- Email: [email protected]
EUSOI — Not Suitable for Repeated Use
Bobath Approach
- Which
MADAM - May I respond to Michele Bottos and Paul Beelen on the 'right' and 'left' reading of the Bobath approach in 'Personal View', (Physiotherapy, March 1989, pages 155 -1 56)) The essence of the Bobath approach to the treatment of children with cerebral palsy is that it is a concept rather than a method. This has inevitably led to varying interpretations, some of which barely resemble the treatment as known in this country today. This concept is based on the recognition that the release of abnormal reflex activity associated with abnormal quality of postural tone interferes with the development of normal co-ordination. From this basis many techniques have evolved and continue to do so, according to the needs of the individual child and the changing face of cerebral palsy. Dr and Mrs Bobath's contribution over the past forty years is not only to the child with cerebral palsy. They have shared and disseminated their knowledge with therapists and doctors world-wide. If the courses run abroad have been taught by well qualified people but with less questing minds than the Bobaths, then subsequent generations of therapists may have been taught 'techniques' rather than a 'concept'. Those of us lucky enough to have been taught and/or have worked closely with the Bobaths for many years have learnt that
What is Normal Movement? MADAM - We wish to express our sympathy with S J Rouse, who in his letter in the April issue of Physiotherapy expresses doubt about the teaching of normal movement. We agree with him that movements in the main have a highly individual character, varying with the individual, and changing with age. Practically all the short courses advertised on this subject are given by Bobath trained tutors. We believe that the term 'normal movement' is a misnomer. What is taught in Bobath courses are the basic factors of postural control and co-ordination, such as head and trunk control, righting and equilibrium reactions which form the normal postural background of our highly individual motility. This teaching is an integral part of our full course on the treatment of adults and children suffering from brain lesions of the upper motor neurone, and serves to give course participants an understanding of how pathologically released patterns of spasticity and abnormal co-ordination interfere with the basic patterns of postural control. This cannot be taught as a separate course but should give students insight into the way in which abnormal patterns of coordination, in conjunction with abnormal tonus qualities, interfere with normal patterns of co-ordination of posture and movement. This gives a direct insight into the approach of treatment based on the inhibition of the released abnormal patterns and the facilitation of the basic normal movements. It is, therefore necessary for the student to be taught the basic principles of normal co-ordination in order to compare it with what is found in the abnormal. It is very important for physiotherapists who have
Physiotherapy, June 1989, vol75, no 6
is Right?
there is no 'one way' to treat. We must use only those techniques that work, based on a full assessment of the child. This means that the way we handle or treat is childdetermined and the parents are taught to respect this and utilise it in daily functional situations. The European Association of NDT (Bobath) Training Centres provides a forum for discussion between teaching therapists from different countries and cultures. The purpose of the association is to maintain standards and to keep the Bobath concept as dynamic as its creators. Recent meetings have shown a desire to do just that. In the light of present day 'glasnost' is it not counter-productive to maintain the rigid divide of 'right' and 'left'? JENNIFER BRYCE MCSP Principal, Bobath Centre London NW3
C 0R R ECTI0N Right and Left Reading We regret that in the 'Personal View' by
M Bottos and P Beelen published in the March issue of Physiotherapy, in the penultimate reference, the address from which the video-cassette may be obtained should have ended 'Bern, Switzerland'.
been trained in terms of joints, muscle groups and biomechanics, to know that these have little relevance in neurological conditions. K BOBATH MD DPM FRCPsych B BOBATH MBE FCSP PhD(Hon)Boston London NW3
Support for Isolated Therapists MADAM - We are a small group of occupational therapists working for voluntary organisations. At a recent meeting/training day we addressed the issue of the need for support from our peers due to our isolated working conditions and wondered if there were any other therapists who would like to join us. Any therapists working in voluntary organisations or the private sector w h o would be interested i n exchanging information, sharing skills and setting up joint training to meet our needs and that of our client group, would be very welcome. We all work in an advisory capacity and met because of a need to liaise and for mutual support. We cover between us England, Scotland and Wales, including the Isle of Man and the Isle of Wight. We look forward to hearing from all interested therapists at either of the addresses below. BARBARA CULLEN DipCOT The Spastics Society Molyneux House 44a Crosby Road North 'Waterloo Liverpool L22 4QQ
Ankle Ambiguities MADAM - I was saddened
to read 'Paraesthesia of the anterior aspect of the ankle: An early sign of lumbar spine disorders in sportsmen' by Testa, Capasso and Mafulli i n the April issue of Physiotherapy. The authors looked at t w o groups of sportspeople presenting with paraesthesia and pain on the supero-anterior aspect of the ankle. The athletes had been subjected to 'local' treatment to the ankle consisting of rest (unspecified as to whether this meant stoppage of athletic activity or total bed rest) and physiotherapy (also unspecified was it treatment affecting muscles or joint structures, general exercises, or specific manipulation?) The authors claimed t o have fully examined the spines with a great variety of exotic tests but the results of these tests were not tabled, therefore there was no indication whether the athletes received treatment for the lumbar spine only if all tests were positive or when some of the tests were positive. The treatments stated to have been successful were bed rest - this would of course also rest a local inflammatory lesion of the ankle - and physiotherapy (unspecified). In the discussion the authors concede that there was a discrepancy in the results between the shoe-wearing group and the non-shoe-wearing group. This they find puzzling. Surely the question one must ask is not whether the lumbar spine can refer symptoms to the supero-anterior aspect of the ankle, which is a well established and documented fact, accepted and acted on with treatment by clinicians for many years, but rather whether the joints ,of the foot and ankle had been fully examined in the initial consultation. As physiotherapy research in this country is attempting and gradually succeeding to achieve high standards of valid work, it was sad to see precious space in our Journal taken up by a paper of this level. AGNETA LAND0 MCSP London SW19
EUSOI Not Suitable for Repeated Use MADAM - We weravery interested to read the article on leg ulcers that appeared in the February Journal (Odetunde, Z 0, 'The treatment of venous leg ulcers'). However, we feel obliged to point out that considerable evidence is accumulating to show detrimental effects of repeated use of Eusol for wound cleansing. GWYNETH JONES BSc MCSP RUTH TRUESDALE BSc MCSP Morriston Hospital Swansea REFERENCES Morison, M J (1989). 'Wound cleansing Which solution?', The Professional Nurse, February 1989, 220-225. The Dressings Times, (19881. Produced by the Welsh Centre for the Quality Control of Surgical Dressings, vol 1, no 3.
LESLEY HOPKINSON DipCOT The Leonard Cheshire Foundation 26 Maunsel Street London SWlP 2QN
325
- Which
MADAM - May I respond to Michele Bottos and Paul Beelen on the 'right' and 'left' reading of the Bobath approach in 'Personal View', (Physiotherapy, March 1989, pages 155 -1 56)) The essence of the Bobath approach to the treatment of children with cerebral palsy is that it is a concept rather than a method. This has inevitably led to varying interpretations, some of which barely resemble the treatment as known in this country today. This concept is based on the recognition that the release of abnormal reflex activity associated with abnormal quality of postural tone interferes with the development of normal co-ordination. From this basis many techniques have evolved and continue to do so, according to the needs of the individual child and the changing face of cerebral palsy. Dr and Mrs Bobath's contribution over the past forty years is not only to the child with cerebral palsy. They have shared and disseminated their knowledge with therapists and doctors world-wide. If the courses run abroad have been taught by well qualified people but with less questing minds than the Bobaths, then subsequent generations of therapists may have been taught 'techniques' rather than a 'concept'. Those of us lucky enough to have been taught and/or have worked closely with the Bobaths for many years have learnt that
What is Normal Movement? MADAM - We wish to express our sympathy with S J Rouse, who in his letter in the April issue of Physiotherapy expresses doubt about the teaching of normal movement. We agree with him that movements in the main have a highly individual character, varying with the individual, and changing with age. Practically all the short courses advertised on this subject are given by Bobath trained tutors. We believe that the term 'normal movement' is a misnomer. What is taught in Bobath courses are the basic factors of postural control and co-ordination, such as head and trunk control, righting and equilibrium reactions which form the normal postural background of our highly individual motility. This teaching is an integral part of our full course on the treatment of adults and children suffering from brain lesions of the upper motor neurone, and serves to give course participants an understanding of how pathologically released patterns of spasticity and abnormal co-ordination interfere with the basic patterns of postural control. This cannot be taught as a separate course but should give students insight into the way in which abnormal patterns of coordination, in conjunction with abnormal tonus qualities, interfere with normal patterns of co-ordination of posture and movement. This gives a direct insight into the approach of treatment based on the inhibition of the released abnormal patterns and the facilitation of the basic normal movements. It is, therefore necessary for the student to be taught the basic principles of normal co-ordination in order to compare it with what is found in the abnormal. It is very important for physiotherapists who have
Physiotherapy, June 1989, vol75, no 6
is Right?
there is no 'one way' to treat. We must use only those techniques that work, based on a full assessment of the child. This means that the way we handle or treat is childdetermined and the parents are taught to respect this and utilise it in daily functional situations. The European Association of NDT (Bobath) Training Centres provides a forum for discussion between teaching therapists from different countries and cultures. The purpose of the association is to maintain standards and to keep the Bobath concept as dynamic as its creators. Recent meetings have shown a desire to do just that. In the light of present day 'glasnost' is it not counter-productive to maintain the rigid divide of 'right' and 'left'? JENNIFER BRYCE MCSP Principal, Bobath Centre London NW3
C 0R R ECTI0N Right and Left Reading We regret that in the 'Personal View' by
M Bottos and P Beelen published in the March issue of Physiotherapy, in the penultimate reference, the address from which the video-cassette may be obtained should have ended 'Bern, Switzerland'.
been trained in terms of joints, muscle groups and biomechanics, to know that these have little relevance in neurological conditions. K BOBATH MD DPM FRCPsych B BOBATH MBE FCSP PhD(Hon)Boston London NW3
Support for Isolated Therapists MADAM - We are a small group of occupational therapists working for voluntary organisations. At a recent meeting/training day we addressed the issue of the need for support from our peers due to our isolated working conditions and wondered if there were any other therapists who would like to join us. Any therapists working in voluntary organisations or the private sector w h o would be interested i n exchanging information, sharing skills and setting up joint training to meet our needs and that of our client group, would be very welcome. We all work in an advisory capacity and met because of a need to liaise and for mutual support. We cover between us England, Scotland and Wales, including the Isle of Man and the Isle of Wight. We look forward to hearing from all interested therapists at either of the addresses below. BARBARA CULLEN DipCOT The Spastics Society Molyneux House 44a Crosby Road North 'Waterloo Liverpool L22 4QQ
Ankle Ambiguities MADAM - I was saddened
to read 'Paraesthesia of the anterior aspect of the ankle: An early sign of lumbar spine disorders in sportsmen' by Testa, Capasso and Mafulli i n the April issue of Physiotherapy. The authors looked at t w o groups of sportspeople presenting with paraesthesia and pain on the supero-anterior aspect of the ankle. The athletes had been subjected to 'local' treatment to the ankle consisting of rest (unspecified as to whether this meant stoppage of athletic activity or total bed rest) and physiotherapy (also unspecified was it treatment affecting muscles or joint structures, general exercises, or specific manipulation?) The authors claimed t o have fully examined the spines with a great variety of exotic tests but the results of these tests were not tabled, therefore there was no indication whether the athletes received treatment for the lumbar spine only if all tests were positive or when some of the tests were positive. The treatments stated to have been successful were bed rest - this would of course also rest a local inflammatory lesion of the ankle - and physiotherapy (unspecified). In the discussion the authors concede that there was a discrepancy in the results between the shoe-wearing group and the non-shoe-wearing group. This they find puzzling. Surely the question one must ask is not whether the lumbar spine can refer symptoms to the supero-anterior aspect of the ankle, which is a well established and documented fact, accepted and acted on with treatment by clinicians for many years, but rather whether the joints ,of the foot and ankle had been fully examined in the initial consultation. As physiotherapy research in this country is attempting and gradually succeeding to achieve high standards of valid work, it was sad to see precious space in our Journal taken up by a paper of this level. AGNETA LAND0 MCSP London SW19
EUSOI Not Suitable for Repeated Use MADAM - We weravery interested to read the article on leg ulcers that appeared in the February Journal (Odetunde, Z 0, 'The treatment of venous leg ulcers'). However, we feel obliged to point out that considerable evidence is accumulating to show detrimental effects of repeated use of Eusol for wound cleansing. GWYNETH JONES BSc MCSP RUTH TRUESDALE BSc MCSP Morriston Hospital Swansea REFERENCES Morison, M J (1989). 'Wound cleansing Which solution?', The Professional Nurse, February 1989, 220-225. The Dressings Times, (19881. Produced by the Welsh Centre for the Quality Control of Surgical Dressings, vol 1, no 3.
LESLEY HOPKINSON DipCOT The Leonard Cheshire Foundation 26 Maunsel Street London SWlP 2QN
325