tone and movement sequence. It is important to note that the four articles examined in this review focused on an earlier interpretation of the approach where task specific training is not included. Therefore, future research on the subject is required to ascertain as to how beneficial the Bobath approach is in combination with task specific practice.

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