HANDLING Kim Hyuk Il Glory Hospital

무엇인가를 전문용어 없이 일상적인 언어로 설명할수 없다면, 그것은 당신이 그 문제를 제대로 이해하지 못했다는 증거이다. ( 브라이언 그린, 1999/ 엘러건트 유니버스 )

The bobath concept is unfinished, we hope it will continue to grow and develop in years to come ( K. Baboth 1986 )

보바스 치료는 끊임없이 변화하고 발전해왔 다 나는 한국의 다음 세대의 보바스 치료사들이 보여줄 새로운 치료의 모델을 기대해본다. ( 황병룡, 2014 / 보바스 학술대회 )

- 시스템이론을 적용한 과제지향 접근법에 관심 - 운동조절을 위하여 시행되는 치료접근법들이 환자의 기능에 해로운 것이 아님 - 특정한 치료방법이 다른 치료방법에 대하여 우수하다는 충 분한 증거 없음 - 임상적 적용을 위한 기초과학의 적용과 근거제시 강조 ( 우영근, 2014)

UMN Syndrome Damage to the descending motor pathways anywhere along this trajectory gives rise to a set of symptoms

Neural Problem Non-Neural Problem Mechanical Impairment Chemical Communication

Hesse demonstrated improvement in spatial and temporal parameters and pattern of muscle activation during facilitation gait. Miyai et al. showed similar spatial and temporal changes, accompanied by changes in cortical activation in the affected cerebral hemisphere.

Bobath concept It is problem-solving and analytical approach An understanding of tone, pattern of movement and postural control that underlie of performance of functional tasks. The idea that it is possible to modify the way a task is performed through handling and activation to make it more efficient, effective and successful for the individual. It encourages the active participation of the individual. The importance of application of movement, with practice, into function.

Greater openness to the use of other modalities and adjuncts which will complement the bobath concept such as treadmill training, structured practice, the use of orthotis and muscle strengthening.(sue raine, 2009)

Definition Physical contact with client’s body to directly guide the movement and postural adaptation to a more normal pattern. (Glossary, Neurological rehabilitation, 1990) Using the hand in such ways as to normalize tone and facilitate normal movement. (Davies,1998) Using the hand (and or other body parts) to sustain the performance.

Definition Touch may be one of the strongest direct influence on the patient, physically and psychologically/emotionally. The used of handling is based on clinical reasoning, problem analysis, hypothesis formulation, goal, and which tools to use to help the patient to achieve his goals. Handling is dynamic, specific, and varied; it may be mobilizing (musculature, joint), stabilizing, and/ or facilitatory. The aim of using handling as a treatment tool is to recruit neuromuscular activity in a functional context.

Normal Movement Normal movement or activity may considered to be a skill acquired through learning for the purpose of achieving the most efficient and economic movement or the performance in a given task and specific to the individual. (shumway-cook&woollacott, 1995)

The therapist aim to utilize afferent input to re-educate the individual internal referance systems to enable the person to have more movement choices and greater efficiency of movement. (Julie vaughan graham, 2009)

Movement Perception Environment Individua l Task Cognition Action

Postural Set A postural set is an alignment of key points that creates the lowest tone for the individual whilst allowing selective movement - Against gravity - with gravity - within a posture

Movement Movements must be ‘owned’ by the patient and be experienced both with and ultimately without the handling of the therapist. ( Raine 2007)

Facilitation via handling skill is intended to provied key components of the spital and temporal aspects of a specific movement/ task to enable the individule to have an experience of movement that is not passive. Facilition is designed to make activity possible. (Julie vaughan graham, 2009)

Handling principle Use to trunk & L/E Two hand but different task HAND-> PATIENT -> BRAIN Speed, ROM, Compression, Direction Rotation Proprioceptive input Environment Functional hand

Perception, motivation, ideation - hobby, job, environment Appropriate use of voice (communication) - with patient’s brain, active & passive Grip - direct contact. Muscle& skin, gentle Gravity ( activation of antigravity muscle) Feet awareness COG in the BOS ( LOS increase) Stability & Mobility - task, selective movement

Therapist have to be: Skilled in the analysis of human movement Aware of the principles of motor learning: - Active participation - Opportunities for practice - Meaningful goals (Mayston 2000)

BOS INVITE ACTIVAT E FOLLOW ACTIVITY PLAC E ACTIVITY LET GO HANDLING

Make possible (realignment,information) Make nacessary(demands) Let it happen(activity) Facilitation HANDLING

Thank you!!!