What is NDT or Bobath therapy, and why is it so widely used?

Neurodevelopmental Therapy, often called the Bobath approach, was developed in the 1950s and is based on a therapist physically facilitating what were considered more normal movement patterns while inhibiting abnormal ones. It became extremely widely adopted over the following decades and, in some countries, is still considered the standard, default approach taught to physiotherapists working with children with CP.

What does the actual research evidence say about NDT/Bobath specifically?

Honestly, the evidence is now quite clear and has been for some time. A 2022 meta-analysis published in the American Academy of Pediatrics' own journal explicitly concluded that its results support the deimplementation of NDT in clinical practice, and named several evidence-based alternatives instead. A 2024 editorial in a leading child neurology journal reinforced this directly, in response to an attempt to rebrand the approach, noting that the proposed new model was based on expert opinion rather than data and had never actually been tested.

What does the evidence favour instead of NDT alone?

Goal-directed and task-specific training, where a child actively and repeatedly practises the actual functional task they're working toward, currently has the strongest, broadest evidence base, with documented benefits across motor function, self-care, communication, and participation. Constraint-induced movement therapy and bimanual therapy specifically for hand and arm function also carry genuinely high-level evidence.

Is it true that strength training used to be avoided in CP, and has that changed?

Yes, genuinely. Strength training was historically avoided out of concern it would worsen spasticity. Multiple systematic reviews and meta-analyses have since consistently found no evidence of increased spasticity from appropriately dosed strength training, along with real, positive effects on strength, balance, gait speed, and gross motor function, particularly for children functioning at GMFCS levels I through III. One honest caveat: evidence for how well these gains are sustained after training stops remains more limited.

Which Physiotherapy Approaches Work Best for CP? Comparing the Evidence

Treatment 13 min read

Which Physiotherapy Approaches Work Best for CP? Comparing the Evidence

Q: Does this mean NDT has no place at all in a child's care?

Not quite, and this deserves an honest, balanced answer. Even the critical 2022 review acknowledged that elements of NDT may remain reasonably incorporated within individualised early-intervention programmes, particularly when delivered as part of a broader, multimodal, goal-directed approach, rather than as a stand-alone method claimed to be superior on its own.

Q: How should I actually raise this with my child's current physiotherapist?

As a genuine, non-adversarial question rather than a confrontation. Asking directly whether your child's programme incorporates goal-directed, task-specific practice toward concrete functional goals, alongside whatever specific techniques are being used, is a completely reasonable thing to raise with any therapist, and most will welcome the conversation.

Years of sessions, real money, real hope invested, often without anyone laying out which approach actually has strong evidence behind it. This article does that honestly, including a finding that may genuinely surprise you about the most widely taught approach in the world.

Written by CP Clinic Medical Team Tovmed Medical Center, Vinnytsia, Ukraine

Medically reviewed by Prof. Vigein Tovmasian PhD · Orthopedic Surgeon · Honorary Doctor of Ukraine

NDT/Bobath: the most widely used approach

Neurodevelopmental Therapy, commonly called the Bobath approach, was developed in the 1950s. It’s based on a therapist physically facilitating what were considered more normal movement patterns, while inhibiting patterns considered abnormal. It became extremely widely adopted over the following decades and, in some countries, remains the standard, default approach taught to physiotherapists working with children with CP.

What the evidence actually says

A 2022 meta-analysis published in Pediatrics, the American Academy of Pediatrics’ own flagship journal, explicitly concluded that its results support the deimplementation of NDT in clinical practice, and named specific evidence-based alternatives to use instead: task-specific training, goal-directed training, treadmill training, constraint-induced movement therapy, action observation, and bimanual therapy.

This finding also converges with a substantial body of stroke rehabilitation research in adults, where task-specific training has repeatedly been found superior to Bobath therapy for both arm and walking outcomes, with moderate-to-large effect sizes.

When the field pushed back

In 2024, three global Bobath leaders proposed repositioning the approach as a “clinical reasoning framework” rather than a measurable treatment. A direct editorial response in a leading child neurology journal noted plainly that this new model was based on expert opinion, not data, and had never actually been tested.

The honest, balanced part

This doesn’t mean NDT has zero place in a child’s care. Even the critical 2022 review acknowledged that elements of it may remain reasonably incorporated within individualised early-intervention programmes, particularly when delivered as part of a broader, multimodal, goal-directed approach, rather than practiced as a stand-alone method claimed to be superior on its own.

Goal-directed and task-specific training

Goal-Directed Training (GDT)

Currently favoured by the evidence

A child actively and repeatedly practises the actual functional task they’re working toward, rather than having movement patterns externally facilitated or corrected in the abstract. A comprehensive review synthesising 112 intervention studies found measurable benefits across motor function, self-care, communication, and participation, a genuinely broad, multi-domain evidence base.

Honestly worth noting: even here, a real gap exists between what the evidence supports and what actually gets implemented in everyday clinical practice, which is exactly why asking your own therapist about it directly is worthwhile.

Constraint-induced and bimanual therapy

For hand and arm function specifically, particularly relevant in hemiplegia, constraint-induced movement therapy and bimanual therapy both carry genuinely high-level supporting evidence, among the strongest evidence bases of any approach covered in this article.

Strength training: a reversed old fear

Strength training was historically avoided in CP care out of concern it would worsen spasticity. Multiple systematic reviews and meta-analyses have since consistently found no evidence of increased spasticity from appropriately dosed strength training, alongside real, positive effects on muscle strength, balance, gait speed, and gross motor function, particularly for children functioning at GMFCS levels I through III when proper dosage and principles are used.

One honest caveat worth knowing: evidence on how well these gains are sustained after a training program ends remains more limited, which is a reasonable thing to ask about when starting one.

How to raise this with your therapist

This is genuinely worth approaching as a normal, non-adversarial question rather than a confrontation. Asking directly whether your child’s programme incorporates goal-directed, task-specific practice toward concrete functional goals, alongside whatever specific hands-on techniques are being used, is a completely reasonable thing to bring up with any therapist. Most welcome this exact conversation.

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Frequently asked questions

What is NDT/Bobath, and why is it so widely used?

Developed in the 1950s, based on a therapist facilitating “normal” movement patterns while inhibiting “abnormal” ones. Became widely adopted and remains the default standard in some countries.

What does the evidence actually say about NDT?

A 2022 Pediatrics meta-analysis explicitly supported deimplementing NDT, naming evidence-based alternatives instead. A 2024 editorial responding to a rebranding attempt noted the new model was based on expert opinion, not data, and had never been tested.

Does this mean NDT has no place at all?

Not entirely. Elements may still reasonably fit within individualised, multimodal, goal-directed early-intervention programmes, rather than being used as a stand-alone method claimed to be superior on its own.

What does the evidence favour instead?

Goal-directed and task-specific training, with the broadest multi-domain evidence currently available. Constraint-induced movement therapy and bimanual therapy for hand function also carry high-level evidence.

Is it true strength training used to be avoided?

Yes, out of fear it would worsen spasticity. Multiple reviews now consistently find no spasticity increase, with real positive effects at GMFCS I-III, though sustained long-term gains remain less studied.

How should I raise this with my therapist?

As a normal, non-adversarial question. Ask whether the programme incorporates goal-directed, task-specific practice toward concrete functional goals alongside current techniques.

References

“Neurodevelopmental Therapy for Cerebral Palsy: A Meta-analysis.” Pediatrics, American Academy of Pediatrics. AAP Publications ↗
“Bobath, NeuroDevelopmental Therapy, and clinical science: Rebranding versus rigor.” Developmental Medicine & Child Neurology. Wiley ↗
“Bobath therapy is inferior to task-specific training and not superior to other interventions in improving arm activity and arm strength outcomes after stroke: a systematic review.” ScienceDirect. ScienceDirect ↗
“Defining Goal-Directed Training for Children with Cerebral Palsy: A Scoping Review and Framework for Implementation.” PMC. PMC ↗
“Effect of muscle strength training in children and adolescents with spastic cerebral palsy: A systematic review and meta-analysis.” PMC. PMC ↗
“The Impact of Functional Strength Training on Muscle Strength and Mobility in Children with Spastic Cerebral Palsy.” PubMed. PubMed ↗

Medical disclaimer: This article is for informational purposes. Your child’s specific therapy approach should be decided together with their physiotherapist based on direct assessment.