The Bobath concept was born in the 1940s from the collaboration between a German physiotherapist and a Czechoslovakian doctor, Mr and Mrs Bertha and Karel Bobath. Both Jews, they met in London, cities in which they had taken refuge due to the spread of Nazism. From the beginning of her career, Bertha tried her hand at the rehabilitation of spastic patients. This initial experience laid the foundations for all of his subsequent achievements; since the opening of the center for the treatment of spastic children in London in 1944, to the Western Cerebral Center creation in 1957. On the other hand, since 1951 Bertha had officially joined her own rehabilitation practice with teaching and in 1954, with the discussion of the thesis "Anomalies of posture reflexes in brain lesions", she had become a member of the Chartered Society of Physiotherapy.

Before meeting Bertha, Dr. Karel Bobath had worked mainly in the pediatric field, dealing more specifically with infantile cerebral palsy (Stealth grain 1992). He began collaborating with the Western Cerebral Center (WCC) of Bertha as a consultant since 1957 and his medical training enabled him to provide theoretical support to the empirical results of Bertha's work. It was from their very close collaboration in the WCC that the method that bears their name developed. This is where the idea was born, revolutionary for the time, that spasticity “is not a fixed state, but which can be influenced by appropriate re-education (Cachet et al, 2000). Revolutionary idea because it will take many more years for the scientific world to realize and accept that our central nervous system is anything but a rigid and immutable biological structure, as was believed at the time, and why we start talking about neuroplasticity. We learn from Cachet H.. et all that according to Karel Bobath " (…) children with neurological distress are not born with abnormal Chinese, but they develop them when they try to evolve in their environment. Early therapeutic intervention would therefore be of great help in guiding this development, avoiding the establishment of irreversible schemes.” (Cachet et al, 2000).

"THE TONE IS THE SHADOW OF MOVEMENT". The centrality of the role of muscle tone in the Bobath Concept. Notes on the method.

In reality it is extremely difficult to elaborate a synthetic disclosure on the Bobath Concept because this method does not deliberately have a structured approach.. That the rejection of a structured approach is an inherent feature of the Bobath Concept can be seen immediately by reading the premise of the first edition of one of the most popular reference texts on the subject (Cachet et al, 2000): “Since it is a concept and not a technique, there are no absolute rules that can be applied equally to all patients. Anything that contributes to allowing the patient to learn a new skill or to move in a more normal way can certainly be included in the treatment plan ". In reality, this idea is repeated quite frequently when we approach texts that deal with the Bobath Concept: "Mrs Bobath felt it was important that the treatment did not consist of a structured set of exercises to be prescribed to all patients, but rather a wide variety of adaptable and flexible techniques in such a way as to meet the changing needs of individuals” (Stealth grain, 1992).

However, we can identify a common thread within this method: muscle tone. Its centrality within the Bobath Concept is such that the famous phrase of the Bobath spouses, "The tone is the shadow of movement", it ended up becoming almost a synonym for the method itself.

The neurological knowledge of the time had already highlighted how spastic hypertonia, found in hemiplegic patients, was due to a lack of inhibitory control by the central snow system (SNC) due to a lesion of specific areas (CNS lesion of the pyramidal type). These notions suggested to Bertha Bobath the idea that rehabilitation treatment should mainly aim at restoring that lack of inhibition. She therefore tried her hand at the beginning of her career to identify the methods of treatment that they could induce an inhibitory effect on muscle tone to promote the production of physiological movements. This intuition was reflected in the results of his rehabilitation practice from which it emerged that indeed, with an early clinical intervention "it was possible to influence the tone through afferent inputs" (Bobath, 1970). In the nineties Bertha, illustrating the results she and Karol had achieved over many years of work, will write that "the main problem observed in the patients was a abnormal coordination of motor patterns in combination with an abnormal tone, is that strength and activity of individual muscles were of secondary importance.” (Bobath, 1990).

The evolution of the method over the years led to the identification and use of inhibitory postures (reflex inhibiting postures) and movement patterns with an inhibitory effect (reflex inhibiting patterns): in the first case these are static postures that have the effect of inhibiting abnormal tone and reflexes; in the second case of movement patterns in which rotary components prevail and which have the purpose of inhibiting stereotyped movement patterns. (Bobath 1990).

In the subsequent elaboration of the method, the patient played an increasingly active role in the treatment: "The best inhibition turned out to be the patient's activity itself" (Mayston, 1992); the normalization of tone and the facilitation of voluntary movement were then pursued by intervening on Key Points of Control or specific areas of the body (shoulders, hip bone, hands, feet..) that appropriately stimulated manually by the physiotherapist with inhibitory or facilitating techniques (handling) they can lead the patient to maintain correct posture or to perform physiological movements.

Among the different methods of intervention typical of this method we also find placing (technique involving the movement of a patient's limb in a certain position that he will have to maintain against gravity), guiding (guided movement therapy: the therapist guides the patient's hands and body during the execution of concrete tasks that require interaction with the environment in order to solve a problem), the re-education of equilibrium reactions, techniques of self-inhibition of muscle tone and associated reactions.

BIBLIOGRAPHY

KOLLEN, Baldwin J., et al. The effectiveness of the Bobath concept in stroke rehabilitation: what is the evidence?. Stroke 2009, 40:e89-e97.

Cochet H., Allamargot T., Bertin A., Jaillard P., Lapierre S., Lasalle T., Bobath reeducation concept in neurology. Encycl Med Chir (Scientific and Medical Editions Elservier SAS, Paris) Rehabilitation Medicine, 26-060-8-10, 2000, 14 p.

Patricia M. Davies. Step by step. Integrated treatment of patients with hemiplegia. Springer 2004

(Stealth grain 1992) in COLLEN, Baldwin J., et al. The effectiveness of the Bobath concept in stroke rehabilitation: what is the evidence?. Stroke 2009

(Bobath 1970, 1978) in COLLEN, Baldwin J., et al. The effectiveness of the Bobath concept in stroke rehabilitation: what is the evidence?. Stroke 2009

Bobath 1990 in COLLEN, Baldwin J., et al. The effectiveness of the Bobath concept in stroke rehabilitation: what is the evidence?. Stroke 2009

Mayston 1992 in COLLEN, Baldwin J., et al. The effectiveness of the Bobath concept in stroke rehabilitation: what is the evidence?. Stroke 2009