Named approach

Bobath / NDT

Neurodevelopmental treatment, the Bobath concept

The most widely taught approach in the world, and the one whose evidence has been examined most closely. It has not been shown to outperform goal-directed therapy of the same intensity.

Origin. Developed in London from the 1940s by Berta Bobath, a physiotherapist, and Karel Bobath, a physician.

What a session looks like

• A therapist uses hands-on guidance at key points of the body — pelvis, shoulders, trunk — to influence how the child holds and moves themselves.
• Classically the aim was to inhibit movement patterns judged abnormal and facilitate ones judged normal, often with the child positioned on a bench or ball.
• Contemporary Bobath practice has changed considerably. Many therapists trained in the concept now work towards functional goals with far less handling than the original model, which is one reason the label alone tells you little about what actually happens in the room.

The reasoning behind it

The original reasoning came from a hierarchical view of the nervous system: damage releases primitive reflexes, abnormal tone dominates, and the therapist's job is to suppress the abnormal so the normal can emerge.

That model of motor control has largely been superseded. Movement is now understood as emerging from the interaction of the child, the task and the environment, with the child's own active attempts doing the learning.

This matters practically. If change comes from the child solving a movement problem, then a therapist's hands guiding the limb through a correct trajectory may be removing the very thing that drives improvement.

What the evidence shows

• Bobath has been studied more than every other named approach on this site combined, largely because it is the default in so many countries.
• Systematic reviews have repeatedly found it no better than comparison interventions of similar intensity, and in several comparisons goal-directed, task-specific training performed better on functional outcomes.
• Major cerebral palsy guidance has moved accordingly, and now recommends activity-based, goal-directed approaches as first line rather than Bobath as a default.
• There is no evidence that it is harmful, and no reason for a family to feel that past therapy was wasted.

The argument on each side

Who it tends to suit

A skilled Bobath-trained therapist delivering intensive, goal-directed practice is very likely helping your child. The training label is not the active ingredient — what happens in the session is.

Practical burden

• Widely available and usually funded, which is a real practical advantage over imported alternatives.
• Low cost compared with the intensive branded programmes delivered abroad.

Questions to ask

1. In a typical session, how much of the time is my child actively doing something?
2. What goal are we working on, and how will we know in eight weeks whether it moved?
3. How do you decide when to use your hands and when to let my child struggle with the task?

Other approaches