Physiotherapeutic interventions: Bobath, Vojta, and motor learning approaches

Abstract

This chapter describes different approaches to physiotherapy in children with cerebral palsy (CP) and the principles of learning processes. Bobath and Vojta developed their concepts in the 1960s. These were based on the level of knowledge at that time, regarding normal motor development and its restrictions in cerebral lesions. Their objective was to improve the abnormal neurophysiological function in patients with cerebral movement disorders and to avoid development of such abnormal function by early therapy. Several controlled studies designed to evaluate this therapeutic approach could not prove the special effects of these “process-oriented” therapies, amongst others, due to methodological reasons. Based on current knowledge, motor learning is considered to be a basic principle of therapeutic interventions intended to improve the patient’s ability to accomplish age-appropriate, adequate tasks and self-initiated activities. The learning processes involved depend on the following elements: control of motor function and cognition, storage of learning objectives, and a central reward system to improve motivation, neuroplasticity, and reorganisation. Therefore, Bobath’s therapy was modified, and the focus of attention shifted to individual learning objectives, improving the child’s autonomy in small steps and supporting social integration. Controlled studies of the effectiveness of these “goal-directed” or “task-oriented” interventions indicate that a specific effect is quite likely, at least for children with mild to moderate CP.