Tuesday, 28 April 2015

BOBATH – MEEH

Familiar stuff

'Bobath' is often held up as some sort or unquestionable gold standard. Acquaintance with the research literature makes one wonder how it has gained and maintained this enviable status. At times, however the contrary judgement bursts through.

Does anything in the following acerbic example, however, look familiar?

Neuro-Developmental Treatment: meh

NDT/Bobath has been used on stroke survivors for decades and decades. When I was in school [at college/university?] professors talked about it as if it was the most awesomest thing that had ever been awesome. It was the pinnacle. But it was complicated. It was so complicated you couldn't even learn it in school. You have to learn it from other NDT/Bobath practitioners. You could've gone to the Harvard school of physical therapy (if there was one -- which there isn't) and you still couldn't learn NDT/Bobath. Which is a red flag right there. If it works so well it would be required.

Instead, after graduating you have to go and get "certified" by NDT/Bobath gurus. Those gurus would've learned from other gurus, and up the pyramid it goes. NDT/Bobath training is expensive. We're talking about thousands of dollars and weeks of a therapist's life...

NDT/Bobath always does poorly in systematic reviews. And that should be the end of it, right? It doesn't work. Goodbye. But not so fast....Research doesn't know what works so I can use anything I want...

Here are some arguments made by NDT/Bobath therapists:
  • There's research that says it works, and research that says it doesn't work. It's 'He said, she said'. I choose to believe the research that says it works.…
  • NDT incorporates all the latest research into NDT. Therefore NDT is research-based...
  • Research doesn't know what works so I can use anything I want...
  • I don't need research to tell me something works. I've seen it work...
  • What do I use for very low-level survivors? They can't move and/or can't follow directions. So, I move them. At least I'm doing something. Nothing else stops the plague so we're sticking with leeches...
Read this in full at:
http://recoverfromstroke.blogspot.co.uk/2013/01/neuro-developmental-treatment.html

Susie Mallett picked this posting up via a notification on Dean's Stroke Musings. She emailed me with its URL, struck by the parallels with criticisms of Conductive Education.

The is a posting is on a critical research blog Stronger after stroke that has run since 2007, written by Peter Levine the author of a book of the same name:
http://www.amazon.com/Peter-G.-Levine/e/B001JOVQJU/ref=dp_byline_cont_book_1

Mr Levine is especially concerned for neuroplasticity and for evidence-based practice. He appears not yet to have turned his attention to Conductive Education...

'Meh': a new word to me, or is it?

The final word in the title of the blog posting referred to here is a new one to me, at least in this written form. I thought at first that this was a typo. A quick check on line, however, found that this written word is a few years old, being found in casual written communications of younger people in the United States. 

Further consideration, however, suggested that I have known and even used the spoken form for years, perhaps since childhood. I just have never seen it attempted in written speech, nor had the need to write it myself.

In my own British English I know the sound differently, as another way to represent the ragged bleating or baahing of a sheep  'meeh'':

http://www.sheep.com/sheep_sounds.cfm 

I do not know whether there is a possible etymology here for the onomatopaeic word's quite common use to indicate indifference, used when one simply does not care about something. 
Thus:
Bobath, meeh
Used in this way, this can also indicate something rather less neutral, a sound to show the speaker's feeling of disparagement to what is being mentioned, something like 'as if'', 'piffle', 'bollocks'. 

I do hope that this helps explain the title of the item referred to below...

Reference

Levine, P. G. (2013) Neuro-Developmental Treatment: meh, Stronger after stroke, 5 January

2 comments:

  1. P G Levine has a touching faith in systematic reviews, evidently.

    ReplyDelete
    Replies
    1. Surely, Norman, all faith is touching if you chose to regard it that way. Technicians, scientists and science-writers are human too and there seems no cause to separate them from this.

      Delete