AXONV OLUME 26 ❖ NUMBER 2 ❖ DECEMBER 200413
By Cydnee Seneviratne and Marlene Reimer
The aim of this article is to review neurodevelopmental
treatment (NDT) literature and existing stroke NDT nursing
research, as well as explore issues related to professional
collaboration in stroke rehabilitation and implications for
neuroscience nursing practice. NDTor the Bobath approach is
used to encourage stroke patients to use the affected side of
their body in order to promote and relearn normal movement
and to reduce muscle spasticity. Neuroscience nurses have an
important role in facilitating stroke patients to practise
transferring out of bed and performing activities of daily living
outside of physiotherapy and occupational therapy sessions.
Neuroscience nurses also care for stroke patients over a 24-
hour perio. Therefore, it is important that nurses understand
physiotherapy and occupational therapy strategies in stroke
Approximately 50,000 strokes occur in Canada each year
and 80% of stroke survivors are left with a permanent
disability (Heart and Stroke Foundation of Canada, 2002;
Canadian Stroke Network, 2003). Individual deficits can
range from cognitive impairments such as aphasia or
memory loss, to unilateral neglect and deficits altering
motor function (Doolittle, 1988; Riddoch, Humphreys &
Bateman, 1995; Taylor, Ashburn & Ward, 1994).
Rehabilitation for stroke patients is designed to address
individual deficits and tailor therapy toward achieving
personal rehabilitation goals. The ideal is for all members of
the health care team to collaborate in order to promote
optimal rehabilitation and therapy, as negotiated with the
stroke survivor. Physiotherapists and occupational therapists
use stroke rehabilitation
neurodevelopmental treatment to establish a program that
promotes recovery and facilitates new learning (Davis,
therapies such as
The Bobath concept or neurodevelopmental treatment (NDT),
as it is termed in North America, was first developed in the
1940s in England by Dr. Karel Bobath and his wife Bertha
Bobath, a physiotherapist and researcher. NDT is known and
used by some physiotherapists and occupational therapists in
North America, but it is used more commonly in Europe as a
primary therapy for stroke rehabilitation by all health care
professionals including nurses (Paci, 2003). The main
principle of NDT is to reduce muscle spasticity and promote
normal patterns of movement (Bobath, 1970). Neuroscience
nurses have an “influential role in managing spasticity” as
activities of daily living, positioning, and joint range of motion
are practised and reinforced outside of one-hour therapy
sessions (Habel, 1997, p. 122). Collaboration is the key to
promoting optimal stroke recovery, and nurses need to
understand and critique physiotherapy and occupational
therapy strategies such as NDT in order to be an integral part
of the stroke rehabilitation team. The purpose of this article is
to review: i) neurodevelopmental treatment literature and
and stroke rehabilitation:
A critique and extension for
neuroscience nursing practice
Traitement neurodévelopmental et
réhabilitation post acv: Une critique et
une expansion pour la pratique infirmière
L’objectif de cet article est de revoir la littérature sur le
traitement neurodévelopmental ainsi que sur la recherche
infirmière existante dans le domaine des accidents
cérébraux vasculaires et le traitement neurodévelopmental.
Ainsi qu’à explorer différentes questions reliées à la
collaboration professionnelle dans la réhabilitation post-
acv et les implications pour la pratique infirmière en
neurosciences. Le traitement neurodévelopmental ou
l’approche Bobath est utilisé pour encourager les patients
ayant subi un acv à utiliser le côté affecté de leur corps
dans le but de promouvoir et d’apprendre à nouveau des
mouvements normaux et de réduire la spasticité.
Les infirmières en neurosciences ont un rôle important
pour ces patients. Après les sessions en physiothérapie et
ergothérapie, elles doivent aider ces patients à pratiquer le
transfert du lit et à exécuter des activités journalières. Les
infirmières en neurosciences administrent des soins à ces
patients 24 heures par jour. Donc il est important qu’elles
puissent connaître des stratégies en physiothérapie et en
ergothérapie dans le processus de la réhabilitation de leurs
14 V OLUME 26 ❖ NUMBER 2 ❖ DECEMBER 2004AXON
existing stroke NDT nursing research; and ii) explore issues
related to professional collaboration in stroke rehabilitation
and implications for neuroscience nursing practice.
Different descriptions of the Bobath concept and therapy exist
(Ashburn, 1995; Bohman, 1987; Davies, 1985; Goodgold-
Edwards, 1993; Sodring, 1980). The scope of this article offers
an ideal opportunity to introduce the Bobath concept to
neuroscience nurses. Therefore, this discussion is based
mainly on the writings of Bobath (1970, 1990).
The Bobath concept
The Bobath concept or NDT for the treatment of hemiplegia
originated out of principles developed for the care of children
with cerebral palsy (Bobath, 1963). The aim of NDT is to
concentrate therapy on both the affected and unaffected side of
the hemiplegic patient in order to promote symmetrical
movement (Bobath, 1970). Instead of accepting that the
affected side is untreatable and concentrating therapy on the
physical strength of the unaffected side, therapists focus on
normal patterns of movement in order to decrease spasticity.
Bobath (1970) states, “by reducing the patients’spasticity and
by giving [the patient] more normal postural sets to initiate
movements, reflex-inhibiting patterns, inhibit abnormal motor
activity, and at the same time facilitate more normal activity”
(p. 73). Movement where both sides move in symmetry
promotes normal function. The ideal is to change or suppress
abnormal movement in order to introduce normal patterns of
The control of postural tone and reduction of spasticity are the
two main goals of NDT. Bobath (1970, 1990) describes the
different phases of adult hemiplegia in three stages: initial
flaccid stage, stage of spasticity, and stage of relative recovery.
At the onset of hemiplegia, the stroke survivor initially
experiences a state of flaccidity. During this state of complete
hemiplegia, the therapist focuses therapy on normal posture.
Techniques that support normal posture are practising neutral
pelvic placement and weight transfer while sitting and
standing. Bobath therapists stress the importance of correct
normal movement of the patient at ‘key points’ such as the
trunk, shoulder girdle, and pelvis (Lennon, 1996). Essentially,
the stroke patient is an active participant and the therapist
helps the patient to obtain normal posture and movement by
guiding the patient through the treatment. However, in this
stage of flaccidity, periods of spasticity can occur and,
therefore, treatment is focused on preventing or decreasing
periods of high tone during therapy or as the patient progresses
to the next stage of spasticity (Lennon).
Spasticity usually develops slowly in the extensor muscles of
the leg and flexor muscles of the arm (Bobath, 1970, 1990).
However, in severe cases, strong spasticity can occur even early
in the onset of stroke. Bobath (1970) stated that spasticity
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AXONV OLUME 26 ❖ NUMBER 2 ❖ DECEMBER 200415
occurs in specific patterns. That is “the patterns of spasticity
…have to be prevented during treatment by special techniques
of handling the patient, techniques which counteract the
abnormal patterns of tonic reflex-activity” (p. 72). An example
of one of the Bobath techniques is mobilization of the affected
shoulder girdle to prevent the scapula from contracting
spastically backward. By placing a hand on the patient’s
scapula and moving the shoulder forward away from the spine
following normal range of motion, the nurse or therapist
effectively reinforces normal movement, and thereby decreases
spasticity. Other areas of focus are the neck, spine, pelvis, and
legs. According to Bobath (1970), the patient can often stand in
the second stage, with some if not all weight on the affected leg.
The nurse or therapist works on decreasing spasticity while
preparing for standing and walking by teaching the patient
bridging. While in a supine position, the therapist or nurse
supports the patient’s bent knee as the patient raises their pelvis
to an equal height off the support or bed creating a bridge.
Bobath (1970) insists it is essential that the patient begin to
walk independently only when normal patterns of movement
occur without signs of spasticity in order to decrease the risk of
injury to the patient, nurse, and therapist.
In the recovery stage, spasticity is slight and the stroke patient
can walk relatively independently (Bobath, 1970).
Rehabilitation in this stage focuses on continuing to practise
neutral posture and proper positioning prior to movement
depending on the individualized needs of the patient. The work
of the patient and the therapist or nurse is a process of practice
and negotiation. Bobath (1970, 1990) stated that these
recommendations are only meant as an outline for therapy. It
is the therapist who will “develop his or her own technique”,
and must adjust treatment according to the responses of the
patient (p. 115).
Although the concept of hemiplegic treatment is presented by
Bobath (1970) in stages, it is acknowledged that the three
stages are intertwined. Treatment depends greatly on the level
of recovery that the patient has reached. Bobath stresses that
the earlier treatment is initiated, the better rehabilitation
outcome for the stroke survivor. A positive impact of NDT is
that practice will aid the patient to continue the use of normal
posture outside of the therapy session.
Lennon and Ashburn (2000) conducted research that aimed to
investigate how the Bobath concept evolved since the last
publication in 1990. Expert physiotherapists were organized
into two focus groups by area of interest (neurology and elder
care) and given critical questions for group discussion. The
outcome of this study was the finding that Bobath principles
had changed since 1990 (Lennon & Ashburn). Both groups
agreed that the basic tenants of the treatment had not changed,
but differed on ways in which the treatment was conducted.
The neurology group was mainly made up of Bobath purists
who concentrated their key assumptions on control of tone and
on preparation. Conversely, the elder care group focused on
‘task specific practice’and goal setting. The authors concluded
that it is essential that further experimental research be
conducted on such assumptions.
Since NDT has widespread use by physiotherapists and
occupational therapists, NDT therapy needs to be justified
with more than just clinical experience and practical skills, but
with research-based practices and updated treatment regimens
(Lennon, Baxter, & Ashburn, 2001; Partridge & Edwards,
1996; Riddoch, 1994). Walker, Drummond, Gatt, and Sackley
(2000) stated that a current climate exists where a large
number of occupational therapists are unable to describe the
theoretical underpinnings of treatment, and are unfamiliar with
standard assessments used with stroke patients. A blind
acceptance of practice exists where therapists tend to rely on
what they already know rather than on research evidence
(Carr, Mungovan, Shepherd, Dean, & Nordholm, 1994;
Shah (1998) suggested that controversy also exists regarding
which stroke rehabilitation therapy clearly produces a
significantly better stroke recovery outcome. A Canadian
research group concluded that the NDT approach does provide
a base from which the stroke patient may be evaluated
(Corriveau, Arsenault, Dutil, & LePage, 1992; Guarna,
Corriveau, Chamberland, Arsenault, Dutil, & Drouin, 1988).
The general consensus of most researchers has been that NDT
compared to other treatment strategies such as the motor
relearning program, or the Brunnstrom technique were similar
in outcome rather than clinically superior (Dickstein,
Hocherman, Pillar, & Shaham, 1986; Gelber, Josefczyk,
Herrman, Good, & Verhulst, 1995; Hiraoka, 2001). In a recent
published research article related to NDT effectiveness, the
author concluded that there was no evidence that NDT was
superior to other methods, but cautioned that the merit could
not be discarded without further study (Paci, 2003). Some
researchers, specifically Brunham and Snow (1992) and
Lennon (2001) used small sample sizes of one and two
participants respectively and, therefore, methodological issues
have limited their NDT studies in terms of generalizing
In addition to effectiveness studies, many authors compared
NDT and the Motor Relearning Programme (MRP) developed
by Carr and Shepherd (1987). The basic aim of MRP is to
improve functioning of everyday life and is based on the
assumption that the impaired, such as stroke patients, learn the
same as the unimpaired. Biomechanics theory is used to
analyze movements, provide feedback, and encourage
relearning (Carr, Shepherd & Ada, 1995).
Comparisons of NDT and MRP led to mixed conclusions.
Miles-Breslin (1996) welcomed MRP treatment strategies as
an addition to current occupational therapy theory and
practices. MRP compared to NDT
complementary rather than superior to NDT (Lettinga,
Siemonsma, & van Veen, 1999). In addition, Langhammer and
Stranghelle (2000) conducted a double-blind controlled study
where 61 acute, first-ever stroke patients were randomized into
two groups based on gender and site of hemiplegia. Thirty-
three patients received MRP therapy and 28 patients received
NDT as a therapy treatment post-acute stroke. These authors
concluded that motor function in the group of stroke patients
being treated with MRP was significantly improved
was viewed as
16V OLUME 26 ❖ NUMBER 2 ❖ DECEMBER 2004AXON
(Langhammer & Stranghelle). However, Bobath supporters
have recently challenged this study for two reasons. First, it is
suggested that Langhammer and Stranghelle have
misrepresented NDT because they did not acknowledge that
the Bobath concept has evolved since the 1990 Bobath
publication (Barrett, Evans, Chappell, Fraser & Clayton, 2001;
Paturnin, 2001). Second, Gustavsen, Jansen, Kjendahl, and
Lorentzen (2002) asserted that data comparing the two groups
did not support MRP as a favourable therapy but, in fact, the
results reveal that the NDT group caught up to the MRP group
in treatment outcome. Another significant finding from the
Langhammer and Stranghelle research which has not been
identified in the literature debate is that the patients’quality of
life scores were equal in value for both the NDT and MRP
groups. That is, neither the MRP nor NDT technique showed
efficacy in increasing the patients’ quality of life. So an
important critique of this research is why such low scores were
achieved in relation to quality of life. It would be interesting to
research whether individualized therapy, i.e., using the most
appropriate method of therapy based on personal functional
outcomes and increased quality of life indicators is more
effective than utilizing a standardized therapy adopted by a
unit, physiotherapy department, or hospital.
To add to this controversy, nursing researchers have also
analyzed the effectiveness of NDT compared to traditional
techniques. Salter, Camp, Pierce, and Mion (1991) audited 87
stroke patient charts. Forty-three were treated with NDT and
37 with the traditional approach where therapy and care is
focused on the patients’ non-hemiplegic side or remaining
abilities such as feeding. Even though the findings of this
study were not statistically significant, 86% of the NDT group
was discharged home as compared to 76% of the traditional
group. The researchers concluded that the NDT approach was
not superior to the traditional nursing approach. However,
Lewis (1986) and Passarella and Lewis (1987) conducted
similar research studies to Salter and colleagues (1991), but
concluded that NDT appeared to be the treatment of choice,
indicating that further research is needed before nurses commit
to one rehabilitation approach. This controversy will continue
until more therapists and nurses critically analyze their
practice not only through anecdotal evidence based on
experience, but also through larger controlled trials which can
be generalized and utilized in neuroscience practice.
NDT and rehabilitation nursing
NDT is used by some practitioners in North America, but is
used widely in European countries such as England, Holland,
Germany, and Norway. For example, in the Netherlands,
nurses have a well-established reputation for incorporating
NDT principles into nursing strategies in order to promote 24-
hour therapy (Hafsteinsdóttir, 1996). The following is an
exploration of NDT nursing literature and related
rehabilitation issues regarding collaboration between nursing,
physiotherapy, and occupational therapy.
It is not uncommon to observe a physiotherapy treatment such
as NDT incorporated in rehabilitation nursing practice
(Passarella & Lewis, 1987). NDT principles of promoting
neutral posture and normal patterns of movement are utilized
by nurses while positioning, transferring, and helping stroke
patients with activities of daily living (Camp, Davis, Salter, &
Pierce, 1995). In traditional nursing care, nurses focus
treatment on the unaffected side in order to promote unilateral
function. Comparatively, NDT offers nursing techniques to
help the patient to relearn normal and bilateral postural
movement safely (Borgman & Passarella, 1991). NDT nursing
techniques teach natural movement, beginning with
positioning in bed, in order to promote calm safe movement
with minimal anxiety. In other words, to avoid periods of high
tone, the nurse guides movement of the patient to reduce
excessive exertion, a leading cause of spasticity (Passarella &
Lewis, 1987; Passarella & Gee, 1987).
Positioning. NDT nursing techniques begin with teaching the
stroke patient natural positioning and movement in bed.
Rolling or turning in bed is taught to the patient to promote
guidance of the nurse,
rather than two nurses
the patient, the patient
clasping their hands in
front of them then lifting
their head and shoulders
Figure One (above): Use of traditional technique for turning. Figure Two (below): Use of NDT technique for turning.
Reprinted with permission from Camp, Y.G., Davis, T.M., Salter, J.P. & Pierce, L.L. (1995). Stop and look: Two approaches to
manage stroke patients. Journal of Neuroscience Nursing, 27(1), 24-28. Copyright 1995 by the American Association of
AXONV OLUME 26 ❖ NUMBER 2 ❖ DECEMBER 200417
off the bed, and looking in the direction of the turn (Camp et al.,
1995). Turning begins with the patient’s knees raised off the
bed as the nurse guides the roll toward him or her while
supporting the patient’s back and knees (see Figure One, Figure
Two). After the turn is complete, the nurse strategically places
supports in key areas to control spasticity (Hafsteinsdóttir,
1996). The side-lying shoulder is protracted forward and
externally rotated with a support placed under the extended
supine forearm and hand. A support is also placed behind the
back and the pelvis is protracted and externally rotated, thereby
encouraging natural placement of the top leg forward with knee
and ankle flexed and supported with a pillow (Hafsteinsdóttir;
Passarella & Lewis, 1987; Passarella & Gee, 1987).
Transfers. NDT transfers are also based on natural body
movement with the focus being on neutral positioning of the
pelvis. The pivot transfer begins with the patient’s hands clasped
together leaning slightly forward with both feet flat on the floor
sitting upright at the edge of the bed (Camp et al., 1995). To
ensure the transfer is safe, the nurse places his or her knees at
either side of the patient’s with the nurse’s hands placed below
the patient’s waist (see Figure Three, Figure Four). “Abackward
movement of the nurse then assists the patient to raise [their]
buttocks just high enough to clear the surface and the patient
rotates on the balls of the feet 90 degrees toward the second
surface and sits in an upright position” (p. 26). Camp and
colleagues suggested that the pivot transfer encourages natural
movement and concentration on the part of the patient.
Adjusting position while seated. After the patient transfers to
a chair or wheelchair, they often slide down in the chair,
rounding their lower back and creating abnormal posture. The
traditional nursing technique is to stand behind the wheelchair
wrapping your arms around and under the patient’s arms and
then lifting the patient back in the chair. With this approach,
there is an increased risk of causing shoulder subluxation
creating permanent pain in the patient’s shoulder girdle
(Hafsteinsdóttir, 1996). However, using the NDT technique,
the risk of shoulder subluxation is eliminated and the amount
of energy used for both the nurse and the stroke patient is
decreased. With the patient’s feet on the floor and with the
nurse standing on the patient’s affected side, the patient leans
forward and the nurse moves the patient’s hips backward
(Passarella & Lewis, 1987). “Bringing the patient’s weight
over [their] feet enables [the nurse] to move [the patient’s] hips
back in the chair without lifting” (p. 108). The key to this
movement is transfer of the nurse’s weight from the front to
the back foot, thereby creating movement using leverage.
Dressing, grooming, and eating. Using a traditional
technique, nurses encourage patients to use their functional
side to either wash their face or don their clothes using many
steps creating a frustrating process. The NDT approach,
however, encourages the use of both the hemiplegic and non-
hemiplegic side, thereby treating neglect related to right
middle cerebral artery stroke syndrome (Camp et al., 1995).
The patient, with the assistance of the nurse if needed, can
effectively feed himself or herself, for example, by
incorporating both limbs (see Figure Five, Figure Six). The
patient can lift their mug or cup to their mouth using both
hands with deliberate aid by the nurse on the hemiplegic side.
When washing, the patient can grasp the face cloth and their
hemiplegic hand with their functional hand and move in a
circular motion to wash their face. In essence, the patient is
forced not to leave their hemiplegic arm behind and physically
promotes movement of that limb (Camp, et al.).
The aforementioned NDT nursing techniques are not utilized
in isolation. If it is determined that NDT is the treatment of
choice for a stroke patient, it is critical that the entire health
care team be consistent in the approach used. Since nurses
work most directly with stroke patients from the onset of
stroke through acute treatment, rehabilitation, to home, it is
important that nurses are a primary element of the stroke
rehabilitation team (Garrett & Bechtel, 1996; Gibbon 1993). It
is the nurse who helps the patient change their position every
two hours and helps the patient to and from the bathroom.
Therefore, it is most important that nurses incorporate
rehabilitative techniques such as NDT into their practice to
continue and add to the patients designated weekday one-hour
According to Gibbon (1993), rehabilitative goals set by the
stroke patient must be carried out consistently by all disciplines
for optimal rehabilitation to be achieved. In order for
consistency to occur between all members of the health care
team, collaboration through sharing of information is critical.
According to Gibbon and Little (1995), nurses must increase
their understanding and knowledge of techniques used by
physiotherapists and occupational therapists thereby creating a
collaborative atmosphere. For example, if NDT is used for a
Figure Three (above): Traditional, supine to sit. Figure
Four (below): NDT, supine to sit.
Reprinted with permission from Camp, Y.G., Davis, T.M.,
Salter, J.P. & Pierce, L.L. (1995). Stop and look: Two
approaches to manage stroke patients. Journal of
Neuroscience Nursing, 27(1), 24-28. Copyright 1995 by the
American Association of Neuroscience Nurses.
18 V OLUME 26 ❖ NUMBER 2 ❖ DECEMBER 2004AXON
particular patient’s therapy, it is essential that the nurse caring
for that patient is knowledgeable of that therapy. In addition,
Christensen (1995) offers that therapists have an obligation to be
collaborative and “communicate changes in the use of concepts
or principles to the nursing staff, in order to be reliable co-
workers to nurses” (p. 270). Such communication can ensure
that the patient’s therapy is continued over a 24-hour period. It
is in a collaborative relationship which values communication
that better outcomes for stroke patients can be achieved.
Nurses are an active and essential element in the rehabilitation
of stroke patients. Nurses coordinate, encourage, facilitate, and
care for stroke patients, but nurses also continue the role of
physiotherapists, occupational therapists, and social workers
after four p.m. and on the weekends. The nursing role in stroke
rehabilitation is viewed as essential, but exactly what that
contribution is remains undefined (Gibbon, 1993; Gibbon &
Little, 1995; Waters & Luker, 1996). According to Waters and
Luker, nurses are an under-valued and under-utilized resource
in rehabilitation. The following are excerpts from research
conducted to uncover the attitudes of professionals working in
rehabilitation that highlight differing opinions of the nursing
role. One consultant geriatrician to a rehabilitation unit
regarding basic nursing care stated that he “expected [the]
nursing service to make sure the patients are fed, watered,
washed, and put in a clean bed” (Waters & Luker, p. 110). A
physiotherapist commented that nurses “get the body able to
function so that I can get at it” (Waters & Luker, 110). But, it
is interesting and sad to note that the nurses’ comments about
their rehabilitation role were similar. Nurses viewed
themselves as good at basic care and had little time for
rehabilitative care, thereby agreeing with the argument that
nurses have a role that includes maintenance and coordination
of care rather than part of rehabilitation (Waters & Luker;
Gibbon & Little, 1995). However, Kirkevold (1997) offered
that nursing has a unique function in rehabilitation of stroke
patients. The nurse has an:
1. Interpretive function – referring to ways in which nurses
help stroke patients and their families understand the process
and outcome of stroke,
2. Consoling function – where the nurse provides emotional
support when the patient is developing their own
understanding of their stroke experience, in essence building a
3. Conserving function – the focus is on maintaining normal
function. For example, preventing complications and
supporting the patients’ basic needs,
4. Integrative function – referring to ways the nurse can aid the
patient to take activities of daily living (ADL) learned in the
therapy sessions and utilizing them in practical situations. An
example of this is practising getting out of bed, getting
dressed, washing, and eating (p. 59-60).
Whether defining their rehabilitative nursing role as different
functional components or as a single belief system,
neuroscience nurses need to clearly define their rehabilitation
practice to include a rehabilitative component.
Neuroscience nurses should be commended for the care they
provide regarding rehabilitation of stroke patients. A key
part of what nurses do is encourage and teach patients to
maintain their basic needs, and this should not be discarded.
However, nurses, whether in acute care, rehabilitation, or
homecare, should take a greater interest in rehabilitation
education and become active in the therapy provided to
stroke patients by physiotherapists and occupational
therapists. As stated earlier in this article, nurses are in an
important position because they can provide therapy like
NDT on a 24-hour basis, support treatments recommended
in collaboration with physiotherapists for their patients, and
ensure that the patient and their family have learned the
therapy techniques so that rehabilitation continues at home
(Bukowski, Bonavolonta, Keehn, & Morgan, 1986). It is
consistent and collaborative care that is most important for
optimal rehabilitation for stroke patients (Booth, Davidson,
Winstanley, & Waters, 2001).
Implications for neuroscience nursing
Rehabilitation for stroke patients does not begin when the
patient is transferred to a rehabilitation unit. The rehabilitation
process begins as soon as the patient is diagnosed with either
an ischemic or hemorrhagic stroke (Hickey, 2003). It is when
the stroke patient is admitted to an acute care unit that
neuroscience nurses have an opportunity to begin the
rehabilitation process. Research conducted by Hamrin (1982)
questioned whether or not introducing an activation nursing
program early in the care of stroke patients would affect
recovery post stroke. The rehabilitation program introduced
included preventive care and rehabilitation principles over a
three-month period starting in acute care. It was concluded that
the program did stimulate early recovery (Hamrin).
Furthermore, according to
multidisciplinary rehabilitation in conjunction with medical
regimens is crucial for optimal recovery post stroke.
Neuroscience nurses are a critical part of the rehabilitation
process and should be involved in multidisciplinary research
regarding stroke rehabilitation in acute care.
Hagell (1999), early
Figure Five (above): Traditional use of cup. Figure Six
(below): NDT use of cup.
Reprinted with permission from Camp, Y.G., Davis, T.M.,
Salter, J.P. & Pierce, L.L. (1995). Stop and look: Two
approaches to manage stroke patients. Journal of
Neuroscience Nursing, 27(1), 24-28. Copyright 1995 by the
American Association of Neuroscience Nurses.
AXONV OLUME 26 ❖ NUMBER 2 ❖ DECEMBER 200419
Ashburn, A. (1995). A review of current physiotherapy in
the management of stroke. In M.A. Harrison, Physiotherapy in
stroke management (pp. 3-22). Edinburgh: Churchill
Barrett, J.A., Evans, L., Chappell, J., Fraser, C., & Clayton,
L. (2001). Letters to the editor. Bobath or motor relearning
programme: A continuing debate. Clinical Rehabilitation, 15,
Bobath, B. (1963). Treatment principles and planning in
cerebral palsy. Physiotherapy, 49, 122-124.
Bobath, B. (1970). Adult hemiplegia: Evaluation and
treatment. London: Heinemann.
Bobath, B. (1990). Adult hemiplegia: Evaluation and
treatment. (3rd ed.). London: Heinemann.
Bohman, I. (1987). The Bobath approach and the geriatric
stroke patient. Clinical Physical Therapy, 14, 183-195.
Booth, J., Davidson, I., Winstanley, J., & Waters, K. (2001).
Observing washing and dressing of stroke patients: Nursing
intervention compared with occupational therapists. What is the
difference? Journal of Advanced Nursing, 33(1), 98-105.
Borgman, M.F., & Passarella, P.M. (1991). Nursing care of
the stroke patient using Bobath principles: An approach to altered
movement. Nursing Clinics of North America, 26(4), 1019-
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Many nursing researchers have concluded that more research
is needed in nursing regarding stroke rehabilitation. Areas for
research are rehabilitation therapies, stroke rehabilitation
education, nurses’ role in stroke care and rehabilitation,
professional collaboration, acute care nursing and stroke
rehabilitation, and the stroke experience in acute care and
rehabilitation (Camp et al., 1995; Doolittle, 1988; Gibbon,
1993; Hafsteinsdóttir, 1996; Waters & Luker, 1996). The
following are examples of possible nursing research questions
related to stroke rehabilitation:
1. Does the use of NDT as a rehabilitation therapy affect
quality of life post stroke?
2. What is the role of nursing in stroke rehabilitation? What is
the role of nursing in continuing stroke rehabilitation in home
3. What is the current status of stroke rehabilitation education
in baccalaureate programs across Canada?
4. What are stroke rehabilitation patients’ perspectives
regarding multidisciplinary collaboration?
5. What perceptions or beliefs do acute nurses hold regarding
6. What is the experience of a stroke patient during
rehabilitation? What is the experience of stroke families
Although controversy exists whether NDT is the optimal
treatment for stroke patients, it is important that nurses
increase their knowledge of different treatments available to
their patients. NDT is one stroke rehabilitation regimen that
can be utilized with stroke patients. Bobath (1970, 1990)
asserts the sooner that the hemiplegic patient begins treatment,
the sooner the patient will begin to naturally assume neutral
posturing, decrease spasticity, and increase normal movement.
Neuroscience nurses care for stroke patients during the entire
continuum of care, therefore, nurses are in an optimal position
to reinforce and educate stroke patients and their families
about their particular therapy. Furthermore, it is critical that all
members of the health care team collaborate regarding stroke
rehabilitation treatment in order to optimize stroke
rehabilitation and recovery,
multidisciplinary practice-based research. Neuroscience
nursing includes rehabilitative care and, in order to propel
nursing toward leadership in stroke care, further nursing
research must be conducted in stroke rehabilitation.
I would like to acknowledge Dr. Marlene Reimer for all of her
assistance in writing this manuscript and for her excellent
supervision of my doctoral studies.
as well as conduct
About the authors
Cydnee Seneviratne is an instructor and PhD student at the
University of Calgary, Faculty of Nursing. As well, Cydnee is
a research trainee in The FUTURE Program for
Cardiovascular Nurse Scientists.
Marlene Reimer is a professor at the University of Calgary,
Faculty of Nursing.
Comments or requests for further information can be directed
to Cydnee Seneviratne at email@example.com.
20 V OLUME 26 ❖ NUMBER 2 ❖ DECEMBER 2004AXON
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