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HandFun Meeting 2013
HandFun Meeting 2013
HandFun Meeting 2013
HandFun Meeting 2013

HandFun Meeting 2013

Bobath Concept

qAssessment and rehabilitation of persons with disorders of function, movement and postural control.

qCurrent Neurophysiology.

Bobath Concept q   Assessment and rehabilitation of persons with disorders of function, movement and postural

qScience movement (motor control, motor learning).

qBiomechanics and sensory components, perceptual, cognitive, adaptive and motor.

qNormal movement.

Where does our hand begin?

Where does our hand begin? Hand as the organ that explores and interacts with the world.

Hand as the organ that explores and interacts with the world.

Tallis, 2008

Hand evaluation

qPsychological / Cognitive / Emotional (Physiotherapist, Occupational Therapists, Neuropsychologist)

qSensitive / proprioceptive and perceptive.

qMotor.

Standardized Tests:

  • - Rivermead

  • - Fugl-Meyer Scale

  • - Motor Activity Log (MAL)

  • - etc

Hand evaluation q   Psychological / Cognitive / Emotional (Physiotherapist, Occupational Therapists, Neuropsychologist … ) q

Specific work of the hand

Individual C. Task Environment
Individual C.
Task
Environment
Specific work of the hand Individual C. Task Environment

Specific work of the hand

1. Individual characteristics

qStability precedes mobility.

qPostural Control ßà Hand

qActive participation by the patient.

qLearning organization and integration.

Specific work of the hand 1. Individual characteristics q   Stability precedes mobility . q  
Specific work of the hand 1. Individual characteristics q   Stability precedes mobility . q  
Specific work of the hand 1. Individual characteristics q   Stability precedes mobility . q  

Specific work of the hand

2.Environment

Specific work of the hand 2.Environment
Specific work of the hand 2.Environment

Specific work of the hand

3.Task

The patients participation

Specific work of the hand 3.Task The patients participation Motivation Cognitive processes/Planning Cortical organization/Learning Movement facilitation

Motivation Cognitive processes/Planning Cortical organization/Learning

Movement facilitation by physiotherapist

Specific work of the hand 3.Task The patients participation Motivation Cognitive processes/Planning Cortical organization/Learning Movement facilitation

Search normal patterns of movement Task success Reinforce feedback and help feedforward

Visual input Parietal cortex Primary motor cortex Movement Somesthetic input Premotor cortex
Visual input
Parietal cortex
Primary motor
cortex
Movement
Somesthetic input
Premotor cortex

FUNCTIONALITY

Specific work of the hand

Motor Sensitive Components to make an EFFICIENT MOVEMENT
Motor
Sensitive
Components to
make an
EFFICIENT
MOVEMENT
Cognitive
Cognitive
Biomechanical
Biomechanical
FUNCTIONALITY Specific work of the hand Motor Sensitive Components to make an EFFICIENT MOVEMENT Cognitive Biomechanical
Perceptual
Perceptual

Mayston, 1999

FUNCTIONALITY Specific work of the hand Motor Sensitive Components to make an EFFICIENT MOVEMENT Cognitive Biomechanical
FUNCTIONALITY Specific work of the hand Motor Sensitive Components to make an EFFICIENT MOVEMENT Cognitive Biomechanical

Environment and contact with the space

Environment and contact with the space Patient Gives meaning to the task. Physiotherapist Gives the preparation
Environment and contact with the space Patient Gives meaning to the task. Physiotherapist Gives the preparation

Patient

Environment and contact with the space Patient Gives meaning to the task. Physiotherapist Gives the preparation

Gives meaning to the task.

Physiotherapist

Environment and contact with the space Patient Gives meaning to the task. Physiotherapist Gives the preparation

Gives the preparation of the hand (form, size ).

CONCLUSIONS

qIt’s a concept, not a technique or a method.

qIt kept in mind postural control and motor learning.

qComponent cognitive, sensory, proprioceptive, motor and integration into daily life.

qThree factors to consider: individual, task and environment.

qCollaboration with other professionals, therapies and approaches.

qMirror Therapy, forced use therapy, new technologies, splints and other assistance.

BIBLIOGRAPHY

Bobath, B.; Hemiplejia del adulto: Evaluación y Tratamiento; 1999; Editorial Médica Panamericana

De Diego C, Puig S, Navarro X. A sensorimotor stimulation program for rehabilitation of chronic stroke patients. Restor Neurol Neurosci. 2013; 31(4):361-71

Majnemer, A., Bourbonnais, D., Frak, V., (2008). The role of sensation for hand function in children with cerebral palsy. Clinics in Developmental Medicine: Improving hand function in cerebral palsy: theory, evidence and intervention . A-C Eliasson, and P. Burtner. Eds, MacKeith Press.

Mayston M (1999) An overview of the central nervous system. Workshop, SA Neurodevelopmental therapy Association, Johannesburg , 1999.

Ertelt D, Hemmelmann C, Dettmers C, Ziegler A, Binkofski F.; Observation and execution of upper-limb movements as a tool for rehabilitation of motor deficits in paretic stroke patients: protocol pf a randomized clinical trial. BMC Neurology 2012, 12:42

Oujamaa L, Relave I, Froger J, Mottet D, Pelissier JY. Rehabilitation of arm function after stroke. Literature review. Ann Phys Rehabil Med. 2009; 52(3):269-93.

Paeth, B.; Experiencias con el concepto Bobath: fundamentos, tratamiento, casos; 2006; Editorial Médica Panamericana

Partridge CJ.; Physiotherapy approaches to the treatment of neurological conditions - an historical perspective. In:

Edwards S, editor(s). Neurological physiotherapy. A problem-solving approach. Edinburgh: Churchill Livingstone, 1996:3-14.

BIBLIOGRAPHY

Paci M. Physiotherapy based on the Bobath concept for adults with post-stroke hemiplegia: a review of effectiveness studies. J Rehabil Med 2003; 35:2-7.

Scalha TB, Miyasaki E et al; Correlations between motor and sensory functions in upper limb chronic hemiparetics after stroke. Arquivos de Neuro-Psiquiatria 2011; 69 (4), 624-9

Schabrun S, Hillier SL; Evidence for the retraining of sensation after stroke: a systematic review. Clinical Rehabilitation 2009; 23; 27-39

Shumway-Cook A, Woollacott MH. Motor control: translating research into clinical practice. 3rd ed. Philadelphia:

Lippincott Williams & Wilkins; 2007Tallis, R.; The Hand; 2008

Smania N, Montagnana B, Faccioli S, Fiaschi A, et al. Rehabilitation of somatic sensation and related deficit of motor control in patients with pure sensory stroke. Archives of Physical Medicine and Rehabilitation 2003; 84(11):1692-702.

Waller, SM.; Prettyman, MG; Arm training in standing also improves postural control in participants with chronic stroke.

Gait & Posture, Volume 36, Issue 3, 2012: 419-42

Winges, SA., Weber, D J., Santello, M. The role of vision on hand preshaping during reach to grasp. Experimental Brain Research, 2003; 152(4):489-98.

Wolf, S.L., Winstein, C.J., Taub, E., Uswatte, G., Morris, D., Giuliani, C., Light, K.E., and Nicholas-Larsen, D. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: The EXCITE randomized clinical trial. JAMA : The Journal of the American Medical Association. 2006, 296(17), 2095-2104.

Wolf, S. L., Winstein, C. J., Miller, P., Thompson, P. A., Taub, E., Uswatte, G., Morris, D., Blanton, S., Nicols-Larsen, D., and Clark, P. Retention of upper limb function in stroke survivors who have received constraint-induced movement therapy: the EXCITE randomized trial. Lancet Neurological 2008; 7:33-40.

¡ THANKS !