Effects of Vojta approach on diaphragm movement in children with spastic cerebral palsy

Critical review of the evidence for Vojta Therapy: a systematic review and meta-analysis

Introduction

It is essential to link the theoretical framework of any neurophysiotherapy approach with a detailed analysis of the central motor control mechanisms that influence motor behavior. Vojta therapy (VT) falls within interventions aiming to modify neuronal activity. Although it is often mistakenly perceived as exclusively pediatric, its utility spans various functional disorders by acting on central pattern modulation. This study aims to review the existing evidence on the effectiveness of VT across a wide range of conditions, both in the adult population and in pediatrics, and analyze common therapeutic mechanisms, focusing on motor control modulation.

Aim

The goals of this systematic review are to delineate the existing body of evidence concerning the efficacy of Vojta therapy (VT) in treating a broad range of conditions, as well as understand the common therapeutic mechanisms underlying VT with a specific focus on the neuromodulation of motor control parameters.

Methods

PubMed, Cochrane Library, SCOPUS, Web of Science, and Embase databases were searched for eligible studies. The methodological quality of the studies was assessed using the PEDro list and the Risk-Of-Bias Tool to assess the risk of bias in randomized trials. Methodological quality was evaluated using the Risk-Of-Bias Tool for randomized trials. Random-effects meta-analyses with 95% CI were used to quantify the change scores between the VT and control groups. The certainty of our findings (the closeness of the estimated effect to the true effect) was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE).

Results

Fifty-five studies were included in the qualitative analysis and 18 in the meta-analysis. Significant differences in cortical activity (p = 0.0001) and muscle activity (p = 0.001) were observed in adults undergoing VT compared to the control, as well as in balance in those living with multiple sclerosis (p < 0.03). Non-significant differences were found in the meta-analysis when evaluating gross motor function, oxygen saturation, respiratory rate, height, and head circumference in pediatrics.

Conclusion

Although current evidence supporting VT is limited in quality, there are indications suggesting its potential usefulness for the treatment of respiratory, neurological, and orthopedic pathology. This systematic review and meta-analysis show the robustness of the neurophysiological mechanisms of VT, and that it could be an effective tool for the treatment of balance in adult neurological pathology. Neuromodulation of motor control areas has been confirmed by research focusing on the neurophysiological mechanisms underlying the therapeutic efficacy of VT.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=476848, CRD42023476848.

Synergy of Muscle and Cortical Activation through Vojta Reflex Locomotion Therapy in Young Healthy Adults: A Pilot Randomized Controlled Trial

BACKGROUND

Vojta Therapy is a neurorehabilitation therapy that allows to activate reflex movement patterns. The scientific literature has shown its ability to generate muscle contractions. The activation of brain neural networks has also been proven. However, the relationship between these processes has not yet been demonstrated. For this reason, the aim of this study is to verify brain activation produced by recording with near-infrared spectroscopy and its relationship with muscle activation produced in the abdominal muscles recorded with surface electromyography.

METHODS

A total sample of 27 healthy subjects over 18 years of age was recruited. An experimental study on a cohort was conducted. Two experimental conditions were considered: stimuli according to the Vojta protocol, and a control non-stimuli condition. Abdominal muscle activation was measured using surface electromyography, and the activation of the motor cortex was assessed with near-infrared spectroscopy.

RESULTS

In relation to the oxygenated hemoglobin concentration (HbO), an interaction between the stimulation phase and group was observed. Specifically, the Vojta stimulation group exhibited an increase in concentration from the baseline phase to the first resting period in the right hemisphere, contralateral to the stimulation area. This rise coincided with an enhanced wavelet coherence between the HbO concentration and the electromyography (EMG) signal within a gamma frequency band (very low frequency) during the first resting period.

CONCLUSIONS

The results underscore the neurophysiological effects on the brain following tactile stimulation via Vojta Therapy, highlighting increased activity in pivotal areas essential for sensory processing, motor planning, and control. This activation, particularly evident in the Vojta stimulation group, aligns with previous findings, suggesting that tactile stimuli can not only evoke the intention to move but can also initiate actual muscle contractions, emphasizing the therapy's potential in enhancing innate locomotion and rolling movements in patients with neurological disorders.

The Benefits of Combining Bobath and Vojta Therapies in Infants with Motor Development Impairment-A Pilot Study

Background: In infants presenting with motor development impairment, early kinesiotherapeutic interventions aim to normalise the pattern of movements and improve recovery. By applying Bobath and Vojta methods, we aimed to identify a combined approach regarding motor deficit in infants with neurological disabilities. Methods: We designed a prospective interventional study on 108 infants with motor developmental delay and applied Bobath, Vojta, or combined Bobath and Vojta therapy in three equal groups. Results: In the combined Bobath and Vojta group, complete motor recovery was achieved for 50% of the participants, with full recovery after six months, whereas in Bobath- or Vojta-only therapy groups, the total recovery for all participants was achieved at seven months. Regarding infants with muscular hypertonia, Bobath therapy initiation demonstrated complete recovery in 5 months in more than 50% of the cases, while for Vojta this was achieved in only 33.57% of the cases. Conclusions: The comparative evaluation conducted by analysing the data regarding the application of the Bobath and Vojta methods showed that combining these two therapies results in a shorter motor deficit recovery time than if a single therapy is applied. These findings have important implications for the selection of rehabilitation therapies in infants with neurological motor development issues.

Effect of Dynamic Neuromuscular Stabilization and Vojta Therapy on Respiratory Complications in Neuromuscular Diseases: A Literature Review

Objective

The purpose of this study was to review the literature on the effect of dynamic neuromuscular stabilization (DNS)/Vojta on respiratory complications of neuromuscular diseases.

Methods

The search strategy was conducted, based on the population, intervention, comparison, and outcome method, in the PubMed, Embase, ISI Web of Knowledge, ProQuest, and Scopus databases from inception to August 2021. The quality assessment of included papers was performed through the Physiotherapy Evidence Database scale. A narrative analysis was performed since a meta-analysis could not be conducted.

Results

A total of 7 papers were chosen for the final assessment. All studies, except 1, evaluated individuals with neurological disease. Three studies evaluated Vojta therapy effects, and 4 studies evaluated DNS effects on respiratory parameters. Although the studies had limitations in their methodology according to the Physiotherapy Evidence Database scale, 4 were identified as level 1 evidence. None of the studies reported any adverse effects of Vojta therapy or DNS on respiratory parameters. However, not enough clinical trials were found to examine the effect of DNS on respiratory disease.

Conclusion

Although the studies were weak in internal and external validity, this review suggests that Vojta therapy and DNS may influence respiratory parameters, such as blood gases, diaphragm movements, and functional respiratory parameters, in patients with neuromuscular diseases.

HIPPOTHERAPY IN CEREBRAL PALSY - SURVEY RESEARCH

OBJECTIVE

The aim: To assess the effects of a one-year hippotherapy programme on the physical and mental functioning of children with cerebral palsy.

PATIENTS AND METHODS

Materials and methods: The study included 15 children with cerebral palsy whose mean age was 9 years. The children participated in hippotherapy ses¬sions at the Rehabilitation Centre in Rusinowice (one-year observation). The clinical presentation was dominated by manifestations of motor and postural abnormalities caused by central nervous system damage. A survey questionnaire was used in the study to collect information about problems associated with everyday life and functioning.

RESULTS

Results: The results obtained in this study showed that spastic CP was the most common form of the disorder, affecting 8 out of 15 children (53%). It was followed by mixed CP (40%, 6 children). Among the respondents, 67% (10 people) were already familiar with hippotherapy whereas 33% did not know this method.

CONCLUSION

Conclusions: There was a strong correlation between being familiar with effects of hippotherapy and the level of education of the parent/guardian. This result had a moderate influence on the frequency of hippotherapy sessions. Systematic hippotherapy sessions helped improve physical fitness and everyday functioning in children with cerebral palsy.

Studying the Research-Practice Gap in Physical Therapies for Cerebral Palsy: Preliminary Outcomes Based on a Survey of Spanish Clinicians

The purpose of this work is to study the gap between the research evidence and the clinical practice in the physical rehabilitation of people with cerebral palsy. A review process was performed to (1) identify physical therapies to improve postural control in children with cerebral palsy and (2) determine the scientific evidence supporting the effectiveness of those therapies. A Likert-based survey addressing a total of 43 healthcare professionals involved in pediatric physical therapy departments in Spain was carried out. The discussion was mainly supported by studies of level I or II evidence (according to the Oxford scale). The search process yielded 50 studies reporting 16 therapies. A strong positive correlation between the most used treatments and elevated levels of satisfaction was found. Some well-known but not often used techniques, such as hippotherapy, were identified. The treatment with the highest degree of use and satisfaction-neurodevelopment therapy (Bobath)-and some emerging techniques, such as virtual reality, were also identified. The fact that there is a meaningful gap between clinical practice and the scientific evidence was confirmed. The identified gap brings a certain degree of controversy. While some classic and well-known therapies had poor levels of supporting evidence, other relatively new approaches showed promising results.

Electromyographic Response of the Abdominal Muscles and Stabilizers of the Trunk to Reflex Locomotion Therapy (RLT). A Preliminary Study

Reflex locomotion therapy (RLT) was developed by Vaclav Vojta in 1954 as a diagnostic and treatment tool. This therapy is mainly used to rehabilitate children with motor disorders and risk of cerebral palsy. It is also used for adults with neurological and motor impairment. RLT is based on specific postures and regular stimulation points through which a series of reflex responses are triggered. The neurophysiological mechanisms of this therapy have recently been discovered. This study aims to objectively evaluate muscular responses at the abdominal level after stimulation in the first phase of reflex rolling by showing, with surface electromyography analysis (sEMG), the muscular activity in trunk stabilizing muscles (rectus abdominis, external oblique, internal oblique, and serratus anterior) before, during, and after the application of RLT. A total sample of 27 healthy subjects over 18 years of age was recruited. An experimental study on a cohort was conducted. Two experimental conditions were considered: stimuli according to the Vojta protocol, and a control non-STI condition. Regarding muscular electrical activity, statistically significant differences were determined in all muscles during right-sided stimulation in the VSTI condition (p < 0.001), but not in the non-STI condition. The mean increase in muscle activity in the VSTI condition during the first stimulation ranged from 7% to 20% in the different abdominal muscles. In conclusion, an sEMG response was observed in the abdominal muscles during stimulation of the pectoral area as described in RLT, compared to stimulation of non-described areas.

Factors affecting rehabilitation of infants with Central Coordination Disorders during a three-month-long observation

Background

Central coordination disorders (CCD) encompass various abnormalities observed in infants but early therapy may have an impact on their condition. The aim was to seek factors that may affect the early results of therapy of infants with CCD.

Methods

We analyzed the outcomes of a three-month period of rehabilitation of infants living with CCD. Children were treated at Non-public Specialist Healthcare Institution Medi-Reh in Kalisz in the period from 1 Jan 2014 to 31 Nov 2019. In our retrospective study results of three-month therapy of infants, aged 1 to 6 months, with CCD were analysed regards to the effectiveness and the potential impact of different factors. Therapy and assessment of children were conducted with the use of the Vojta method, which was performed during the first visit (WW) and the follow-up visit (after 3 months- 1WK). The analysis of the influence of various factors on the effect of therapy included: mother's age at the time of delivery, duration of breastfeeding, child APGAR, gestational age in which the child was born, sex of the child, birth weight, age of the child at WW, type of delivery, craniosacral therapy as an additive treatment.

Results

Based on the examination results from 66 medical records it was demonstrated that after active period of the therapy, improvement was observed in 54 (81.81%) (p=0.48) children (condition during WW versus 1WK among the group). The sole factor impacting improvement after 3 months was the age of the child at WW, when the child started therapy. This factor significantly (p=0.002) increased the chance of achieving improvement - by 3.2 times (OR= 3,2; CI= 95). No statistically significant differences were shown for the other studied factors.

Conclusions

Prompt implementation of rehabilitation in children with CCD provides a better chance of improving their motor function. The rehabilitation should be started as soon as possible after the diagnosis is constituted.

Vojta Therapy in Neuromotor Development of Pediatrics Patients with Periventricular Leukomalacia: Case Series

Background and Objectives: Vojta therapy is used by physiotherapists and is based on stimulation through peripheral pressure that leads to the activation of involuntary motor response patterns, thus triggering patterns of reflex locomotion, hence also called reflex locomotion therapy. Objective: To analyze the changes produced by Vojta therapy in the evolution of infant motor development in patients with maturational delay due to periventricular leukomalacia. Materials and methods: One session of Vojta Therapy per week for eleven months, patients’ neuromotor development was evaluated through the Denver II Test and the Baleys Scale. Results: A clinically significant increase in the development of the patients is observed. Conclusions: Neuromotor development seems to generate an adequate progression in the motor area.

Reflex zone stimulation reduces ventilation inhomogeneity in cystic fibrosis: A randomised controlled cross-over study

BACKGROUND

The reflex zone stimulation technique (RST) activates complex motor responses and has a positive impact on the locomotor system. This technique may also indirectly affect breathing; however, the use of this technique as adjunct of the treatment of cystic fibrosis (CF) has not yet been characterised.

METHODS

We performed a randomised controlled single-centre interventional trial to evaluate the short-term effects of RST on lung function in 21 paediatric CF patients with normal baseline spirometry. The effect of 30 min of RST was compared to that of sham therapy in a crossover design. The interventions were performed in random order and planned 6 months apart. The primary outcome was a change in global ventilation inhomogeneity after intervention, assessed by lung clearance index (LCI_2.5 ) derived from a nitrogen multiple breath washout test. Secondary outcomes included changes in regional ventilation inhomogeneity (indices of acinar [Sacin*Vt] and conductive airway [Scond*Vt] inhomogeneity) and spirometry parameters (inspiratory capacity, forced vital capacity, and forced expiratory volume in 1 s). Trunk deformity was assessed by physiotherapists at study entry.

RESULTS

After the RST intervention, the LCI_2.5 (p = .004) and Scond*Vt (p = .009) decreased significantly, while inspiratory capacity increased (p = .012). In the sham-therapy group, none of the parameters changed significantly. Trunk deformity was seen in 76.5% of all patients, and 92.9% of those with trunk deformity showed a decrease in LCI_2.5 after RST.

CONCLUSION

RST has multiple positive short-term effects on lung function, especially in CF patients with trunk deformities.

State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

PURPOSE OF REVIEW

Cerebral palsy is the most common physical disability of childhood, but the rate is falling, and severity is lessening. We conducted a systematic overview of best available evidence (2012-2019), appraising evidence using GRADE and the Evidence Alert Traffic Light System and then aggregated the new findings with our previous 2013 findings. This article summarizes the best available evidence interventions for preventing and managing cerebral palsy in 2019.

RECENT FINDINGS

Effective prevention strategies include antenatal corticosteroids, magnesium sulfate, caffeine, and neonatal hypothermia. Effective allied health interventions include acceptance and commitment therapy, action observations, bimanual training, casting, constraint-induced movement therapy, environmental enrichment, fitness training, goal-directed training, hippotherapy, home programs, literacy interventions, mobility training, oral sensorimotor, oral sensorimotor plus electrical stimulation, pressure care, stepping stones triple P, strength training, task-specific training, treadmill training, partial body weight support treadmill training, and weight-bearing. Effective medical and surgical interventions include anti-convulsants, bisphosphonates, botulinum toxin, botulinum toxin plus occupational therapy, botulinum toxin plus casting, diazepam, dentistry, hip surveillance, intrathecal baclofen, scoliosis correction, selective dorsal rhizotomy, and umbilical cord blood cell therapy. We have provided guidance about what works and what does not to inform decision-making, and highlighted areas for more research.

The Vojta approach changes thicknesses of abdominal muscles and gait in children with spastic cerebral palsy: A randomized controlled trial, pilot study

BACKGROUND

Children with cerebral palsy (CP) have abnormal postures and gait patterns. Many physiotherapists use the Vojta approach as intervention for children with CP. However, its effects remain unclear.

OBJECTIVE

This study aimed to investigate the effect of the Vojta approach on abdominal muscles and gait in children with spastic CP.

METHODS

Thirteen children with spastic CP were randomly assigned to a general exercise and a Vojta approach group. The interventions were administered in 30 min sessions, 3 times a week for a total of 6 weeks. We used ultrasonography to measure the thicknesses of the abdominal muscles. The gait and foot pressure were measured by GAITRite.

RESULTS

The Vojta approach group showed significant difference in the thicknesses of the rectus abdominis, and external oblique abdominal muscles, which are involved in trunk stability (p< 0.05). There were significant differences in the step width, functional ambulation profile, swing time, stance time, and single support % of cycle as well as foot pressure distribution (p< 0.05).

CONCLUSION

The Vojta approach may be considered as an effective treatment method for improving trunk stability and gait functions of children with spastic CP.