GUIDE TO ASSESSMENT

POSTURAL TONE, AXIS, CORTICAL LEVEL

By: Johannes Purwanto
 BOBATH CONCEPT ASSESSMENT
• The Bobath concept is a problem-solving approach
to the assessment and treatment of individual with
disturbances of function, movement, and postural
control due to a lession of the central nerve system
(IBITA, 2004)
• Analysis of the QUALITY OF MOVEMENT is a central
theme.
 ASSESSMENT FIRST

MAIN
ASSESSMENT TREATMENT
PROBLEM

WRONG WRONG
CLASSIFICATION TREATMENT

CP CLASSIFICATION NOT ONLY OBSERVE FROM DISTRIBUTION OF

ABNORMAL TONE, BUT ALSO FROM QUALITY AND PATTERN OF MOVEMENT
HISTORY TAKING
 HISTORY TAKING
• Child identity
• Parent identity
• Birth of date
• Pregnancy history
• Delivery history
• Post natal history
• Medical history
• Medication history
 GENERAL IMPRESSION
• Alertness
• Awareness
• Coqnitive
• Motivation
• Emotional
 CP CLASSIFICATION
• Spastic diplegia
• Spastic quadriplegia
• Spastic hemiplegia
• Hypotonia/ low tone
• Atethoid
• Ataxia
• Mixed
FUNCTIONAL ABILITIES - INABILITIES
• Lying GMFCS LEVEL:
• Supine
• Rolling over
• Creeping
• Sitting
• Crawling
• Standing
• Walking
 POSTURAL TONE assessment

Hipertone?
Hypotone?
Fluctuative?

“The Bobath therapist asssses postural tone by observing

the quality of movement during functional activity.”
(Bobath Center London, 1997)
 POSTURAL TONE
• Facial Muscles:
- Occular muscle NECK DYN
STABILITY
- Masseter muscle
• Neck Muscles:
PROX DYN
- SCM muscle STABILITY
- Upper trapezius
muscle
• Proximal Muscles:
- Abdominal muscles
- Erector spine
muscles
 AXIS assessment

“The problems is not of individual muscle or joint,

but as a components to perform functional skills.”
(Bobath Center London, 1997)
 AXIS
• EYES • PELVIC
• NECK • LEGS
• TRUNK • ANKLE
• SHOULDER • FOOT
• HANDS • + BOS
 CORTICAL LEVEL assessment

"A passive recipient will never be an active learner

and will get most out of treatment.
The active learner needs to be engaged, challenged
and involved in the meaningful task practice. “
(Mrs.Bobath, 1990)
 CORTICAL LEVEL ACTIVITIES
• EYES
• EARS
• MOUTH
• HAND
• FOOT
 ASSOCIATED PROBLEMS
assessment
• Vital functios
– Breathing problems
– Feeding problems
– Sleeping cycles
• Sensory problems
• Intelegence/mentallity problems
• Speech problems
• Emotional problems
• Contracture/deformities
• Muscle properties problems
• Seizures problems
MAIN PROBLEMS?
GOAL OF TREATMENT?
SHORT TERM GOAL & LONG TERM GOAL
 “See what you see,
and not what you think to see”