The Bobath Clinical Reasoning Framework: A systems science approach to the complexity of neurodevelopmental conditions, including cerebral palsy

Abstract

The current recommended developmental Bobath practice within the Bobath Clinical Reasoning Framework (BCRF) can be conceptualized using the lens of systems science, thereby providing a holistic perspective on the interrelatedness and interconnectedness of the variables associated with childhood‐onset disability. The BCRF is defined as an in‐depth clinical reasoning framework that can be applied to help understand the relationships between the domains of the International Classification of Functioning, Disability and Health, how those domains can be influenced, and how they impact each other. The BCRF is a transdisciplinary observational system and practical reasoning approach that results in an intervention plan. This provides a holistic understanding of the complexity of situations associated with disorders such as cerebral palsy (CP) and the basis for the lifelong management and habilitation of people living with neurological disorders. The clinical reasoning used by the BCRF draws on the important contextual factors of the individual and their social environment, primarily the family unit. It is rooted in an understanding of the interrelationships between typical and atypical development, pathophysiology (sensorimotor, cognitive, behavioural), and neuroscience, and the impact of these body structure and function constructs on activity and participation. The systems science model integral to the BCRF is a useful way forward in understanding and responding to the complexity of CP, the overarching goal being to optimize the lived experience of any individual in any context.

The Bobath Clinical Reasoning Framework for neurodevelopmental conditions: A call for collaboration instead of de‐implementation

“…As therapists, we use single treatments as a way to enhance motor learning and skill acquisition in our patients within conceptual frameworks such as the International Classification of Functioning, Disability and Health (ICF) and the Bobath Clinical Reasoning Framework (BCRF). 1 I agree with Mayston et al that the BCRF consists of a system of interventions with many components and therefore cannot be compared to a single treatment like constraintinduced movement therapy (CIMT) or treadmill training. 2 Nevertheless, we need intervention studies in addition to theoretical frameworks to facilitate treatment planning and support our clinical reasoning.…”

“…Mayston et al 1 provide a theoretical framework for Bo bath practitioners to enhance their clinical reasoning and treatment planning for children with complex neurodevelopmental conditions. As (physio)therapists, we try to provide optimal support to children with special needs and their families.…”

The Bobath Clinical Reasoning Framework: Open to debate

“…The Bobath Clinical Reasoning Framework: Open to debate EDITOR-We appreciate the various letters to the editor in response to our article about the Bobath Clinical Reasoning Framework (BCRF) [1][2][3][4] and welcome the opportunity to respond.…”

“…However, it is important to clarify our view that therapeutic handling is merely one tool that might be used, for example by parents/ caregivers, to support their child's functioning in daily life (as discussed in Case study 2 for a young person in Gross Motor Function Classification System level V). 2 The signature of the BCRF is clinical reasoning not therapeutic handling, which we use minimally in keeping with current recommendations. 7 Furthermore, the adult stroke literature referenced to comment on Bobath efficacy 1 is not at all relevant to CP.…”

“…Our hope is that the BCRF will support clinicians in applying systems science as a holistic approach to complex situations (Figure 3). 2 Unfortunately, there are limitations in complex disability research, which has been found to lack rigour and thus the certainty to provide evidence-based intervention at all stages of life. [8][9][10] These limitations can be countered using good clinical reasoning, like the structured BCRF clinical reasoning cycle.…”