Using Bobath Therapy to develop independent living skills in

teenagers who have cerebral palsy.

Nicola Parkinson
Clinical Service Development Lead and
the Bobath Therapy Team
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INTRODUCTION
Cerebral Palsy is a lifelong condition that requires ongoing therapy provision and monitoring, ideally
by an interdisciplinary team in order to develop and optimise levels of independence. Transition
from childhood to adulthood involves many changes and challenges (physical, emotional and
social), and is an important developmental stage for all young people. Adolescence is a time of
increasing independence, however for young people with cerebral palsy this may not be the case1.
They may face many hurdles and barriers which impact on participation and achieving autonomy
and independence - environmental restrictions, reduced awareness of resources, reduced
confidence within themselves and reduced support in general2.

THE CENTRE MEASURES

Bobath Childrenʼs Therapy Centre Wales (BCTCW) offers specialist Bobath therapy to children with
cerebral palsy in Wales regardless of severity of disability. It provides intensive therapy blocks, working
in collaboration with community teams. A trans-disciplinary model is used by Physiotherapists (PT),
Occupational Therapists (OT) and Speech and Language Therapists (SLT).
BCTCW had previously run a successful independent living skills (ILS) therapy block for eight young
people and their families, so the Centre wanted to offer a further group the same opportunity.
• The Canadian Occupational Performance Measure (COPM) was used during the initial session
with each young person to discuss and clarify the specific areas they wished to work on. The COPM
is an individualised measure designed to detect change in a clientʼs self-perception of occupational
performance and satisfaction over the course of therapy. It is carried out through a semi-structured
interview, looking at areas within self care, productivity and leisure5. Each identified area is rated in
terms of importance (10 = extremely important), with the young person rating the top five in terms of
performance and satisfaction (10 point scale). Using the COPM with the young people benefits them
as it increases partnership working, helps the young person identify and prioritise what is important

INDEPENDENT LIVING SKILLS (ILS) THERAPY BLOCK:

to them6 as well as facilitating a change in their self perception and competency2:
• Goals were set for specific areas identified by young people to achieve by the end of the block,
Aim:
using Goal Attainment Scaling (GAS).

To deliver an intensive block of Bobath therapy with the specific focus of improving independent living skills in young
people with cerebral palsy.
Specific opportunities were created during the therapy block (informally and formally) to meet peers, both for the young
OUTCOMES
people and parents. • COPM: reviewed during the last session with regards to performance and satisfaction
Clients: (2 point difference is significant).

• Seven young clients with cerebral palsy, aged between 11 and 16 years attended with their parents.
• Levels of ability within young people:
• GMFCS - E & R3: range from level I to IV. • MACS4: range from level II to III.
Preparation:
Performance scores pre and post therapy Satisfaction scores pre and post therapy

• Young clients: completed questionnaires prior to the block, identifying areas they wished to work on and therefore
10 10

starting to focus on skills of independence.

8 8

• The Centre:
• Planning, discussion and preparation – therapists, family support worker and administration team.
6 6
pre therapy

• Training for therapists - particularly task analysis of functional daily activities, outcome measures.
Therapy:
4 4
post therapy
2 2

Individual: Group:
0 0

• Ten sessions of approximately • Three lunches at the Centre.

C E G J L T W C E G J L T W

1 hour 15 minutes.
• Time period: 2 – 5 weeks.
• Provided by a combination of
Bobath trained OT, PT and SLT.
• Informal discussions in waiting area.
• Specific group for young people lead by therapists – meet peers, share
experiences, discuss what it means and how it feels to develop independence,
highlighting that ʻ….independence does not mean “without assistance”ʼ
thoughʼ2 and is different for each young person.
• Specific group for parents lead by family support worker – share experiences,
consider independence within their children, discuss the future
(potential challenges and possibilities).
• Meet role model and presentation of certificates of achievement.
• 4 out of 7 young people achieved a significant change in their performance
(average change: 3.94; range: 2.8 – 6.15), with the other three all scoring positive change (range: 1.4 – 1.8).
• 5 out of 7 young people achieved a significant change in their satisfaction
(average change: 4.94; range: 3.4 – 6.7), with the other two scoring positive change (0.5 and 0.8).
• GAS: total of 17 goals were set and re-rated at the end of the block. 1 was not rescored as the
position changed to enable the young person to be more functional.

Achieved

Exceeded

Partially Achieved

DISCUSSION AND POSSIBLE CHANGES:

Not Achieved

FEEDBACK:
Young person:
• individual sessions (7 returned): all identified learnt something functional could do themselves; four identified further
things like to work on therefore raising own expectation and challenge for the future.
• group session (4 returned): all highlighted enjoyed meeting other young people, peer social interaction
and opportunities to meet new potential friends.
• Importance of planning, discussion and preparation with all staff involved to ensure a co-ordinated
and effective block is delivered, with staff empowered.
• Importance of providing opportunities for social interaction with peers (both for young people
and parents) and meeting older role models who inspire all.
• Consider incorporating further social opportunities into the next therapy block offered
(possible evening activity).

Parents:
• individual sessions (7 returned): majority reported more confidence in young person carrying out functional activities
COMPARISON WITH PREVIOUS TWO WEEK ILS BLOCK:
with increased independence and were more positive about their future. • Previously young people achieved slightly higher average COPM score for performance,
• group session (4 returned): all reported good to talk with other parents about CP, to think about the future (possibilities, however satisfaction was slightly lower.
ideas, potential). All reported they would attend another group session. • 80% goals were achieved previously, compared to 65% achieved during this ILS therapy block.
• Previously complete focus of centre is ILS, which created a ʻbuzzʼ.
Therapists carrying out the ILS block:
• Therapists enjoyed it, learnt a lot from it, which they can integrate into activities with other clients attending the Centre.

CONCLUSIONS:
Intensive blocks of Bobath Therapy can be effective in improving both performance of and satisfaction with activities of independent living skills in young people who have cerebral palsy. Feedback received identifies
increased confidence in the young people, with both them and their parents looking to the future with more positive outlooks.

ACKNOWLEDGEMENTS:
Thank you to the young people and families in agreeing to us sharing this information and their success, as well as staff at BCTCW who provided therapy for the young people.

REFERENCES:
1. Chamberlain M, Kent R. Europa Medicophysica. 2005 June; 41 (2): 111-23.
2. Binks J, Barden W, Burke T, Young N. Archives Physical Medicine Rehabilitation August 2007; 88: 1064 – 1073.
3. Palisano R, Rosenbaum P, Bartlett D, Livingston M. CanChild Centre for Childhood Disability Research 2007 McMaster University.
4. Eliasson A, Krumlinde Sundholm L, Rosblad B, Beckung E, Arner M, Ohrvall A, Rosenbaum P. Developmental Medicine and Child
Neurology 2006 48: 549-554.
5. Law M, Baptiste S, Carswell A, McColl M, Polatajko H, Pollock N. 2005. Ottawa: CAOT Publications ACE.
6. Parker D, Sykes C. British Journal Of Occupational Therapy April 2006 69(4).

Bobath Children’s Therapy Centre Wales

19 Park Road, Whitchurch, Cardiff Cf14 7BP
Telephone: (029) 20522600 Fax: (029) 20521477