BOBATH AND

BRUNNSTORM
APPROACHES

Presented to: Dr.Saima Gul

Presented by: Kafayat Ali Khan
What is the Bobath Approach?
• The Bobath is Holistic Approach designed to address the
unique needs of each patient. It is a personalized approach
that considers the individual's specific impairments,
abilities, and goals.

• Primarily used in neurorehabilitation, the Bobath Approach

aims to improve motor control and functional abilities in
patients with neurological conditions, such as stroke,
cerebral palsy, and traumatic brain injuries.
 Founders: Berta and Karel
• Bobath
The Bobath Approach was developed in the 1940s
and 1950s, a time when understanding of
neuroplasticity and motor control was expanding.
Berta and Karel Bobath’s work was revolutionary in
integrating these concepts into practical
therapeutic techniques.
• Berta Bobath : A physiotherapist who, alongside her
husband, developed this approach. Her expertise in
movement and neurological conditions helped
shape the principles and techniques used in the
Bobath Approach.
• Karel Bobath : A neurologist who worked closely
with Berta, providing the medical and neurological
insights that grounded the approach in scientific
understanding.
 Key Principles of the Bobath Approach
= Focus on Normal Movement Patterns:

• Restoring Normal Movement: The Bobath Approach prioritizes the

restoration of normal movement patterns. This means that therapists
aim to help patients perform movements in a way that is as close to
normal as possible. The goal is to integrate these normal movements
into the patient’s daily activities, thereby improving their overall
function and quality of life.
• Functional Tasks: Normal movement patterns are often practiced
through functional tasks that patients encounter in their everyday
lives. For example, reaching, grasping, standing, and walking are all
activities where normal movement patterns are encouraged and
reinforced.
 Key Principles of the Bobath Approach
= Inhibition of Abnormal Movement:

• Reducing Abnormal Tone: Abnormal muscle tone, such as spasticity

(increased muscle tone) or flaccidity (decreased muscle tone), is a
common issue in patients with neurological impairments. The Bobath
Approach uses specific techniques to reduce this abnormal tone. This
can involve gentle stretching, positioning, and other manual
techniques to normalize muscle tone.
• Minimizing Abnormal Reflexes: In some cases, patients may exhibit
abnormal reflexes or involuntary movements. The Bobath Approach
aims to minimize these abnormal reflexes by using handling
techniques that promote more controlled and voluntary movements.
 Key Principles of the Bobath Approach
= Facilitation of Normal Postural Control:

• Stability and Balance: Good postural control involves achieving

stability and balance. Therapists use various techniques to help
patients develop the ability to maintain balance in different positions,
whether sitting, standing, or moving.
• Dynamic Postural Adjustments: Normal postural control also involves
the ability to make dynamic adjustments as the body moves. For
example, when reaching for an object, the body must adjust its
posture to maintain balance. The Bobath Approach helps patients
practice these adjustments to improve their overall functional abilities.
 Bobath Approach Techniques

Handling: Use of specific techniques to guide movement.

Positioning: Proper positioning to promote normal movement patterns.
Therapeutic exercises: Exercises tailored to improve functional
movement.
 Handling:
Guiding Movement:
• Manual Guidance: Handling involves the therapist using
their hands to guide and support the patient’s movements.
This helps the patient perform movements that are closer
to normal and functional.
• Facilitation: Through careful and skilled handling, therapists
facilitate the activation of muscles and movement patterns
that are needed for normal, coordinated actions.
Examples of Handling Techniques:
• Inhibiting Spasticity: Using gentle, sustained pressure or
slow movements to reduce spasticity and muscle
overactivity, thereby enabling smoother, more controlled
movements.

• Assisting Transfers: During activities like moving from

sitting to standing, the therapist might use their hands to
guide the patient's hips and trunk to ensure proper
alignment and weight distribution.
 Positioning:
• Promoting Normal Movement Patterns:
⚬ Alignment: Proper positioning ensures that the patient’s
body is aligned in a way that promotes normal
movement and reduces abnormal tone.

⚬ Comfort and Functionality: Positioning is not just about

static alignment but also about placing the patient in a
position that is comfortable and functional, allowing
them to engage in meaningful activities.
Examples of Positioning Strategies:
• Bed Positioning: Positioning the patient in bed to prevent
contractures and pressure sores. For instance, placing a pillow
under the affected arm to support the shoulder and prevent it
from pulling forward.

• Sitting Position: Ensuring that the patient sits with their feet flat
on the floor, knees and hips at a right angle, and the trunk
upright to encourage proper postural control and ease of
movement.

• Wheelchair Positioning: Adjusting the wheelchair to support the

patient's posture, ensuring their pelvis is in a neutral position,
and providing support for the trunk and head if needed.
Therapeutic Exercises:
• Improving Functional Movement:
• Task-Oriented: Exercises are designed to be functional and
relevant to the patient's daily activities. They focus on
improving specific movements that the patient needs to
perform regularly.

• Repetition and Practice: Repetition of these exercises helps

to reinforce normal movement patterns and improve motor
learning.
Examples of Therapeutic Exercises:
• Reaching Tasks: Practicing reaching for objects in various
directions to improve arm function and coordination.
• Weight Shifting: Exercises that involve shifting weight from one
side to the other to improve balance and postural control. For
example, side-to-side weight shifts while standing or sitting.
• Step Training: Practicing stepping forward, backward, and
sideways to improve gait and balance. This can be done using
parallel bars or other supports initially and gradually moving to
more independent steps.
• Trunk Rotation: Exercises that encourage trunk rotation and
control, such as reaching across the body while sitting or
standing.
Benefits of the Bobath
Approach

Promotes functional Improves quality of

independence: movement:
Helps patients achieve Focuses on efficient,
everyday tasks. effective movement.
What is the Brunnstrom Approach?
Structured Method for Motor Recovery:

• The Brunnstrom Approach is a systematic method used in

neurorehabilitation that focuses on the stages of motor recovery
after a stroke or other neurological injury. It involves guiding
patients through a series of stages to regain motor control and
function.
• This approach recognizes that patients typically progress through
specific stages of recovery, starting from no movement to more
complex voluntary movements. Each stage has specific
characteristics and goals.
 Founders: Signe Brunnstrom
• Signe Brunnstrom was a physical therapist
who developed this approach in the mid-20th
century. Her work was instrumental in
understanding and treating motor
impairments in stroke patients.

• Brunnstrom's approach was groundbreaking

at the time because it provided a clear
framework for assessing and treating motor
recovery, which was particularly useful for
therapists working with stroke patients.
 Principles of the Brunnstrom Approach
Use of Synergy Patterns:
• Definition:
⚬ Synergy Patterns: Synergy patterns are coordinated
muscle movements that often appear during the early
stages of motor recovery. They are involuntary and
usually consist of groups of muscles working together in
fixed patterns.
 Principles of the Brunnstrom Approach
Encourages Use of Reflexes and Movement Patterns:
• Primitive Reflexes: In the early stages of recovery, patients
often rely on primitive reflexes (basic, automatic
movements) to initiate movement. These reflexes are used
to help the patient begin moving even when voluntary
control is limited.
• Facilitation of Movement: By encouraging the use of these
natural reflexes and synergy patterns, therapists can help
patients achieve some movement early in their recovery
process, providing a foundation to build upon as they
progress.
Principles of the Brunnstrom Approach
• Example of Synergy Patterns:
⚬ Flexor Synergy Pattern: Common in the upper limbs, this
involves bending the arm at the elbow, bringing the
hand towards the shoulder, and typically includes
shoulder elevation and wrist flexion.
⚬ Extensor Synergy Pattern: Common in the lower limbs,
this involves extending the leg at the knee, pointing the
toes downward, and typically includes hip extension and
adduction.
 Principles of the Brunnstrom Approach
Stages of Motor Recovery:
• Stage 1: Flaccidity: No voluntary movement or muscle tone
is present. The limb is limp and unable to move on its own.
• Stage 2: Spasticity Appears: Basic movement patterns, or
synergies, begin to appear. The patient may show small,
involuntary movements.
• Stage 3: Increased Spasticity: Synergy patterns become
stronger, and the patient can start moving voluntarily
within these patterns.
 Principles of the Brunnstrom Approach
Stages of Motor Recovery:
• Stage 4: Decreased Spasticity: The patient gains more
voluntary control and can begin performing movements
outside of the synergy patterns.
• Stage 5: Complex Movements: The patient can perform
more complex and coordinated movements, with minimal
spasticity.
• Stage 6: Normal Function: Spasticity disappears, and the
patient can perform normal, isolated movements.
Coordination and motor control return to near-normal
levels.
 Principles of the Brunnstrom Approach
Functional Improvement:
⚬ Daily Activities: The ultimate goal of the Brunnstrom
Approach is to enhance the patient's ability to perform
daily activities independently. This includes tasks like
dressing, eating, and walking.
⚬ Functional Independence: By progressing through the
stages and improving motor control, patients can
achieve greater functional independence, significantly
improving their quality of life.
 Brunnstrom Approach Techniques

1.Encouraging Movement through Reflexes and

Synergies
2.Facilitation Techniques
 Encouraging Movement through
Reflexes and Synergies:
• Utilizing Existing Reflexes:
⚬ Primitive Reflexes: These are automatic movements
that the body naturally performs, such as the grasp
reflex where a hand closes when something touches the
palm.
⚬ Early Stages: In the early stages of recovery, therapists
use these natural reflexes to help patients start moving.
For example, they might stimulate a reflex to help a
patient begin to move their arm or leg.
 Encouraging Movement through
Reflexes and Synergies:
Synergy Patterns:
• Coordinated Muscle Movements: Synergy patterns involve
groups of muscles working together in fixed, predictable
ways. For example, lifting the arm might automatically
involve bending the elbow and wrist.
• Initial Movement: By encouraging these patterns,
therapists help patients achieve some initial movement
even if they can't move voluntarily yet. This sets the stage
for further recovery.
 Facilitation Techniques:
Helping Patients Achieve Voluntary Control:
• Guided Practice: Therapists use their hands to guide and
support the patient’s movements, helping them perform
specific actions more effectively.
• Providing Feedback: As patients practice these movements,
therapists provide feedback and adjustments to improve
their control and reduce abnormal movements.
• Building on Success: Each small movement achieved
through facilitation helps build the patient’s confidence and
ability to perform more complex movements over time.
Examples:
• Reflex Training: Stimulating a reflex, such as tapping the
knee to produce a leg kick, to initiate movement in the
early stages.
• Guided Reaching: Using the therapist’s hands to guide a
patient's arm as they reach for an object, helping them
learn to control the movement better.
• Step-by-Step Progression: Starting with simple movements
like bending the elbow, and gradually working up to more
complex tasks like reaching overhead or walking.
Benefits of the Brunnstrom
Approach

Identifying recovery
Structured approach:
stages:
Clear stages for
Helps in assessing
therapists to follow.
patient progress.
Thank You