As a physician and neurorehabilitationist whose primary professional concern has

been with adult patients, it may seem strange that I feel so deeply indebted to Karel

and Berta Bobath, who devoted much of their lives to the rehabilitation of children

with neurological problems, especially cerebral palsy. And yet, it is true. I believe

that the benefi cent infl uence of the Bobaths on our approach to neurological rehabilitation

has been incomparable, and all of us who are involved in the care of people

struggling to overcome the impact of neurological damage owe them a debt of gratitude.

Things that we now take for granted were regarded as heretical or eccentric

when the Bobaths started out on their careers so many years ago and developed an

approached which combined science, and a deeply humane concern for the plight of

individuals, with neurological damage with something we might call ‘clinical nous‘.

The results are plain to see for all those who have long enough memories. When

I began my career as a doctor in the 1970s, stroke patients were not welcomed on

medical wards and rehabilitation services were poorly developed. The nihilism of

Hughlings Jackson, the father of British neurology – encapsulated in his observation

that ‘You can’t treat a hole in the brain’ – summarised the prevailing attitude.

The physiotherapy these patients received was often misguided, having an orthopaedic

bias, as Sue Raine notes in her contribution: massage, heat, passive and

active movement techniques such as the use of pulleys, suspension and weights.

The results were dreadful: stroke patients routinely ended up with severe fl exion

of the upper limbs (with the fi ngers curled over so tightly that hygiene was almost

impossible), extension of the lower limbs and foot drop, so that walking was a

perilous business – requiring circumduction at the hip – and not infrequently, the

chronic misery of severe shoulder pain. Inappropriate splints and walking aids

added to the demoralisation of the patient.