REFRAMING NEUROMUSCULAR REHABILITATION: BEYOND BOBATH AND TOWARD DYNAMIC MOVEMENT INTERVENTION

Abstract

Background: Rehabilitation of children with spastic cerebral palsy (CP) has traditionally relied on the Bobath concept or Neurodevelopmental Treatment (NDT). However, growing evidence from neuroscience and motor learning research has questioned the functional effectiveness of tone-centered approaches, highlighting the need for task-specific, activity-based interventions that translate into meaningful functional gains. Dynamic Movement Intervention (DMI) has recently emerged as an alternative framework aligned with neuroplasticity principles and functional rehabilitation goals.

Objective: To evaluate the effectiveness of Dynamic Movement Intervention in improving trunk control and gross motor function in children with spastic cerebral palsy compared with traditional Bobath-based therapy.

Methods: A randomized controlled design was used in which children with spastic cerebral palsy received either Dynamic Movement Intervention or Bobath-based therapy, with outcomes assessed using validated tools including the Gross Motor Function Measure-88 and Trunk Impairment Scale.

Results: Evidence from comparative studies indicates that dynamic, trunk-focused interventions produce greater improvements in trunk stability and gross motor function than conventional physiotherapy or Bobath-based approaches. DMI promotes active engagement, task specificity, and multisensory integration through dynamic surfaces, facilitating motor learning and functional participation. Preliminary findings from ongoing randomized controlled trials suggest superior outcomes on standardized measures such as the Gross Motor Function Measure-88 and Trunk Impairment Scale, supporting the clinical relevance of this approach.

Conclusion: Dynamic Movement Intervention represents a paradigm shift in pediatric neurorehabilitation from normalization of movement toward functional empowerment. By emphasizing active participation, trunk control, and task-specific motor learning, DMI aligns with contemporary evidence and the ICF framework. While further large-scale trials are warranted, current findings support the integration of DMI into evidence-informed rehabilitation practice to enhance functional independence and participation in children with spastic cerebral palsy.