Dear Reader,

Welcome to NeuroAiD's November 2009 Newsletter. The idea of this monthly release is to share vital information for stroke patients and their families, and help them deal successfully with the common challenges life presents after a stroke.

This month, we are going to talk about the very popular treatment in the western world: The Bobath concept. What is the theory and in general how does it work? We are going to give a general introduction of this approach. We also try to find the link of fever after stroke and its recovery. Is post-stroke high temperature critical? You will find the answer in our newsletter.

We want this to be more than a one-way communication, and would be most happy to hear back from you. What you have experienced and learned will be very valuable to others and we will make sure it reaches as many people in our community as possible. Do also let us know what topics you wish to read in future issues of your NeuroAiD's newsletter.

We would like to assist you in your return to daily life while recovering from stroke. As you are probably already aware, making the best use of time is of vital importance in your stroke recovery. Therefore, please allow us to call you at a number, day and time of your convenience, to hear your questions and explain our answers. If you agree, kindly email us the table below at info@neuroaid.com :

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If you choose to contact us yourself instead, call us on our US toll free number: 1-800-882-4046 / +65-6478-9430 or email us at info@neuroaid.com

The NeuroAiD™ Team at Moleac

Mrs. Berta Bobath was born in 1907 and grew up in Berlin. In 1943, with her husband Karel Bobath, she began to develop a different way of treating spasticity which was, over time, to lead her into developing a concept of treatment, for adults with hemiplegia, or even children with cerebral palsy. That is what we call today “The Bobath Concept”.

The Bobath Concept is summarized in Adult Hemiplegia: Evaluation and Treatment, by Berte and Karel Bobath. The third edition was published in 1990, where the interesting foreword has resumed the fundamental of the Bobath concept.

Here is a doctor who meets his patient with hemiplegia, he first tries to find out the cause, and by then treats the condition giving rise to the hemiplegia. The doctor either chooses a policy of persuading the patient to use the hemiplegic limbs and retrain the affected side, or else a policy of encouraging the patient to neglect the hemiplegic side and to use the unaffected side for all tasks previously done by the limbs of both sides. This choice affects only the upper limb and the general posture of the patient. However it seems that there is no choice about the lower limb, the patients have to learn to use it, and to learn it properly. Certainly, if the patient gives in to his neurological disorder, he will become an invalid. If he learns to train his hemiplegic side, he will return to life.

The Bobath concentrates on the first of these alternatives that is on the retraining of the affected side. Numerous successes she had made in training hemiplegics have made it obvious to her. That is the best policy.

In details, the Bobath Concept is an important approach to rehabilitation in the care of patients with injuries to the brain. The theory might appear complicated, it aims to stress the central nervous and muscular systems so that an individual creates, maintains and reinforces the sensorimotor pathways to enable efficient motor control in their desired environment. In the United States, the Bobath Concept is usually referred to NDT – “neuro-developmental treatment”, with its theory based on brain’s ability to reorganize and recover after neurological injury, especially in motor development.

The Bobath believed that, understanding the interaction and coordination of various posture and movement combinations that compose a skill, including the components of multiple neuronal systems and the purpose of the skill is important to treat many positions at the same time. They also strongly maintained that it is more important to observe and describe the quality of posture and movement, rather than focusing on little steps in the achievement in motor milestones.

For example, in order to develop the trunk and hip extension and orientation to the vertical position, the best way is to treat and observe why the patient is standing, where several movement components are involved.

This approach to neurological rehabilitation not only involves physiotherapist, but also occupational therapists and speech and language therapists. This most popular treatment approach in western countries continues to be enriched with the emergence of new theories, new models and new information. It can continue to evolve as the characteristics of the population change. However, the effectiveness of this approach doesn’t seem to be much superior to others.

There are several Bobath centers in the world. Usually, in a Bobath center, treatment is usually tailored to clients’ individual needs and based on an assessment of their abilities and analysis of the movement disorder. Therapy sessions at the Bobath Centre focus on giving the client the opportunity to experience more efficient and effective movement and on finding ways to enable the client to incorporate these different movement strategies into their daily activities.

Sources:
Book: Adult Hemiplegia: Evaluation and Treatment, by B. Bobath
Book: Neuro-developmental treatment approach, theoretical doundations and principles o f clinical practice, by J.M.Howle
https://www.bobath.org.uk/

You may not know it, the brain is quite resilient and it is often able to bounce back relatively well after a stroke. There are examples that people recover to a quasi-normal shape. We have always introduced multiple factors which speed recovery, including an adequate rehabilitation, nutrition or continuous treatment. However, there are some in-hospital complications after stroke, which can slow down and sometimes can even halt recovery, like the fever.

In patients with acute stroke, fever is not uncommon. Whatever the cause, fever should be suppressed in these patients.

Previously, a variety of studies has already shown that body temperature after stroke is linked with outcomes. It was supposed that the higher risk of death in the first 10 days, usually due to neurological mechanisms, suggested that high temperature was a reason of poor prognosis and not only a syndrome of other complications in the course after a stroke. As the same as in animal studies, it is found that patients with higher temperature had a worse stroke outcome.

Recently, a study conducted in Canada has compared the outcomes of ischemic stroke patients who were affected by high body temperature in the acute period of the stroke. The study has found that high body temperature, which is called “hyperthermia” in a more scientific term, defined as higher than 37.2 degree Celcius, predicted a poor outcome. It mattered when in the first week after stroke the high temperatures occurred, with later, rather than earlier, fevers leading to a worse outcome.

It is very important for neurologists and other doctors to treat acute stroke patients in the hospital where they should implement aggressive measures to cool down the body temperature in patients in the first week after stroke. If a stroke patient encounters a fever after the accident, please do take it seriously and report to the doctor.

Sources:
Stroke Journal