Bobath Couch, Neurological Table, Bobath Neurological Table, Wide Plinth, Double Plinth are all names for the wide treatment tables commonly used by physiotherapists for neurological rehabilitation. For the purpose of this paper, they will be referred to as Bobath Tables.
Originally specified by Dr Karel & Mrs Berta Bobath in the 1940s, the Bobath technique uses a range of movements to enhance recovery of people with neurological problems. Given the range and type of movements, a wider table / ‘work surface’ provided greater support to both patient and physiotherapist during treatment. Bobath Tables widths are typically in the 110 – 120cm range but can be as wide as 180cm or more and up to 200cm or more in length. These tables are cumbersome and heavy to deliver and position and ideally need a door wide enoughto allow for the table to be wheeled through. Specialist delivery teams are recommended for the wider tables.
Initially, Bobath Tables were simply a fixed height table with a padded top. As manufacturers developed the mechanism to allow for height adjustments, Bobath Tables are now almost all designed to allow for height adjustment over a range. Thisallows for easy patient access to the table either unaided or aided and adjustment to a suitable working height for the physiotherapist. Typically, a minimum height is in the order of 50cm – close to a wheel chair seat height. A maximum heigh will be in the order of 90cm – a convenient height for a slide transfer from a bed while minimizing the need for the people making the transfer to bend their backs. A further advantage of adjustable height Bobath Tables is that they can be set to a height suitable for a specific exercise.
The mechanism to adjust height on a Bobath Table was initially a hydraulic jack. This needed to be lifted by pumping on a foot lever to adjust the height – hard to dowhile also supervising the patient. Hydraulic jacks have been almost entirely superseded in the last 20 – 25 years with electric linear actuators, generally controlled with a foot operated switch. Even more recently, electric columns have provided further enhancements to the height adjustment process.
Both hydraulic jacks and electric linear actuators adjust the height of the Bobath Table by pushing a lifting arm in a circular motion. The change in height is accompanied by a lateral movement along the direction of the push which can be up to 20cm or more depending on the geometry and height. This can cause problems in constricted spaces. Electric columns provide a direct lift with no lateral movement.
When a patient sits on the side of a Bobath Table, there will be a twisting force delivered through the structure which is aggravated if the height is adjusted at the same time. When choosing a Bobath Table, check the lifting mechanism. Is it as wide as practicable, or is it simply a mechanism suitable for a narrower table with and extended frame? The wider the lifting mechanism, the longer your Bobath Table will last. This is especially relevant with the increasing average weight of patients. Breathe holes make the treatment process more comfortable for patients. Multiple breathe holes are particularly beneficial when patients are exercising by rolling on the table.A backrest helps with patient positioning. These are heavy to adjust and provision ofan electric actuator to control the adjustment makes it easier and safer for the physiotherapist.