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Seale J, Utsey C. Physical therapist's clinical reasoning in patients with gait impairments from hemiplegia. Physiother Theory Pract 2019; 36:1379-1389. [PMID: 30676183 DOI: 10.1080/09593985.2019.1567889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: During stroke rehabilitation, physical therapists (PTs) perform gait analysis and design treatments based on this analysis. Objectives: To investigate the current trends in PTs clinical reasoning in assessing and managing gait in persons with hemiplegia. Design: A qualitative study using a phenomenological approach using a semi-structured interview protocol with FG. Methods: Participants consisted of expert and novice PTs working in a neurologic rehabilitation setting. FG were conducted in person and via web. Constant comparative qualitative analysis was used to analyze the qualitative data. Results: A total of 22 PTs participated in five FG (2 novice and 3 expert groups). From the analysis of qualitative data, five themes emerged. Novice and experienced clinicians: 1) take a systematic approach to examination and evaluation of persons with hemiplegia; 2) are in agreement in common gait deficits found in persons with hemiplegia; 3) may differ in their approach to treatment based on the amount of experience of the clinician; 4) generally agree on the manner in which orthotics are used in the management of persons with hemiplegia; and 5) demonstrate professional accountability to patients concerning the use of orthotic devices. Conclusions: This qualitative study provided insight into the variability in PTs' strategies for gait analysis, and their identification and interpretation of common deviations and impairments in persons with hemiplegia following stroke. Reluctance to utilize orthotics for patients with hemiplegia was a consistent theme across FG.
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Affiliation(s)
- Jill Seale
- School of Physical Therapy, South College , Knoxville, TN, USA
| | - Carolyn Utsey
- Department of Physical Therapy, University of Texas Medical Branch , Galveston, TX, USA
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Theofanidis D, Gibbon B. Nursing interventions in stroke care delivery: An evidence-based clinical review. JOURNAL OF VASCULAR NURSING 2016; 34:144-151. [DOI: 10.1016/j.jvn.2016.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/02/2016] [Accepted: 07/06/2016] [Indexed: 10/20/2022]
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Krukowska J, Bugajski M, Sienkiewicz M, Czernicki J. The influence of NDT-Bobath and PNF methods on the field support and total path length measure foot pressure (COP) in patients after stroke. Neurol Neurochir Pol 2016; 50:449-454. [PMID: 27585746 DOI: 10.1016/j.pjnns.2016.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 08/10/2016] [Indexed: 11/17/2022]
Abstract
In stroke patients, the NDT - (Bobath - Neurodevelopmental Treatment) and PNF (Proprioceptive Neuromuscular Facilitation) methods are used to achieve the main objective of rehabilitation, which aims at the restoration of maximum patient independence in the shortest possible period of time (especially the balance of the body). The aim of the study is to evaluate the effect of the NDT-Bobath and PNF methods on the field support and total path length measure foot pressure (COP) in patients after stroke. The study included 72 patients aged from 20 to 69 years after ischemic stroke with Hemiparesis. The patients were divided into 4 groups by a simple randomization. The criteria for this division were: the body side (right or left) affected by paresis and the applied rehabilitation methods. All the patients were applied the recommended kinesitherapeutic method (randomized), 35 therapy sessions, every day for a period of six weeks. Before initiation of therapy and after 6 weeks was measured the total area of the support and path length (COP (Center Of Pressure) measure foot pressure) using stabilometer platform - alpha. The results were statistically analyzed. After treatment studied traits decreased in all groups. The greatest improvement was obtained in groups with NDT-Bobath therapy. NDT-Bobath method for improving the balance of the body is a more effective method of treatment in comparison with of the PNF method. In stroke patients, the effectiveness of NDT-Bobath method does not depend on hand paresis.
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Affiliation(s)
- Jolanta Krukowska
- Physiotherapy Laboratory, Department of Physical Medicine, Medical University of Lodz, Lodz, Poland; Faculty of Pedagogy and Health Promotion, Some College of Informatics and Skills of Lodz, Lodz, Poland.
| | - Marcin Bugajski
- Department of Rehabilitation, Medical University of Lodz, Lodz, Poland.
| | - Monika Sienkiewicz
- Department of Allergology and Respiratory Rehabilitation, Medical University of Lodz, Lodz, Poland.
| | - Jan Czernicki
- Physiotherapy Laboratory, Department of Physical Medicine, Medical University of Lodz, Lodz, Poland.
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Vaughan-Graham J, Cott C. Defining a Bobath clinical framework – A modified e-Delphi study. Physiother Theory Pract 2016; 32:612-627. [DOI: 10.1080/09593985.2016.1228722] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Julie Vaughan-Graham
- Department of Physical Therapy, Rehabilitation Science Institute, University of Toronto, Toronto, ON, Canada
| | - Cheryl Cott
- Department of Physical Therapy, Rehabilitation Science Institute, University of Toronto, Toronto, ON, Canada
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Effects of mirror therapy integrated with task-oriented exercise on the balance function of patients with poststroke hemiparesis: a randomized-controlled pilot trial. Int J Rehabil Res 2016; 39:70-6. [PMID: 26658524 DOI: 10.1097/mrr.0000000000000148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study aimed to explore the effects of mirror therapy integrated with task-oriented exercise on balance function in poststroke hemiparesis. Twenty patients with poststroke hemiparesis were assigned randomly to an experimental group (EG) and a control group (CG), with 10 individuals each. Participants of the EG and CG received a task-oriented exercise program with a focus on the strengthening of the lower limb and the practice of balance-related functional tasks. An additional option for the EG was front and side wall mirrors to provide visual feedback for their own movements while performing the exercise. The program was performed for 30 min, twice a day, five times per week for 4 weeks. Outcome measures included the Berg balance scale, the timed up-and-go test, and quantitative data (balance index and dynamic limits of stability). In the EG and CG, all variables showed significant differences between pretest and post-test (P<0.05), and post-test values of all variables appeared to be significantly different between two groups (P<0.05). Furthermore, in the EG, the change values between pretest and post-test values of Berg balance scale (13.00±3.20 vs. 6.60±4.55 scores), and timed up-and-go test (6.45±3.00 vs. 3.61±1.84 s), balance index (2.29±0.51 vs. 0.96±0.65 scores), dynamic limits of stability (7.70±3.83 vs. 3.70±4.60 scores) were significantly higher than those of the CG (P<0.05). The findings suggest that a mirror therapy may be used as a beneficial therapeutic option to facilitate the effects of a task-oriented exercise on balance function of patients with poststroke hemiparesis.
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Choi HS, Jeon SB. Effect of Backward Walking Training on Balance Capability and Gait Performance in Patients With Stroke. ACTA ACUST UNITED AC 2015. [DOI: 10.14400/jdc.2015.13.1.367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Vaughan-Graham J, Cott C, Wright FV. The Bobath (NDT) concept in adult neurological rehabilitation: what is the state of the knowledge? A scoping review. Part I: conceptual perspectives. Disabil Rehabil 2014; 37:1793-807. [DOI: 10.3109/09638288.2014.985802] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Effects of an Ankle-Foot Orthosis on Balance and Walking After Stroke: A Systematic Review and Pooled Meta-Analysis. Arch Phys Med Rehabil 2013; 94:1377-85. [PMID: 23416220 DOI: 10.1016/j.apmr.2012.12.025] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 12/13/2012] [Indexed: 11/23/2022]
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Shinohara T, Usuda S. Are contents of physical therapy in nine Japanese hospitals for inpatients with stroke related to inpatients' and physical therapists' characteristics? J Phys Ther Sci 2013; 25:641-7. [PMID: 24259820 PMCID: PMC3804984 DOI: 10.1589/jpts.25.641] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 01/22/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study investigated the factors that influence activities provided during
physical therapy for stroke. [Subjects] Data were collected from 85 physical therapists
and 216 inpatients with stroke. [Methods] Time spent on specific functional activities
provided to inpatients with stroke was recorded at nine rehabilitation facilities. These
were used as dependent variables. Physical therapists’ characteristics, including years
since acquiring a license, gender, and treatment concepts influencing physical therapy for
stroke, were recorded. Inpatients’ characteristics, including age, gender, affected side,
days post stroke, score on the Modified Rankin Scale (mRS), and gait ability measured by
the Functional Independence Measure (FIM gait), were also recorded. Physical therapists’
and inpatients’ characteristics were used as independent variables. The t-test,
correlation coefficients, and analysis of covariance were used to investigate which
independent variables correlated with which dependent variables. [Results] Pre-gait,
advanced gait, and community mobility were significantly correlated with mRS and FIM gait
(|rs| = 0.32–0.62). Time spent on other functional activities had a weak
correlation with inpatients’ characteristics. Time spent on functional activities had no
or few correlations with physical therapists’ characteristics. [Conclusion] Relationships
between time spent on specific functional activities and physical therapists’
characteristics were weaker than those for inpatients’ characteristics. Physical therapy
for stroke includes many factors.
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Affiliation(s)
- Tomoyuki Shinohara
- Acute Rehabilitation Center, Hidaka Hospital ; Graduate School of Health Sciences, Gunma University
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Langhammer B, Stanghelle JK. Reply to letter to the editor: concerns about standards of reporting clinical trials: an RCT comparing the Bobath concept and motor relearning interventions for rehabilitation of stroke patients as an exemplar. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2012; 17:244-7. [PMID: 23174958 DOI: 10.1002/pri.1542] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Khan FR, Vijesh PV, Rahool S, Radha AA, Sukumaran S, Kurupath R. Physiotherapy practice in stroke rehabilitation: a cross-sectional survey of physiotherapists in the state of Kerala, India. Top Stroke Rehabil 2012; 19:405-10. [PMID: 22982827 DOI: 10.1310/tsr1905-405] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Physiotherapy, a major component of rehabilitation for stroke patients, has been shown to have a positive effect on outcome. However, there is debate over efficacy of different interventions related to stroke rehabilitation. PURPOSE The purpose of this study was to compare knowledge and attitudes of physiotherapists working with stroke patients in Kerala, India, with emphasis on demographics, approach to treatment, and beliefs about stroke rehabilitation. METHODS Two hundred one physiotherapists in Kerala were surveyed using questionnaires, which were sent by post. Questionnaires consisted of items related to stroke rehabilitation such as approaches to physiotherapy, use of walking aids, and discharge issues. Data analysis was done using percentage-wise comparisons. RESULTS Examination of results showed variation in the beliefs held by physiotherapists about treatment of stroke patients. Of the 201 respondents, 153 (76.1%) used a conventional treatment approach. There was a strong disparity among physiotherapists regarding use of walking aids by stroke patients: 119 (59.2%) agreed that tripods or quadripods should be given to patients, but 55 (27.4%) disagreed and 27 (13.4%) were unsure. In response to questions about discharge issues, 30 (14.9%) of the 118 respondents agreed that they were actively involved in discharge planning for stroke patients, and 158 (78.6%) agreed that skill of the physiotherapist influences outcomes. CONCLUSION A great deal of variation among physiotherapists in treatment approaches and beliefs was revealed in this study, which indicates the need for development and implementation of a standardized protocol for stroke rehabilitation in Kerala.
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Affiliation(s)
- Fayaz Rahman Khan
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Her JG, Park KD, Yang Y, Ko T, Kim H, Lee J, Woo JH, Ko J. Effects of Balance Training with Various Dual-Task Conditions on Stroke Patients. J Phys Ther Sci 2011. [DOI: 10.1589/jpts.23.713] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Ki-dong Park
- Department of Physical Therapy, Rusk Bundang Rehabilitation Hospital
| | - YeongAe Yang
- Department of Occupational Therapy, Inje University
| | - Taesung Ko
- Department of Physical Therapy, Daewon University College
| | - Heesoo Kim
- Department of Occupational Therapy, Hallym University Medical Center
| | - Jusang Lee
- Department of Physical Therapy, Hallym College
| | - Ji-Hea Woo
- Department of Physical Therapy, Hallym College
| | - Jooyeon Ko
- Department of Rehabilitation Medicine, CHA University, CHA Bundang Medical Center
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Schuster C, Butler J, Andrews B, Kischka U, Ettlin T. Comparison of embedded and added motor imagery training in patients after stroke: study protocol of a randomised controlled pilot trial using a mixed methods approach. Trials 2009; 10:97. [PMID: 19849835 PMCID: PMC2775030 DOI: 10.1186/1745-6215-10-97] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Accepted: 10/22/2009] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Two different approaches have been adopted when applying motor imagery (MI) to stroke patients. MI can be conducted either added to conventional physiotherapy or integrated within therapy sessions. The proposed study aims to compare the efficacy of embedded MI to an added MI intervention. Evidence from pilot studies reported in the literature suggests that both approaches can improve performance of a complex motor skill involving whole body movements, however, it remains to be demonstrated, which is the more effective one. METHODS/DESIGN A single blinded, randomised controlled trial (RCT) with a pre-post intervention design will be carried out. The study design includes two experimental groups and a control group (CG). Both experimental groups (EG1, EG2) will receive physical practice of a clinical relevant motor task ('Going down, laying on the floor, and getting up again') over a two week intervention period: EG1 with embedded MI training, EG2 with MI training added after physiotherapy. The CG will receive standard physiotherapy intervention and an additional control intervention not related to MI. The primary study outcome is the time difference to perform the task from pre to post-intervention. Secondary outcomes include level of help needed, stages of motor task completion, degree of motor impairment, balance ability, fear of falling measure, motivation score, and motor imagery ability score. Four data collection points are proposed: twice during baseline phase, once following the intervention period, and once after a two week follow up. A nested qualitative part should add an important insight into patients' experience and attitudes towards MI. Semi-structured interviews of six to ten patients, who participate in the RCT, will be conducted to investigate patients' previous experience with MI and their expectations towards the MI intervention in the study. Patients will be interviewed prior and after the intervention period. DISCUSSION Results will determine whether embedded MI is superior to added MI. Findings of the semi-structured interviews will help to integrate patient's expectations of MI interventions in the design of research studies to improve practical applicability using MI as an adjunct therapy technique.
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Abstract
BACKGROUND Post-stroke motor impairments cause difficulty controlling the joints of the affected limbs to produce useful movements. One way to manage this to use an orthosis to control the movement of the affected joints but evidence for their benefit is lacking. OBJECTIVES To determine the effectiveness of upper or lower limb orthoses on activity and impairment in people with stroke and other non-progressive brain lesions. SEARCH STRATEGY In February 2007 we searched the trials registers of the Cochrane Stroke, Movement Disorders and Injuries Groups, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2007), MEDLINE (from 1966), EMBASE (from 1980), CINAHL (from 1983), AMED (from 1985), PsycINFO (from 1967) and RECAL (from 1990), and other databases and trials registers. We screened reference lists, contacted lead authors and other researchers in the field. SELECTION CRITERIA We included randomised controlled trials of orthoses applied to the upper or lower limb in people with stroke and other non-progressive brain lesions. DATA COLLECTION AND ANALYSIS Two review authors independently identified trials, extracted data, and assessed trial quality. Results for continuous outcomes were combined and analysed using mean difference or standardised mean difference, both with 95% confidence intervals and fixed-effect model. MAIN RESULTS We analysed 14 trials with 429 participants. The overall effect of lower limb orthoses on walking disability (speed), walking impairment (step/stride length) and balance impairment (weight distribution in standing) was significant and beneficial. There was no significant effect on postural sway (balance impairment) or mobility disability but the numbers of studies and participants were low. However, these were all cross-over trials that looked at the immediate effect while wearing the orthosis; they did not assess the effects of wearing an orthosis over the long term. Upper limb orthoses showed no effect on upper limb function, range of movement at the wrist, fingers or thumb, nor pain. However, this was based on only three trials. AUTHORS' CONCLUSIONS A lower limb orthosis can improve walking and balance but the included studies have only examined the immediate effects while wearing the orthosis; the effects of long-term use have not been investigated. An upper limb orthosis does not effect on upper limb function, range of movement at the wrist, fingers or thumb, nor pain, but this conclusion is based on only three trials.
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Affiliation(s)
- Sarah F Tyson
- University of SalfordCentre for Rehabilitation & Human Performance ResearchFrederick Road CampusSalfordUKM6 6PU
| | - Ruth M Kent
- University of LeedsAcademic Department of Rehabilitation Medicine, Faculty of Medicine and HealthLevel D, Martin Wing, Great George StreetLeeds General InfirmaryLeedsUKLS1 3EX
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A treatment schedule of conventional physical therapy provided to enhance upper limb sensorimotor recovery after stroke: Expert criterion validity and intra-rater reliability. Physiotherapy 2009; 95:110-9. [DOI: 10.1016/j.physio.2008.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 09/30/2008] [Accepted: 11/26/2008] [Indexed: 11/21/2022]
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Abstract
BACKGROUND Post-stroke motor impairments cause difficulty controlling the joints of the affected limbs to produce useful movements. One way to manage this to use an orthosis to control the movement of the affected joints but evidence for their benefit is lacking. OBJECTIVES To determine the effectiveness of upper or lower limb orthoses on activity and impairment in people with stroke and other non-progressive brain lesions. SEARCH STRATEGY In February 2007 we searched the trials registers of the Cochrane Stroke, Movement Disorders and Injuries Groups, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2007), MEDLINE (from 1966), EMBASE (from 1980), CINAHL (from 1983), AMED (from 1985), PsycINFO (from 1967) and RECAL (from 1990), and other databases and trials registers. We screened reference lists, contacted lead authors and other researchers in the field. SELECTION CRITERIA We included randomised controlled trials of orthoses applied to the upper or lower limb in people with stroke and other non-progressive brain lesions. DATA COLLECTION AND ANALYSIS Two review authors independently identified trials, extracted data, and assessed trial quality. Results for continuous outcomes were combined and analysed using mean difference or standardised mean difference, both with 95% confidence intervals and fixed-effect model. MAIN RESULTS We analysed 14 trials with 429 participants. The overall effect of lower limb orthoses on walking disability (speed), walking impairment (step/stride length) and balance impairment (weight distribution in standing) was significant and beneficial. There was no significant effect on postural sway (balance impairment) or mobility disability but the numbers of studies and participants were low. However, these were all cross-over trials that looked at the immediate effect while wearing the orthosis; they did not assess the effects of wearing an orthosis over the long term. Upper limb orthoses showed no effect on upper limb function, range of movement at the wrist, fingers or thumb, nor pain. However, this was based on only three trials. AUTHORS' CONCLUSIONS A lower limb orthosis can improve walking and balance but the included studies have only examined the immediate effects while wearing the orthosis; the effects of long-term use have not been investigated. An upper limb orthosis does not effect on upper limb function, range of movement at the wrist, fingers or thumb, nor pain, but this conclusion is based on only three trials.
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Affiliation(s)
- Sarah F Tyson
- Centre for Rehabilitation & Human Performance Research, University of Salford, Frederick Road Campus, Salford, UK, M6 6PU.
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Mayston M. Bobath Concept: Bobath@50: mid-life crisis--what of the future? PHYSIOTHERAPY RESEARCH INTERNATIONAL 2009; 13:131-6. [PMID: 18752337 DOI: 10.1002/pri.413] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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