vojta therapy for CP

[jimmy79jinta]

HAI FRIENDS WHAT IS VOJTA THERAPY ?
PLEASE SEND REPLY

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• Vojta

[Physiobase]

Vojta Therapy - History

Professor Dr. Hellbruegge of the Kindercentrum (Children’s Centre), University of Munich, developed the groundbreaking Vojta therapy, centered on Dr. Vojta’s pioneering research in this field. NIDD brought this therapy program to the United States and has been active over the past years in developing awareness about the program, promoting the implementation of the program in institutions working with the developmentally delayed worldwide.

Dr. Vaclav Vojta, a Czechoslovakian neurologist concerned with the problems of motor rehabilitation, laid the foundations of Vojta therapy as early as 1960. He carried on his research in Germany where he emigrated in 1968.

Vojta therapy, the brainchild of Dr. Hellbruegge, spread to other parts of Europe and the whole world from Germany through an international system of collaboration. Pediatricians like Dr. Terrance Stull and Dr. Robert Block played major roles along with Fr. Paul Zahler, in bringing the Vojta therapy system from Germany to the United States. Dr. Vojta’s research can be divided into two main streams:

1) Neurological evaluation leading to the development of a methodology of evaluating child development, its dynamics and major disorders.

2) The concept of the nervous system as an open system endowed with a basic, phylogenetic make-up; yet capable of receiving various stimulations that may affect the functioning of the nervous system and have an effect on its anatomical maturation. The reflex locomotion is the physical representation of the meeting of these two complementary aspects.

This served as the groundwork for this novel therapeutic program that was initially intended for children with Cerebral Palsy (CP).

[Physiobase]

History of Vojta Therapy

Professor Dr. Hellbruegge of the Kindercentrum (Children’s Centre), University of Munich, developed the groundbreaking Vojta therapy, centered on Dr. Vojta’s pioneering research in this field. NIDD brought this therapy program to the United States and has been active over the past years in developing awareness about the program, promoting the implementation of the program in institutions working with the developmentally delayed worldwide.

Dr. Vaclav Vojta, a Czechoslovakian neurologist concerned with the problems of motor rehabilitation, laid the foundations of Vojta therapy as early as 1960. He carried on his research in Germany where he emigrated in 1968.

Vojta therapy, the brainchild of Dr. Hellbruegge, spread to other parts of Europe and the whole world from Germany through an international system of collaboration. Pediatricians like Dr. Terrance Stull and Dr. Robert Block played major roles along with Fr. Paul Zahler, in bringing the Vojta therapy system from Germany to the United States. Dr. Vojta’s research can be divided into two main streams:

1) Neurological evaluation leading to the development of a methodology of evaluating child development, its dynamics and major disorders.

2) The concept of the nervous system as an open system endowed with a basic, phylogenetic make-up; yet capable of receiving various stimulations that may affect the functioning of the nervous system and have an effect on its anatomical maturation. The reflex locomotion is the physical representation of the meeting of these two complementary aspects.

This served as the groundwork for this novel therapeutic program that was initially intended for children with Cerebral Palsy (CP).

Vojta - Objectives

An important clinical tool, the Vojta technique is used for evaluating the development of the child right from birth and is a reliable diagnostic feature. To the physiotherapist, it is an effective global therapy that can be used from the first days of life, for prevention as well as cure.

This therapy form, founded on the reflex locomotion, seeks to achieve the following:

Modify the reflex activity of the child and orient the neuromotor development towards a more physiological track. This is done by introducing a different central neurological activity that gives a fresh physical awareness to the patient. Muscular ‘proprioception’ plays an important role in this program.

Modify the spinal automatisms in lesions of the spinal cord.

Control breathing in order to increase vital capacity.

Control the neuro-vegetative reactions and promote balanced growth of the anatomical locomotor system.

Prevent orthopedic degradation prevalent in severe pathological conditions.

Vojta - Methodology

Vojta proposes a three-part methodology from the medical point of view. This includes a study of the automatic postural reactivity; the cinesiological analysis of the spontaneous motor function; and reflexology. The actual methodology comprises physiotherapy based on ‘reflex locomotion’ and ‘pathing’ (forcing a neuronal way).

Medical Perspective

The approach to the clinical evaluation of child development is divided into three parts.

Study of the automatic postural reactivity - Testing the reactions to sudden postural changes of the body in space (7 to 11 tested reactions) helps to highlight any problems in the automatic management of the automatic reactions by the Central Nervous System (CNS). The sequential changes in these reactions during the first year of life, in the case of normal development, are clearly established. Hence, such an examination helps in pointing out functional anomalies of central or peripheral origin and also in identifying the degree of development reached at the time of examination.

Cinesiologic analysis of spontaneous motor function - Each stage of normal development is characterized by behaviors corresponding to specific conditions; orientation, locomotion, etc. These basic requirements stimulate the implementation of locomotor strategies that are automatically adapted to the postural setting of the moment. The uniqueness of Vojta therapy lies in clearly defining the cinesiologic content of these locomotor strategies. This implies that the postures, support polygon and movements characterizing optimum development are clearly defined. The distinction between a multitude of individual variants and fundamental postural components is precisely done to enable the systematic diagnosis of the patient and comparison with possible pathological conditions.

Reflexology - A series of reflexes, whose modes of provocation, answers and interpretation are accurately detailed, comes last in this scheme of medical examination. This not only helps in immediate evaluation but also in specifying the prognosis.

[jimmy79jinta]

thank you for reply

[neurospast]

Physiobase pointed out the background of voita therapy. What is though not mentioned is that it has become over the years a rather controversial method of treatment although its results are rather dramatic. I will try to explain.
Voita method uses positioning of the child (the method is by the way also used within stroke treatment and treatment of other neurological conditions) in a pattern, e.g crawling pattern, and by using stimuli, call it triggerpoint alike points, the child wil try to get out of this position. This in fact has actualy caused a storm because it is not known if these stimuli are painful or just irritating. This made the Norwegian society of physiotherapy decide to start a research into the effect and to my disappointment at the time (1997-1999)the society withdrew the courses from their curriculum. I had at the time a good contact with a physiotherapist working within psychiatry and she reported that there was evidence that rather a large part of 'Voita' children (as well as carers), to her opinion, suffered from mental problems caused by the treatment.
This needs an explanation. Voita alike Bobath is a 24/7 treatment. This means that carers are a lot of time involved in the treatment since it is imposible for a therapist or a assistant to do 6-7 times a day 7 days a week the treatment. In case a carer does the treatment it will interfere with his/hers personal contact, which becomes rather ambigious, as the attention is devided between treatment and care. Keep in mind that it is not known if it is painful or just irritating for the child. So there you have a child screaming under your hands and you still are a carer and a large percentage of these children have some form of mental handicap? I myself have used some of the method treatment e.g. for torticollis and felt it benificial although I have my doubts about the claims of fellow therapists that it was just irritating and not painful. But you have to understand that unless you are a sadist you would not like to hear and/ or know that you hurt someone deliberately (unless you know that the benefit is so much that you can justify the treatment). So in this age of sueing I would not know......
Also keep in mind that the standards of treatment in Norway are much higher than e.g. UK since their healthcare is well organised and last but not least it is in reality one of the richest countries in the world and willing to splash out for good care. Voita as well as other 24/7 treatments are in reality not a good option unless you are willing to use money and capacity for treatment. Cheers!

[Physiobase]

Hey many thanks neurospast for your personal insight and additional information on this topic. It appears to be rather controversial. I hope more might have the time to comment, both for and against.

[physiok]

Hi!
I do not use Vojta, as I think overstimulation of babies with cerebral palsy which often present epilepsia as well is not logical.
I prefer a combination of Feldenkrais/Bobath/Postural stretching applied twice a week in 45mn sessions, hydrotherapy, stimulating environment at home and good positionment based on Dr Albert Grenier research.
The results are dramatic, and the children are happy going to their physio.

[rpreetipj]

hey great to get to know some knowledge abt vojta but i have learned that vojta is great tool for assessment and can give great tool for progression do u ll have some videos of the therapy sesssions i would like to see as i m a freshers and not too much experienced with hands on practise]

[neurospast]

Since you rpreetipj are a 'fresher' with little experience with hands on Voita will be of no use what so ever for you. First get some proper experience before you are reaching for the skies. Voita is an extremely hands on technique and the assessment is no exception! To become a Voita trained phyio you do not just look at some video. The training might take (at least) 4 years. Start with doing some proper observation and think what you actually see. Look at normal posture, movement patterns and adnormal patterns then when you start to undertand the difference and have asked yourself why there are differences, go for the skies. learn to walk before you intend to run. A good start would be an introduction course of bobath or a neuro development course (on children). But it is great to see your enthousiasm.
Cheers.

[neurospast]

Second thought rpreetipj, you are quite right about the assessment tool for infants of Voita. It is depending on reflex which come at a certian stage in infancy, like paraschute reflex (opening arms and legs when a baby is moved fast prone downwards) These reflexes you can look up and then you will have a gross idea about when they should occur and how reflexes like standing on toes and 'walking' occur at a very early stage (UPTO 4 MONTHS of age).

[sdkashif]

Have a look over more information resources on Vojta Therapy.

Vojta Therapy- History

Vojta Therapy- Methodology

Vojta Therapy: Clinic brings a therapy used in Europe to area

Vojta Therapy: Treatment History

Vojta International

Miracle Kids

[estherderu]

better late than never,

I have just read this thread about Vojta therapy.

In Holland more than 100 people became Vojta Therapists. The whole course was completed in 2 months ( language German ) and everybody who passed the theory and practical exam were allowed to call themselves Vojta therapists. The really good thing about the course was that we were trained in assessing normal and abnormal motor development.

The treatment was found to be "child unfriendly" by most of us to say the least.
Many colleagues and patients were very negative because all babies would cry during the "treatment sessions". Nearly everybody doing this course had already been trained in NDT, many in sensomotor therapy and a few were also manual therapists. We formed a Vojta group to study and help each other afterwards and we met regularly. Two of the assisting teachers were also members.

But at the same time ( beginning of the 1990´s... current ideas about therapies were changing....and we began to know about motor planning, brain plasticity and motor control.
The studies published by Esther Thelen and especially B.C.A.Touwen and Mijna Hadders-Algra both developmental neurologists made us aware of the new possibilities all this knowledge was giving us.
The resulting change in using ICIDH ( later ICF) ideas, the use of treatment goals, physiotherapy diagnosics and working according to best practice at the minimum became normal practice.

After a few years the whole Vojta group decided that going on was no longer functional. Most of us hardly ever used the Vojta techniques.
In my own experience every now and again a young patient would ask for Vojta therapy because it would " work better on them".
NB Not only Vojta, but also the NDT techniques were being questioned by us all at that time.

We are now in a situation that we use "functional " therapy using the knowledge of motor control, finding and using as much evidince as can be found.
The dutch paediatric physiotherapist these days heve been trained in: all the current "methods", theories and backgrounds of all types of disorders. After a 3 yr parttime education and exam we are able to enter the official PPT register.
To stay in this register keeping up your education is mandatory.

I have noticed that in some countries ( Germany and Spain that I know of personally ) the "old Vojta curriculum" are still being used.
I hope that the Vojta teachers, like the Euopean Bobath tutors (EBTA), will "change" their curriculum in the near future.

These are exiting times for us paediatric physiotherapists! I am glad I recieved that Vojta education even if I don´t use it anymore. I did learn a lot at that time.
I know that I still use some of the things I learnt at the time.
But times have changes, there are new things to learn out there all the time.

kind regards to every body.
I wish all my colleagues world wide lots of health and wisdom in our wonderful profession.
I hope this has shed some more light on the "vojta" method.

esther

[serious.ptst]

thank you very much

[joshi]

hello,

I need the reflexes from Vojta and the reflexes you use for new born baby's for my documentation as well here in Malaysia.

please help me out for my project!

thanks,

joshi

[physiobob]

Just for general information here is some more info on the Vojta method from their website.

This is the english link to their international organisations website: Therapy -- What is Reflexlocomotion ?

Vojta proposes a three-part methodology from the medical point of view. This includes a study of the automatic postural reactivity; the cinesiological analysis of the spontaneous motor function; and reflexology. The actual methodology comprises physiotherapy based on ‘reflex locomotion’ and ‘pathing’ (forcing a neuronal way).

Medical Perspective

The approach to the clinical evaluation of child development is divided into three parts.

Study of the automatic postural reactivity - Testing the reactions to sudden postural changes of the body in space (7 to 11 tested reactions) helps to highlight any problems in the automatic management of the automatic reactions by the Central Nervous System (CNS). The sequential changes in these reactions during the first year of life, in the case of normal development, are clearly established. Hence, such an examination helps in pointing out functional anomalies of central or peripheral origin and also in identifying the degree of development reached at the time of examination.

Cinesiologic analysis of spontaneous motor function - Each stage of normal development is characterized by behaviors corresponding to specific conditions; orientation, locomotion, etc. These basic requirements stimulate the implementation of locomotor strategies that are automatically adapted to the postural setting of the moment. The uniqueness of Vojta therapy lies in clearly defining the cinesiologic content of these locomotor strategies. This implies that the postures, support polygon and movements characterizing optimum development are clearly defined. The distinction between a multitude of individual variants and fundamental postural components is precisely done to enable the systematic diagnosis of the patient and comparison with possible pathological conditions.

Reflexology - A series of reflexes, whose modes of provocation, answers and interpretation are accurately detailed, comes last in this scheme of medical examination. This not only helps in immediate evaluation but also in specifying the prognosis.

A different physiotherapeutic approach

Disturbances of the postural and movement apparatus require a very complex and often a lengthy treatment especially when they are connected with a cerebral dysfunction.

The Vojta principle was developed between 1950 and 1970 by the neurologist and child neurologist Dr. Vaclav Vojta. It is one of the regular physiotherapeutic treatment programs for children with impaired movement in many countries, especially in Europe.

In the Vojta method normal patterns of movement sequences, for example, reaching and grasping, standing up and walking, are not taught or trained as such. Vojta therapy rather stimulates the brain, activating “innate, stored movement patterns” that are then “exported” as coordinated movements involving the musculature of the trunk and extremities.

It is now acknowledged that through repeated activation of these reflex-like movements, a certain degree of “freeing a switch” or new networking within the functionally blocked network of nerves between the brain and the spinal cord, takes place.

Vojta therapy has a positive influence on the entire coordination of a child in its spontaneous movement, resulting in improved up righting against gravity, balance, gait, grasp, speech and other functions. The improved coordination of movements as a result of the therapeutic “activation” can often be sustained over the duration of the whole day.

A movement impaired patient also gains a better ability to initiate contact and communicate. Therefore a child has better ways to meet the confrontations within its environment. Vojta therapy can be used as the basis for other therapies and help a child meet the tasks set by the psychologist, early educationalist, speech language therapist, occupational therapist, teacher, etc.

For Vojta therapy to be successful it must be carried out several times a day. A treatment lasts between 5-20 minutes. Because the parents carry out the treatment daily, they play a very important role in the implementation of Vojta therapy.

For the entire duration of the therapy – which can last for weeks to months, or years – the Vojta therapist educates the parents how to implement the therapy and is a support person for the parents. The therapy programme, the amount, the pauses from therapy etc. is regularly reviewed in relationship to the patient’s progress and development.

[estherderu]

Dear everyone,

As you can read in this forum I am a Vojta therapist from Holland and I do not use the 'method' Vojta any more.
But, in every method you will find little practical gems that you use and integrate into normal practice.

The only part of the treatment I did keep using was the position spoken of in the article attached below.
The difference being that when using this technique I do not hold the head in place, but talk to the babies in order to facilitate that they will actively turn to me to look at me. By holding my hand against the back of their heads I would stop them turning their heads back and they do not mind this (in most cases).
By doing so I feel I have been integrating the new motor theories and my clinical experience.
This technique helps activate the diaphragma and stomach muscles.

This 'first position' was used to treat infants in the hospital under medical supervision in this study about chest physiotherapy in preterm infants with lung diseases. It is a free access article and you can read it online. It was published in the Italian Journal of Pediatrics. Italian Journal of Pediatrics | Full text | Chest physiotherapy in preterm infants with lung diseases

This is the first study I have found in a long time regarding Vojta.

I do recommend not using this technique without the proper training.

Esther

[venus08]

Vojta therapy lies in clearly defining the kinesiologic content of these locomotor strategies. in other words, vojta establish/restore regulation of body posture. This implies that the postures, support polygon and movements characterizing optimum development are clearly defined.

[estherderu]

Dear Venus,

What are you saying? I do not really understand what you mean by "Vojta therapy lies in clearly defining the kinesiologic content of these locomotor strategies. in other words, vojta establish/restore regulation of body posture. "
and what do you mean by "This implies that the postures, support polygon and movements characterizing optimum development are clearly defined"?
I am so sorry, I really do not understand.
Esther