Improving directional control of the upper limb in severe stroke: Efficacy of the Bobath concept: A pilot randomised trial

Abstract

This study investigated whether a brief intervention based on the Bobath concept in people with severe stroke receiving inpatient rehabilitation resulted in enhanced directional control of the upper limb compared to a control intervention. Fifty-three people with severe upper limb deficits between four to 18 weeks post stroke participated in a single blinded randomised controlled trial, in addition to usual care. Participants in the Bobath group (n = 30) were allocated to six one-hour interventions. Those in the control group (n = 26) received a time-matched intervention including passive or assisted active movement, positioning, and sham transcutaneous electrical nerve stimulation. The primary dependent variable was the Pre-Functional Upper Limb Test (PreFULT). Secondary measures included the Stroke Rehabilitation Assessment of Movement (STREAM), grip strength, and the Chedoke Arm and Hand Inventory. Following the intervention, the Bobath intervention group had significantly higher scores on the PreFULT than the control group (p = 0.042); Bobath baseline median 27.2 cm (interquartile range [IQR] 14.9, 73.4), post intervention median 59 cm (IQR 28.7, 136.4; n = 29), control baseline median 21.7 cm (IQR 11.9, 39.6), post intervention median 35.8 cm (IQR 17.4, 63.8, n = 24). Higher scores were observed for the STREAM post intervention for the Bobath group (p < 0.001). No differences between groups were observed for the other measures. Interventions based on the Bobath concept may be more beneficial for recovery of upper limb control in people with severe deficits following stroke than usual care.