The Bobath concept: a critical review of the theoretical assumptions that guide physiotherapy practice in stroke rehabilitation

Stroke is the third most common cause of death in the adult population and a major consumer of health care resources. Physiotherapists spend a large proportion of their time rehabilitating patients following stroke using a variety of treatment approaches. The Bobath concept has gained international acceptance as one of the leading approaches in stroke rehabilitation. The aim of physiotherapy using this concept is to re-educate normal movement by the manipulation of a variety of afferent inputs which are mainly proprioceptive. Recent papers have criticized this concept for failing to integrate new knowledge into its theoretical rationale.The aim of this paper is to review the published literature concerning physiotherapy using the Bobath concept in stroke rehabilitation. The key assumptions that guide current practice are identified: a systems theory of motor control; neuroplasticity shaped by manipulation of afferent inputs; and neurophysiological dysfunction as the primary cause of movement dysfunction. These assumptions are then discussed in relation to current understanding of how movement is controlled in both normal and brain damaged adults following stroke.