"Bobath or Motor Relearning Programme? A comparison
of two different approaches of physiotherapy and stroke rehabilitation: A randomized
control study."
This "Tip of the Month" is based on an a recent article published in
Clinical Rehabilitation entitled "Bobath or Motor Relearning Programme?
A comparison of two different approaches of physiotherapy and stroke rehabilitation:
A randomized control study."
This study implies that physical therapy treatment using the motor relearning
program (MRP) as taught by Carr and Shepard showed more significant improvements
when compared to the Bobath training program in the acute rehabilitation
of stroke patients.
I think this article is entertaining from the perspective that the major indicator
of improvement was the Motor Assessment Scale (MAS), which was developed by
Carr and Shepard. Since the specific criteria studied (MAS) directly relates
to the treatment program (MRP), then the results may not be showing the effects
of the program but the effects of how well the researcher designed the evaluation
tool to reflect the treatment program. While the Bobath treatment technique
did show improvement in motor function, although not significant based on the
MAS, it is the standard acute stroke treatment program. The true outcome of
the article is that both groups improved. Both motor relearning and Bobath treatment
techniques are effective and show functional improvement.
A subtle point of the article is the importance of using standardized assessment
measures. I believe many therapists continue to use a subjective scale (poor,
fair, good) to rate balance and I’ve never seen anything published about reliability
and validity. Below is the balanced sitting scale from the motor assessment
scale. I consistently use this to evaluate sitting balance because it is more
objective and functional than a subjective scale to rate balance.
Motor Assessment Scale Criteria for Scoring
Balanced Sitting
- Sits only with support. (Therapist should assist patient into sitting).
- Sits unsupported for 10 seconds. (Without holding on, knees and feet together,
feet can be supported on floor.)
- Sits unsupported with weight well forward and evenly distributed. (Weight
should be well forward at the hips, head and thoracic spine extended, weight
evenly distributed on both sides.
- Sits unsupported, turns head and trunk to look behind. (Feet supported and
together on floor. Do not allow legs to abduct or feet to move. Have hands
resting on thighs; do not allow hands to move onto plinth.
- Sits unsupported, reaches forward to touch floor, and returns to starting
position. (Feet supported on floor. Do not allow patients to hold on. Do not
allow legs and feet to move, support affected arm if necessary. Hands must
touch floor at least 10 cm (4in) in front of feet.
- Sits on stool unsupported, reaches sideways to touch floor, and returns
to starting position. (Feet supported on floor. Do not allow patient to hold
on. Do not allow legs and feet to move, support affected arm if necessary.
Patient must reach sideways, not forward.
References:
- Bobath or Motor Relearning Program: A Comparison of Two Different
Approaches of Physiotherapy and Stroke Rehabilitation- A Randomized Control
Study, Clinical Rehabilitation, July/August 2000.
- MAS scale by Carr and Shepard