Evaluaciones bobaht

Evaluation of the functional effects of a course of Bobath therapy in children with cerebral palsy: a preliminary study
Virginia Knox* MSc MCSP Research Physiotherapist, Bobath , Centre; Andrew Lloyd Evans MA MD FRCPCH, Consultant and Senior Lecturer in Neurodevelopmental Paediatrics, Royal Free Hospital, London, UK. *Correspondence to first author at Bobath Centre, 250 East End Road, London N28AU, UK. E-mail: info@bobathlondon.co.uk

This study aimed to evaluate functional effects of Bobath therapy in children with cerebral palsy (CP). Fifteen children with a diagnosis of CP were recruited (9 males, 6 females; mean age 7 years 4 months, SD 2 years 8 months; age range 2 to 12 years). Types of motor disorder were as follows: spastic quadriplegia (n=9); spastic diplegia (n=4); athetoidquadriplegia (n=1), and ataxia (n=1). Participants were distributed across the following Gross Motor Function Classification levels: level I, n=1; level II, n=4; level III, n=5; level IV, n=4; and level V, n=1. Children awaiting orthopaedic intervention were excluded. A repeated measures design was used with participants tested with the Gross Motor Function Measure (GMFM) and Pediatric Evaluation ofDisability Inventory (PEDI) at 6-weekly intervals (baseline, before and after Bobath therapy, and follow-up). As the data were of ordinal type, non-parametric statistics were used, i.e. Wilcoxon’s test. Participants showed a significant improvement in scores in the following areas following Bobath therapy compared with the periods before and after Bobath therapy: GMFM total score (p=0.009); GMFMgoal total (p=0.001); PEDI self care skills (p=0.036); and PEDI caregiver assistance total score (p=0.012). This demonstrates that in this population, gains were made in motor function and self care following a course of Bobath therapy.

At present it is difficult to demonstrate the effects of physiotherapy in children with cerebral palsy (CP). This is because of different motor disorders, avariety of treatment approaches which lack clear description, and a lack of suitable validated evaluative tools. Hur (1995) reviewed 37 studies of therapeutic interventions for children with CP and reported that the majority of the studies had small samples, were poorly controlled, and some lacked rigour in both experimental design and analysis. Of the seven studies using a comparative design, only twoshowed a significant treatment effect. However specific factors associated with physiotherapy have been shown to have a positive impact on the outcome of treatment. For example, the use of specific measurable goals in treatment rather than general aims may be associated with increased motor skill acquisition (Bower and McClellan 1992, Bower et al. 1996). Providing weekly rather than monthly therapy(Mayo 1991) and daily rather than weekly or fortnightly therapy (Bower et al. 1996) may accelerate the acquisition of motor skills. However, this is not supported by other work by Bower and colleagues (2001) where the use of goals did not appear to affect outcome and more intensive daily treatment only produced a limited and temporary improvement. Stretching tight muscle, regular change ofposition, provision of appropriate equipment, and encouraging mobility have all been shown to prevent or slow down the deterioration of secondary deformities (Watt et al. 1986, Tardieu et al. 1988, Myhr and von Wendt 1991, Chad et al. 1999). Treatment strategies involving both parents and children have been shown to be most effective in achieving an enhanced developmental outcome (Barrera et al. 1986,Shonkoff and Hauser-Cram 1987, Short et al. 1989). One therapy approach most widely used within the UK for children with CP is Bobath therapy (Bobath and Bobath 1984). The Bobath concept emphasizes observation and analysis of the client’s current functional skill performance (Mayston et al. 1997) and the identification of clear therapy goals. The aims of treatment are to influence muscle tone and...