Overview of the Bobath approach for children with CP

History and Development of the Bobath Method

Berta and Karel Bobath made a significant contribution to the development of cerebral palsy (CP) rehabilitation methods.
In the 1940s, they began working on their approach based on Berta Bobath’s clinical observations. Their views were influenced by the dominant theory of reflex and hierarchical maturation of the nervous system at that time.

Through numerous publications, lectures, and courses delivered by the Bobaths and their students, the Bobath concept — also known as Neuro-Developmental Treatment (NDT) — spread worldwide and greatly influenced post–World War II rehabilitation principles for children with CP.

Bobath Perspective on Motor Problems in Cerebral Palsy

According to the Bobaths, motor problems in cerebral palsy result from damage to the central nervous system.
This leads to:

• impaired development of postural anti-gravity mechanisms,
• slowed and distorted normal motor development.

The goal of rehabilitation is to:

• stimulate normal motor development,
• prevent contractures and deformities.

Sensory-Motor Components Targeted by the Bobath Method

The Bobath neurodevelopmental approach focuses on sensory-motor components that are most commonly affected in central nervous system disorders:

• muscle tone,
• reflex activity,
• pathological movement patterns,
• postural control,
• sensory processing,
• perception and memory.

Early Principles of the Bobath Approach

Their early therapeutic strategy included:

• using specific body positions,
• applying handling and caregiving techniques that regulated sensory input to the nervous system.

These methods aimed to:

• reduce muscle spasticity,
• decrease pathological reflexes and abnormal movement patterns,
• develop normal muscle tone,
• support balance reactions and functional movement patterns.

In this phase, the child remained a relatively passive recipient of therapy.
An essential theoretical assumption was the strict adherence to the typical sequence of motor development.

How the Bobath Approach Evolved Over Time

Over time, based on clinical experience and advances in neurophysiology, the Bobaths revised many of their original ideas.

1. Positions that Suppressed Pathological Reflexes

Initially, they emphasized placing the child in positions designed to inhibit abnormal reflexes.
Later, they found that:

• The reduction of spasticity was temporary,
• The improvement did not carry over into functional movement.

2. “Key Points of Control”

The focus shifted toward:

• therapeutic handling during active movement,
• suppressing abnormal motor patterns,
• encouraging more functional and efficient alternative movements.

3. Development of Active Movement Control

In their final publication (1984), the Bobaths acknowledged several misconceptions:

• They overemphasized automatic righting reactions, expecting children to transfer these skills to voluntary movements,
• They were too rigid in following the normal sequence of motor development.

As a result, they began placing far more importance on:

• helping the child actively control their own movements,
• supporting the development of balance and postural control.

They concluded that strict adherence to the typical developmental sequence was not appropriate for all children with CP.

About the author

Taras Voloshyn

Neurologist at the Kozyavkin International Rehabilitation Clinic since 2009. Conference participant, author of publications, specialized in the assessment and rehabilitation of patients with cerebral palsy.