Neurological patients very often become orthopedic patients.

Below, you see a photo taken after completing the six-month IBITA Bobath Adult training course with Prof. Marianne Lawton held between 2018 and 2019.

Many ask why I chose to attend a course mainly focused on working with neurological patients, given that my primary professional interest has always been orthopedic manual therapy.

The answer is simple: neurological patients very often become orthopedic patients as well. This usually happens due to chronic muscle tone disorders and abnormal movement patterns. An example is the development of spastic contractures, which limit physiological joint mobility and cause significant biomechanical disturbances.

If a patient functions in this state for many months—especially without appropriate therapy—numerous complications arise. One such complication is static joint overload resulting from improper limb positioning and pathological muscle tension. Over time, this can lead to instability, subluxations, and pain caused by compensatory overload of adjacent structures.

Let me illustrate this with two concrete examples:

🔹 In a post-stroke patient with a spastic flexion contracture of the upper limb, a painful shoulder syndrome often develops. This results from constant tension in the flexor and internal rotator muscles and weakness of the scapular stabilizers. Such asymmetry and disturbed shoulder mechanics affect not only limb function but also body posture and movement.

🔹 On the other hand, patients with decreased muscle tone (hypotonia) also face major problems with postural control and stability. For example, a 68-year-old woman, after prolonged hospitalization and weeks of bed rest, presented with difficulty maintaining sitting and standing positions. Examination revealed weakness of the gluteus medius muscle, pelvic instability during the stance phase, and a positive Trendelenburg sign. Additionally, she exhibited Duchenne’s sign—compensatory lateral trunk bending toward the weak side during walking—to help maintain balance. This compensatory trunk lean over time caused the development of scoliosis. In standing, she showed knee hyperextension and during gait had compensatory trunk lean and frequent tripping. This instability led to overload of the lumbar spine and hip joint on the weight-bearing side and significantly increased her risk of falls.

This is why I decided to deepen my knowledge in the Bobath concept. The Bobath concept, also known as neurodevelopmental therapy (NDT), is based on the idea that the brain has the ability to reorganize and adapt after injury. The goal of this therapy is to restore lost motor functions through neuromuscular re-education. In practice, this means normalizing muscle tone, inhibiting abnormal reflexes, and activating correct movement patterns—critical both in neurological and orthopedic rehabilitation.

From my experience, combining manual therapy with neuromuscular re-education yields the best results—especially for patients with chronic musculoskeletal issues. Structural work alone, without understanding the source of dysfunction and implementing functional therapy, rarely leads to lasting outcomes.

🔹 If you struggle with chronic movement problems, want to regain full function, and are looking for therapy tailored to your needs—you are in the right place.

Do you live in Surrey, near Guildford, Woking, Chertsey, or Egham?

I offer professional rehabilitation in home settings based on the latest knowledge and years of experience. If you value quality, hands- on therapy input, and effectiveness— contact me today, and I will get back to you as soon as possible with available appointment times.

Many ask why I chose to attend a course mainly focused on working with neurological patients, given that my primary professional interest has always been orthopedic manual therapy.

The answer is simple: neurological patients very often become orthopedic patients as well. This usually happens due to chronic muscle tone disorders and abnormal movement patterns. An example is the development of spastic contractures, which limit physiological joint mobility and cause significant biomechanical disturbances.

If a patient functions in this state for many months—especially without appropriate therapy—numerous complications arise. One such complication is static joint overload resulting from improper limb positioning and pathological muscle tension. Over time, this can lead to instability, subluxations, and pain caused by compensatory overload of adjacent structures.

Let me illustrate this with two examples:

🔹 In a post-stroke patient with a spastic flexion contracture of the upper limb, a painful shoulder syndrome often develops. This results from constant tension in the flexor and internal rotator muscles and weakness of the scapular stabilizers. Such asymmetry and disturbed shoulder mechanics affect not only limb function but also body posture and movement.

🔹 On the other hand, patients with decreased muscle tone (hypotonia) also face major problems with postural control and stability. For example, a 68-year-old woman, after prolonged hospitalization and weeks of bed rest, presented with difficulty maintaining sitting and standing positions. Examination revealed weakness of the gluteus medius muscle, pelvic instability during the stance phase, and a positive Trendelenburg sign. Additionally, she exhibited Duchenne’s sign—compensatory lateral trunk bending toward the weak side during walking—to help maintain balance. This compensatory trunk lean over time caused the development of scoliosis. In standing, she showed knee hyperextension and during gait had compensatory trunk lean and frequent tripping. This instability led to overload of the lumbar spine and hip joint on the weight-bearing side and significantly increased her risk of falls.

This is why I decided to deepen my knowledge of the Bobath concept. The Bobath concept, also known as neurodevelopmental therapy (NDT), is based on the idea that the brain has the ability to reorganize and adapt after injury. The goal of this therapy is to restore lost motor functions through neuromuscular re-education. In practice, this means normalizing muscle tone, inhibiting abnormal reflexes, and activating correct movement patterns—critical in both neurological and orthopedic rehabilitation.

From my experience, combining manual therapy with neuromuscular re-education yields the best results—especially for patients with chronic musculoskeletal issues. Structural work alone, without understanding the source of dysfunction and implementing functional therapy, rarely leads to lasting outcomes.

🔹 If you struggle with chronic movement problems, want to regain full function, and are looking for therapy tailored to your needs—you are in the right place.

Do you live in Surrey, near Guildford, Woking, Chertsey, or Egham?

We offer professional rehabilitation in home settings based on the latest knowledge and years of experience. If you value quality, hands- on therapy input, and effectiveness— contact us today, and We will get back to you as soon as possible with available appointment times.