Bobath UPN PDF

NEW BOBATH CONCEPT For Stroke Patient: EVIDENCE INTO PRACTICE @aaggustiyawan  NEW BOBATH CONCEPT The Bobath concept is a problem- solving approach to the assessment and treatment of individuals with disturbances of function, movement and postural control due to...

NEW BOBATH CONCEPT For Stroke Patient: EVIDENCE INTO PRACTICE @aaggustiyawan  NEW BOBATH CONCEPT The Bobath concept is a problem- solving approach to the assessment and treatment of individuals with disturbances of function, movement and postural control due to a lesion of the central nervous system (IBITA 1996, Panturin 2001, Brock et al 2002, Raine 2006).  NEW BOBATH CONCEPT The goal of treatment is to optimize function by improving postural control and selective movement through facilitation. (IBITA, 1995) Backgroun d INDEPENDENT STABILITY, MOVEMENT, CONTROL & FUNCTION DEPENDENT (Raine, 2013)  ACTIVITY IMPAIRMENT PARTICIPATION LIMITATION POSTURAL STABILITY  Center of Central Gravity Line of of Mass Gravity STABILITY MOBILITY Base of Ground Support Force Stability Reaction Limit  FORCES ACTING ON THE BODY MOVEMENT SYSTEM NEURAL CONTROL SYSTEMS APPROACH TO MOTOR CONTRO  PLASTICITY Motor learning is the permanent change in an individual’s motor performance brought about as a result of practice Cortical plasticity Although not totally reversible, there have been numerous findings demonstrating cortical plasticity and remapping following a cortical lesion. Muscle plasticity Skeletal muscle can be either conditioned or deconditioned depending upon the demands put on the muscle, and these can influence properties such as strength, speed and endurance of the muscle.  NEURAL AND MUSCLE PLASTICITY SISTEM STRATEGY NEUROMUSCULAR PERFORM A TASK PLASTICITY  POSTURAL B CONTROL SELECTIVE O MOVEMENT BODY GEOMETRI B TASK BODY DYNAMICS BODY A PERFORMANCE ORIENTATION T MOTOR CONTROL H MOTOR LEARNING  The Concept Bobath Concept exercise is the systematic, planned performance of bodily movements, postures, or physical activities intended to provide a patient/client with the means to: Remediate or prevent impairments. Improve, restore, or enhance physical function. Prevent or reduce health-related risk factors. Optimize overall health status, fitness, or sense of well-being. Postural Control  Core Stability Muscle  The multifidus pass along 2 or 3 spinal level. Work as segmental stabilizers.  Not much in gross movement  Position sensor of spinal segment  Rich composition of muscle spindle  Multifidus have been found to atrophy in people with low back pain.  Core Stability Muscle  Vital component of the core  Transfersus abdominis shown to active before limb movement.  Stabilize the lumbar spine  Amdominal muscle increase intra abdominal pressure, thus imparting functional stability of the lumbar spine. Hodges, 1996 McGill, 2002  Core Stability Muscle  Hip extensor and abductor muscles play significant role in transferring force from lower extremities to pelvic and spine. Nadler, 2001  Trunk Muscle Categorization Primary Secondary Transfersus Internal oblique Rectus abdominalis abdominalis External oblique External oblique Multifidus Quadratus lumborum Erector spine Postural holding with an anti Rapid ballistic and gravity task movement Anticipatory Mechanisms  We are loosing our walking skill Is it the downward pull of gravity of the different exposure to it in ADL HUMAN LOCOMOTION contains two aspects: – Voluntary initiation and adaptation Cognition is involved with visual scanni perception, navigation et – Automatic control of movemen Base Of Suppor Displacement of the COM Displacement of the COM Energi Potensial dan Energi Kinetik Energi Energi Kinetik Potensial  Energy Expenditure 1.6 1.4 1.2 1.0 0.8 20 40 60 80 10 12 14 16 0 0 0 0 Economical parameter of Gait Forwards weight displacement reactive walking pattern Automatical / CPG activity Cadence: >70 Steps/min Normal speed 112-120 Steps/min  Progression  Classic “Butterfly” Ground Force Reaction  Progression initial contact – pre swing  takes place from left to right Research 30 3 times a week for 8 week CENTRAL OF PRESSURE BEFORE (PRE AFTER (POST TEST) TEST) 34,93% CoP (weak 48,80% CoP (weak side) side) Treatment - Lying  Proper lying  Alignment  Stability on Mobility Treatment - Sitting Treatment - Sitting Treatment – Sit to stand waktu waktu Treatment – Standing  Treatment – Walking Initial contact produce optimal GRF Treatment – Walking  Summary Create as efficient movement as possible