American Journal of Health Research

| Peer-Reviewed |

An Individualised Learning and Exercise Program Based on the Bobath Concept to Facilitate Goal Achievement in People with Chronic Stroke

Received: 15 February 2021    Accepted: 24 February 2021    Published: 09 March 2021
Views:       Downloads:

Share This Article

Abstract

Background: To facilitate improvement in participation, therapy needs to be transferred into everyday life of people with chronic stroke. Individualised, home based, self-training exercise programs should be oriented towards the potential of the person, be specific to their ability and impairment levels, avoid compensation strategies as far as possible and operate at the upper limit of the individual’s ability level. Objectives: To investigate the effectiveness of an individualised learning and exercise program based on the Bobath concept for facilitating personal goal achievement in people with chronic stroke. Method: Repeated measures design. Fifty-five people with chronic stroke were recruited from participants in Advanced Bobath training courses. During the five day course, participants learned individualised self-training programs, which they then carried out at home for three months, adapting their program according to their performance level. The primary outcome measure was the Canadian Occupational Performance Measure (COPM) - Performance domain. Secondary measures included the COPM satisfaction domain, World Health Organisation Disability Assessment Score-2 (WHO-DAS2), and Goal Attainment Score (GAS). Measurements were taken three months and immediately prior to the Bobath course and three months after the course. Results: COPM-Perfomance, COPM-Satisfaction and the WHODAS-2 showed a significant difference over the time points, with followup scores significantly greater than both baseline and preintervention (p<.001). Sixty eight percent of participants achieved their personal goals (GAS). Conclusion: The study indicates that an individualised self-training approach based on Bobath principles may enable the transfer of acquired proficiency into the personal goals of people with chronic stroke.

DOI 10.11648/j.ajhr.20210901.14
Published in American Journal of Health Research (Volume 9, Issue 1, January 2021)
Page(s) 26-33
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Bobath, Individual Self Training, Exercise Program, Stroke

References
[1] Graven, C., Brock, K., Hill, K., & Joubert, L. (2011). Are rehabilitation and/or care co-cordinatiin intervention delivered in the community effective in reducing depression, facilitation participation and improving quality of life after stroke? Disabil Rehabil, S. 33 (17-18): 1501-20.
[2] Dobkin, B.-H. (2016). Behavioral self-management strategies for practice and exercise should be included in neurologic rehabilitation trials and care. Curr Opin Neurol, S. 29: 693–699.
[3] Mayo, N., Wood-Dauphinee, S., Côté, R., Durcan, L., & Carlton, J. (Aug 2002). Activity, participation, and quality of life 6 months poststroke. Arch Phys Med Rehabil, S. 83 (8): 1035-42
[4] van Mierlo ML & van Hoogstraten.-M. (2016). Quaility of Life during the first two years post stroke: The restore 4 Stroke Cohort Study. Cerebrovasc Dis., S. 41 (1-2): 19-26. doi: 10.1159/000441197.
[5] Ferrarello F, Baccini M, Rinaldi LA, et al. Efficacy of physiotherapy interventions late after stroke: A meta-analysis. J Neurol Neurosurg Psychiatry. 2011; 82 (2): 136-143. doi: 10.1136/jnnp.2009.196428.
[6] Morris, J., MacGillivray. S, & Mcfarlane. S. (2014). Interventions to promote long term particpation in physical activity after stroke: a systematic review of the literature. Archieves of Physical Medicine and Rehabilitation, S. 95: 956-67.
[7] Brazzelli, M., Saunders, D., Greig, C., & Mead, G. (Nov 2011). Physical fitness training for stroke patients. Cochrane Database Syst Rev., S. 9; (11): CD003316. doi: 10.1002/14651858.CD003316.pub4.
[8] Treger I, Landesman C, Tabacaru E, Kalichman L. Influence of home-based exercises on walking ability and function of post-stroke individuals. Int J Ther Rehabil. 2014; 21 (9): 441-446. doi: 10.12968/ijtr.2014.21.9.441.
[9] Rand, D., Weingarden, H., Weiss, R., et al (2017). Self-training to improve UE function at the chronic stage post-stroke: a pilot randomized controlled trial. Disabil Rehabil., 39 (15): 1541-1548. doi: 10.1080/09638288.2016.1239766. Epub 2016 Oct 28.
[10] Michielsen, M., Vaughan-Graham, J., Holland, A., Magri, A., & Suzuki, M. (2017). The Bobath concept – a model to illustrate clinical practice. Disabil and Rehab, https://doi.org.10.1080/09638288.2017.1417496.
[11] Law, M. B. (2005). Canadian Occupational Performance Measure (4th ed.).. Ottawa, ON: CAOT Publications ACE.
[12] Üstün, T., Chatterji, S., Kostanjsek, N., Rehm, J., & al., (2010). Developing the World Health Organisation Developing Schedule 2.0. Bull World Health Organ (88: 815-823).
[13] Collen, F., Wade, D., Robb, G., & & Bradshaw, C. (1991). The Rivermead Mobility Index: A further development of the Rivermead Motor Assessment. Intern Disabil, Vol 13, 50-54.
[14] Azouvi, P. (2017). The ecological assessment of unilateral neglect. Annals of Physical and Rehabilitation Medicine, 60 (3), 186–190. https://doi.org/10.1016/j.rehab.2015.12.005.
[15] Vaughan-Graham, J., & Cott, C. (2016). Defining a Bobath clinical framework-a modified e-Delphi study. Physiother Theory Pract, S. 32 (8): 612-627.
[16] Bovend’ Eerdt, TJ; Botell, R E, Wade, DT (2009). Writing SMART rehabilitation goals and achieving goal attainment scaling: a practical guide. Clinical Rehabilitation (23: 352-61).
[17] Eckhardt G, Brock K, Haase G, Puschnerus C, Hengelmolen-greb A, Böhm C. Bobath Concept Structural Framework (BCSF): Positioning Partial Aspects Within a Holistic Therapeutic Concept. 2018; 6 (4): 79-85. doi: 10.11648/j.ajhr.20180604.11.
[18] Cup, EH; Scholte op Reimer, WJ.; Thijssen, M., & van Kuyk-Minis, M. (2003). Reliability and validity of the Canadian Occupational Performance Measure in stroke patients. Clin Rehabil., 17 (4): 402-9.
[19] Lund, A. M. (2012). Development of a person-centred lifestyle intervention for older adults following a stroke or transient ischaemic attack.. Scandinavian Journal of Occupational Therapy, 19 (2), 140-149.
[20] McCall, M. M. (2011). Modified constraint-induced movement therapy for elderly clients with subacute stroke. The American Journal of Occupational Therapy, 65 (4), 409-418.
[21] Mew, M. (2010). Normal movement and functional approaches to rehabilitate lower limb dressing following stroke: A pilot randomised controlled trial.. British Journal of Occupational Therapy, 73 (2), 64-70.
[22] Nilsen, D. M. (2012). Effect of imagery perspective on occupational performance after stroke: A randomized controlled trial.. The American Journal of Occupational Therapy, 66 (3), 320-329. doi: 10.5014/ajot.2012.003.
[23] Roberts, P. S. (2005). Client-centered occupational therapy using constraint-induced therapy. Journal of Stroke and Cerebrovascular Diseases, 14 (3), 115–121.
[24] Shaw, L. R. (2010). BoTULS: A multicentre randomised controlled trial to evaluate the clinical effectiveness and cost-effectiveness of treating upper limb spasticity due to stroke with botulinum toxin type A. Health Technology Assessment, 14 (26), 1.
[25] WHO DAS manual. (May 2018). http://apps.who.int/iris/bitstream/handle/10665/43974/9789241547598_eng.pdf;jsessionid=CCE385357E0FCB553C927B70E5D7B3CC?sequence=1. abgerufen May 2018.
[26] Hsieh CL, Hsueh IP, Mao HF. (2000). Validity and responsiveness of the rivermead mobility index in stroke patients. Scand J Rehabil Med. (32 (3): 140-2).
[27] Hsueh, I., Wang, C., Sheu, C., & Hsieh, C. (2003). Comparison of psychometric properties of three mobility measures for patients with stroke. Stroke (34 (7): 1741-5).
[28] Krasny-Pacini, A., Hiebel, J., Pauly, F., Godon, S., & Chevignard, M. (2013). Goal Attainment Scaling in rehabilitation: A literature-based update. Annals of Physical and Rehabilitation Medicine, 56 (3), 212–230. https://doi.org/10.1016/j.rehab.2013.02.002.
[29] Vloothuis.JDM, van Wegen, E., Veerbek, J., Konijnenbelt, M. V.-M., & Kwakkel, G. (2015). Caregiver-mediated exercises for improving outcomes after stroke. Cochrane Library (issue 4, No CD0110058).
[30] Lohse, K., Lang, C., & Boyd, L. (2014). Is more better? Using meta data to explore doese-response relationships in stroke rehabilitation. Stroke (44 (7): 2053-8).
[31] Veerbeek JM, Wegen E Van, Peppen R Van, et al. (2014). What Is the Evidence for Physical Therapy Poststroke ? A Systematic Review and Meta-Analysis. 2014; 9 (2). doi: 10.1371/journal.pone.0087987.
Author Information
  • Center of Physiotherapy and Rehabilitation, Haan, Germany

  • St Vincent’s Hospital, Melbourne, Australia

  • Center of Physiotherapy and Rehabilitation, Haan, Germany

  • Juntendo University Nerima Hospital, Tokyo, Japan

  • Neurological Rehabilitation Center-Leipzig, Leipzig-Bennewitz, Germany

Cite This Article
  • APA Style

    Eckhardt Gabriele, Brock Kim, Haase Gerline, Ishida Toshie, Hummelsheim Horst. (2021). An Individualised Learning and Exercise Program Based on the Bobath Concept to Facilitate Goal Achievement in People with Chronic Stroke. American Journal of Health Research, 9(1), 26-33. https://doi.org/10.11648/j.ajhr.20210901.14

    Copy | Download

    ACS Style

    Eckhardt Gabriele; Brock Kim; Haase Gerline; Ishida Toshie; Hummelsheim Horst. An Individualised Learning and Exercise Program Based on the Bobath Concept to Facilitate Goal Achievement in People with Chronic Stroke. Am. J. Health Res. 2021, 9(1), 26-33. doi: 10.11648/j.ajhr.20210901.14

    Copy | Download

    AMA Style

    Eckhardt Gabriele, Brock Kim, Haase Gerline, Ishida Toshie, Hummelsheim Horst. An Individualised Learning and Exercise Program Based on the Bobath Concept to Facilitate Goal Achievement in People with Chronic Stroke. Am J Health Res. 2021;9(1):26-33. doi: 10.11648/j.ajhr.20210901.14

    Copy | Download

  • @article{10.11648/j.ajhr.20210901.14,
      author = {Eckhardt Gabriele and Brock Kim and Haase Gerline and Ishida Toshie and Hummelsheim Horst},
      title = {An Individualised Learning and Exercise Program Based on the Bobath Concept to Facilitate Goal Achievement in People with Chronic Stroke},
      journal = {American Journal of Health Research},
      volume = {9},
      number = {1},
      pages = {26-33},
      doi = {10.11648/j.ajhr.20210901.14},
      url = {https://doi.org/10.11648/j.ajhr.20210901.14},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ajhr.20210901.14},
      abstract = {Background: To facilitate improvement in participation, therapy needs to be transferred into everyday life of people with chronic stroke. Individualised, home based, self-training exercise programs should be oriented towards the potential of the person, be specific to their ability and impairment levels, avoid compensation strategies as far as possible and operate at the upper limit of the individual’s ability level. Objectives: To investigate the effectiveness of an individualised learning and exercise program based on the Bobath concept for facilitating personal goal achievement in people with chronic stroke. Method: Repeated measures design. Fifty-five people with chronic stroke were recruited from participants in Advanced Bobath training courses. During the five day course, participants learned individualised self-training programs, which they then carried out at home for three months, adapting their program according to their performance level. The primary outcome measure was the Canadian Occupational Performance Measure (COPM) - Performance domain. Secondary measures included the COPM satisfaction domain, World Health Organisation Disability Assessment Score-2 (WHO-DAS2), and Goal Attainment Score (GAS). Measurements were taken three months and immediately prior to the Bobath course and three months after the course. Results: COPM-Perfomance, COPM-Satisfaction and the WHODAS-2 showed a significant difference over the time points, with followup scores significantly greater than both baseline and preintervention (p<.001). Sixty eight percent of participants achieved their personal goals (GAS). Conclusion: The study indicates that an individualised self-training approach based on Bobath principles may enable the transfer of acquired proficiency into the personal goals of people with chronic stroke.},
     year = {2021}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - An Individualised Learning and Exercise Program Based on the Bobath Concept to Facilitate Goal Achievement in People with Chronic Stroke
    AU  - Eckhardt Gabriele
    AU  - Brock Kim
    AU  - Haase Gerline
    AU  - Ishida Toshie
    AU  - Hummelsheim Horst
    Y1  - 2021/03/09
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ajhr.20210901.14
    DO  - 10.11648/j.ajhr.20210901.14
    T2  - American Journal of Health Research
    JF  - American Journal of Health Research
    JO  - American Journal of Health Research
    SP  - 26
    EP  - 33
    PB  - Science Publishing Group
    SN  - 2330-8796
    UR  - https://doi.org/10.11648/j.ajhr.20210901.14
    AB  - Background: To facilitate improvement in participation, therapy needs to be transferred into everyday life of people with chronic stroke. Individualised, home based, self-training exercise programs should be oriented towards the potential of the person, be specific to their ability and impairment levels, avoid compensation strategies as far as possible and operate at the upper limit of the individual’s ability level. Objectives: To investigate the effectiveness of an individualised learning and exercise program based on the Bobath concept for facilitating personal goal achievement in people with chronic stroke. Method: Repeated measures design. Fifty-five people with chronic stroke were recruited from participants in Advanced Bobath training courses. During the five day course, participants learned individualised self-training programs, which they then carried out at home for three months, adapting their program according to their performance level. The primary outcome measure was the Canadian Occupational Performance Measure (COPM) - Performance domain. Secondary measures included the COPM satisfaction domain, World Health Organisation Disability Assessment Score-2 (WHO-DAS2), and Goal Attainment Score (GAS). Measurements were taken three months and immediately prior to the Bobath course and three months after the course. Results: COPM-Perfomance, COPM-Satisfaction and the WHODAS-2 showed a significant difference over the time points, with followup scores significantly greater than both baseline and preintervention (p<.001). Sixty eight percent of participants achieved their personal goals (GAS). Conclusion: The study indicates that an individualised self-training approach based on Bobath principles may enable the transfer of acquired proficiency into the personal goals of people with chronic stroke.
    VL  - 9
    IS  - 1
    ER  - 

    Copy | Download

  • Sections