Section6
Using therapist hand on patient body to produce therapeutic changes in tone &
movement.
The way of touching &moving the child.
Points where we place hands to most effective controlling of movement of child.
Proximal key point of control
Points near the source of problem (head , shoulder , hip).
Distal key point of control
points away from source of problem (thumb , big toe).
Inhibitory techniques
Facilitatory techniques.
Bobath concept
• Therapist shouldn`t attempt to retrain normal movement response until
spasticity is diminished through inhibition ??? Why
• As spasticity blocks the pattern of reciprocal muscle activation needed for
optimal motor & functional performance.
Inhibitory techniques
Process of intervention used for problems of abnormal tone & pattern of
movement.
Facilitatory techniques
Process of intervention used to train normal movement patterns.
Affect of RIPs with Bobath is temporary so during inhibition must follow with
facilitation.
Reflex Inhibiting Patterns (RIPs) by Bobath approach
• Def.
A term for a pattern that counteract the pull of tight or spastic muscle action.
• Aim
1. Modulate muscle tone.
2. Inhibition of released (persistent) abnormal pattern.
3. Facilitation to normal pattern of development.
• How to apply RIPs in:-
1. Head in supine or in prone.
2. Shoulder bilateral shoulder elevation./ bilateral horizontal abduction./ all outward
rotation./ bilateral extension diagonal. / all inward rotation.
3. Hip flexion ,abduction , external rotation. / all outward rotation.
4. Thumb extension & abduction.
5. Big toe extension.
6. Lateral 3 toes dorsiflexion (extension).
(a) Proximal key point of control:-
Any change in head lead to change tone all over the body;
Taking head into
Flexion Inc. flexion tone all over the body(trunk).
Extension Inc. extension tone all over the body (trunk).
Example to apply breakdown bad pattern.
encourage required pattern.
How to facilitate trunk control. Child is supine lying , flex head Inc. flex tone in
trunk ease ability of child to flex his trunk to sit.
How to facilitate reaching. with sitting posture ,extend child`s head Inc.
extension tone in U.L & trunk so child can reach an object.
• To inhibit flex tone in all over the body to facilitate sitting or standing posture erectly.
1. Bilateral arm elevation take both child`s arms to outward & above his head.
2. Bilateral horizontal abduction take both child`s arm to outward away from midline
in yard position.
3. Bilateral diagonal extension take both arms into extension as support him self on a
wall.
4. All outward rotation take both arms to outward rotation as his palm looking up to
the ceiling.
N.B all of the previous handling used not only to inhibit flexion tone but also facilitate
extension tone commonly used with spastic cp as increased flexion tone in trunk so
he can`t counteract pull of gravity.
5. All inward rotation take both arms in flexion then inward rotation as if you take
thumb toward midline & make child support on his hand with his both thumbs in.
This handling only used in case of extension tone inhibition in all over the body to
facilitate sitting with child has excessive head extension lag or incases of
opposthesistonis.
N.B
all shoulder movement should performed bilaterally ,may be performed from sitting on
roll ,wedge.
All these proximal key point affect is temporary so you should facilitate it within
function.
Examples to apply
All inward rotation
Pull to sit pull child passively with his hand (thumbs rotate toward midline wait
for head movement to teach head control.
Get to sit on wedge place child hand & arm in to inward rotation wait for trunk to
move to sit posture to teach trunk control.
All outward rotation
To teach head control & enhance it child is prone on wedge head outside
wedge put both shoulders in all outward rotation (Dec. flex. Tone & Inc. ext. tone)
Bilateral arm elevation
To enhance head control raise child arm into elevation ( flexion & have arm above
head & avoid abduction with elevation position of dislocation.
To enhance trunk control child is kneel standing take both arm into elevation in
front of stand bar. (flex over head)
To inhibit extensor tone of pelvic girdle ( scissor spastic cp) & facilitate flexion tone.
1.All outward rotation take both legs in slight hip ,knee flexion & external
rotation or sometimes you could do it unilaterally.
Example to apply to facilitate lower limb rolling take child leg in slight hip ,knee
flex. To facilitate segmental rolling.
2. Flexion , abduction , external rotation + DF ankle +flex. knee example to apply
cross sitting , sit on roll +feet rested on ground , quadruped.
To inhibit flexor tone of pelvis girdle & facilitate extension tone
3. All inward rotation take one leg in flex & inward rotation of leg.
(b) Distal key point of control:-
Thumb extend & abduct it to inhibit flex. Tone in upper limb & facilitate
extension tone.
Example to apply if you enhancing sitting with hand support use thumb to
facilitate extension tone & weight bear to maintain static sitting.
Big toe or lateral 3 toes extend them to inhibit extension tone in lower limb
& facilitate flexion tone.
