Vojta therapy, also known as Vojta induction therapy, is a facilitative treatment technique consisting of reflexive crawling and reflexive rolling, which induces reflexive movement, as summarized and created by Dr. Vojta, a German scholar. Vojta reported 207 cases of children at risk for cerebral palsy, of which 199 (96%) normalized after treatment training. His assertion that cerebral palsy is treatable with early diagnosis and training caused shock in the medical community.
Vojta therapy has a wide range of applications. It can be utilized from newborn to older children and is a better method of early treatment. The technique is simple and easy to master, and parents can be trained in the treatment, which facilitates family therapy and is effective. Vojta therapy does not require complicated and expensive equipment, but only a warm, well-lit place and a treatment table, which is economical and can be adapted to local conditions. The basic theory of Vojta therapy
The basic theory of Vojta therapy
I. History of Vojta Therapy
Vojta therapy, also known as Vojta induction therapy, is a therapeutic technique consisting of reflexive crawling and reflexive rolling, which induces reflexive movement and is created by a German scholar, Dr. Vojta.
While working at a rehabilitation center in Germany, Dr. Vojta became very interested in cerebral palsy rehabilitation therapy. In his practice, he found that after training the child with compression stimulation and some resistance, the child’s muscle tone gradually decreased, and when continuous resistance was given, the muscle tone of each joint also decreased. He believed that this condition was not only a response at the level of the spinal cord, but also related to the higher centers above the brainstem. The head was extended. If the head was made to dorsiflex, the stepping joint leaped into flexion and formed a pointed foot again. This phenomenon is never a local reaction, but a reflex movement of the whole body. Therefore, when correcting the pointed foot, the pointed foot can be corrected by giving resistance in the head to prevent the head from dorsiflexion and in the foot to prevent the foot from leaping and flexing. From this he envisioned that if resistance stimulation was given at key areas of movement, such as the head and spine, reflex movements at the level of the spinal cord could be induced, and the stronger the stimulation, the stronger the response. By strengthening the stimulation to do isometric contraction movements at key areas, the muscle tension would gradually decrease and the abnormal posture of cerebral palsy could be corrected, but it was harder to maintain this state, so treatment had to be adhered to in order to maintain this effect. This effect cannot occur quickly in children with cerebral palsy: it takes a certain period of induction treatment to occur. vojta combines the stimulation sites of the medial epicondyle of the humerus, the medial femoral condyle, and the head with each other and gives stimulation in a certain posture, the same movement will be induced repeatedly in the limbs and trunk. this movement is a compound movement and a movement movement, and this is how the concept of reflexive movement is formed origin.
Vojta found that children with cerebral palsy were poorly nourished, bedridden for years, and often suffered from pneumonia, which affected their training. This led Vojta to discover the site of stimulation of the reflexive turn-over thoracic evoked zone.
In 1968, Vojta’s monograph was published and Vojta’s induction therapy was developed on the basis of neurodevelopmental motor function, in particular, he advocated early diagnosis and proposed the concept of central coordination disorder for early diagnosis of cerebral palsy. In particular, he advocated early diagnosis and proposed the concept of central coordination disorder for early diagnosis of cerebral palsy, thus starting early treatment of cerebral palsy and achieving remarkable results, opening up another new pathway for the rehabilitation of children with cerebral palsy and making a great contribution to reducing disability and promoting the rehabilitation of children with cerebral palsy. In particular, Vojta reported 207 cases of children at risk for cerebral palsy, with 199 (96%) reaching normalization after treatment and training. His assertion that cerebral palsy is treatable with early diagnosis and training caused shock in the medical community.
II. Awareness of mobile movement
The ultimate day of physiotherapy in rehabilitation medicine is to obtain the function of bipedal walking. The prerequisite for obtaining this function is the transition from the phylogenetic stage to the individual developmental stage, which must go through the developmental process of turning over, ventral crawling, quadruple crawling, and finally bipedal standing and walking. In this process the hand must be freed from the function of support and propulsion in the above movement, and the ability to use tools with both hands must be acquired.
1, the characteristics of mobile movement.
(1) mobile movement is a recurrent, coordinated automatic function that begins in a certain starting limb position and returns to the starting limb position after movement. This movement can be divided into certain phases (periods), such as walking movement is divided into a swing phase and a support phase.
(2) The whole body bony pathway muscles are involved in some kind of regular passage of mobile movement.
(3) each bone skeletal muscle respective role, can be in time and space to interact. Specifically, each movement has active muscles, antagonistic muscles, fixed muscles, and neutralizing muscles, and only the common action of these muscles can ensure the normal movement.
(4) mobile movement itself may not be the purpose, it is often to achieve a certain purpose of a means.
2, the three factors that constitute mobile movement.
(1) posture adjustment energy: posture adjustment energy is the human body for their own body position in space when the change, the head, trunk, limbs of reactive adaptability, divided into two kinds.
①Static response: When the external force makes the body posture change, the response after self-regulation to return to the original posture, such as vertical neck, sitting stability, standing balance response, etc.
② Dynamic reaction: when the strength of the external force is too human or lasts for a long time, the change of body posture is difficult to restore to the original posture, and a new, stable posture is used instead of an energetic reaction, such as protective stretching reaction, etc.
③ Phase motor energy: It is an ability to move a part of the body or make a change in the position of the body. This motor development in humans follows the following sequence: moving the eye to follow an object, reaching for an object in front of the hand, crawling to move to a distant object, and reaching a destination or object alone. There must be postural regulation energy to ensure the successful completion of the phase movement. It is customary in neurophysiology to refer to postural regulation energy as tension activity and phase motor energy as phase activity. m. Rood summarizes both as the development of sensorimotor bodies, with postural regulation energy being the ability to determine body stability and phase motor energy being the ability to determine mobility.
④Lifting structures and supportiveness: Dr. Vojta believes that there are also lifting structures and supportiveness in the mobility motor factors. The development of this structure can be clearly seen during normal pediatric development. At 3 months of age, elbow support can be used to lift the body to the chest, and at 5 or 6 months of age, elbow extension can be used to support the body to the abdomen, and then to the four crawling positions, sitting positions, and standing positions, all of which require lifting structures and support. Can be seen from the horizontal position gradually pick up and finally become vertical position, from the whole body support gradually narrow the basal surface and finally become bipedal support.
3, support points and three-dimensional movement: mobile movement in addition to the above three factors to regulate, but also must always establish the support points and the three-dimensional movement when the phase movement. When moving, first to establish the support point, and then the whole body muscles to support the direction of contraction, the body’s center of gravity to support the point of three-dimensional movement to the vertical direction, the front and side. For example, in belly crawling, the support point is the elbow of the upper limb that extends in front, and the muscles related to the shoulder and elbow joints are contracted in the direction of the elbow joint. The torso passes through the shoulder joint and uses the ball joint of the shoulder joint as a lever to exert force in the direction of the elbow joint. At this time, the shoulder, torso and its body center of gravity carry out a three-dimensional movement to the vertical, lateral and frontal directions. The forward element of this three-dimensional movement becomes manifest in actual action.
The establishment of support points and three-dimensional movement and mobile movement factors are the basic guarantee of smooth mobile movement. The three factors of mobile movement are inseparable and have complementary roles. The postural regulation energy is the foundation, once it is impaired, it cannot ensure the normal support ability and pick-up mechanism to function, so that the phase movement cannot be completed either. Children with cerebral palsy are unable to perform ventral crawl, quadruple crawl, knee forward and bipedal walk, although some of them can elbow support, knee stand and stand, because the development of the three factors of mobile movement and the establishment of support points and three-dimensional movement is impaired in these children. This is because the development of these factors and the establishment of support points and three-dimensional movements are impaired.
Reflexive movement RL
1.Characteristics of reflexive mobile movement.
(1) Reflexive mobile movement includes two kinds, namely reflexive abdominal crawling RK and reflexive turning RU. RK and RU are formed in the evolutionary process of phylogenesis and individual occurrence, and can also be induced in normal newborns.
(2) In RL, there is no purpose and no volitional act of “facilitation or not” is required. Moreover, the stimulus that induces RL is a stimulus to the intrinsic receptors, and the compliance to the stimulus is small. Based on these two points, it is believed that unlimited stimulation can be given when RL is induced.
(3) From the kinematic point of view, the three factors of mobile movement are also present in RL, i.e., responsive adaptability to postural changes in the whole body, lifting mechanism and supportive and phasic movement energy. As mentioned before, there is a complementary relationship between the three, and when we induce one of these factors through Yu techniques, we can facilitate the ability of the other two factors. The clinical symptoms of children with cerebral palsy can be seen to be absent or impaired by these three factors when analyzed from a kinematic point of view. By inducing RL, the factors can be activated and improved, restoring the kinematic composition and thus promoting and improving the motor and postural development of the child.
(4) By inducing RL, the normal motor patterns of the extremity endings, such as external rotation of the forearm, flexion and dorsiflexion of the wrist joint, external rotation and abduction of the lower extremity and dorsiflexion of the stepping joint, can be activated, thus improving the abnormal motor patterns of children with cerebral palsy, such as internal rotation of the forearm, hand clenching, internal retraction and internal rotation of the lower extremity, cross gait and pointed foot, etc.
2. Significance of RL in cerebral palsy motor therapy.
Reflexive abdominal crawling and reflexive rolling are never a facilitator of abdominal crawling and rolling movements per se. Such a motor pattern as reflexive ventral crawling does not exist in the development of pediatric movement. However, a kinematic analysis of the induced whole-body motor patterns shows that they are present in the axial organs and extremities and are necessary for movement from birth to standing and even walking.
The elbow support and metacarpal abduction of the facial side of the upper limb and the flexion and dorsiflexion of the wrist joint of reflexive ventral crawl appear around 3 and 6 months postnatally in normal children, respectively. Flexion and dorsiflexion of the wrist joint of the posterior cephalic side of the upper extremity, finger spreading from the ulnar side, and thumb abduction finger spreading were seen around 6 months after birth. The elbow flexion position upper shoulder joint external rotation flexion, and forearm external rotation appear around 3 years of age. These movements are also seen in the interactive movements of the upper and lower extremities during walking and are necessary for multi-purpose movements of both upper extremities in the extended position. Knee support of the facial side of the lower extremity at the end of flexion of the knee occurs around 7 months of normal motor development and is seen in normal children as they progress from palmar support to four-point support with knee and hand support of weight. The posterior cephalic side of the lower extremity treads the joint in a position intermediate to dorsiflexion and leap flexion, the talonavicular joint is externally rotated while the anterior and posterior cavernous muscles remain coordinated, and the toes are flexed. These movements can be seen on the lower limbs that touch the ground during walking and correspond to a series of movements in which the foot follows the ground, the foot is flattened, and the toes leave the ground, which appear in normal development about 3 months after the start of walking. The latissimus dorsi and lumbar square muscles on the side of the face, through the spine, contract in a bowstring-like manner between the upper arm and the pelvis, causing lateral flexion of the trunk. This lumbar square function is necessary to lift the pelvis toward the trunk during the swing phase of walking and plays an important role in walking along with the adductors during the support phase.
Reflexive turning induces movements such as extension of the cervical and upper thoracic vertebrae, contraction of the adductor muscles of the shoulder masseter, fixation of the shoulder masseter band to the spine and thorax, and induction of supportive upper body movements. These movements occur around 2 months of normal motor development, when the child can fix his head in the median line and gaze at an object. In the case of normal children, movements such as posterior pelvic tilt, flexion of the lower gum to the trunk, and shifting of the body weight to one side are also induced and occur at about 4.5 months of age. In addition, flexion of the lower extremity in the middle position of the stepped joint occurs at about 3 months of age. In the upper extremities, flexion and adduction of the shoulder joint in the external position are induced, and this movement can be seen in the normally developing hand-to-hand coordination at about 2 months of age and in the hand-to-glance coordination at 3-4 months of age.
In children with cerebral palsy, there is an impairment of the inward motion of the skeletal joint in the flexion position and the inward motion of the pectoralis major muscle, which also acts as the shoulder joint in the flexion position. Because coordinated hand-to-hand movements, elbow support, four-point support, and other movements require the internal retraction function of the shoulder joint in the flexion position, the impairment also occurs one after another. Its role in the treatment of pediatric cerebral palsy can be seen in the various reflexive movements that can be induced by the reflexive belly crawl and reflexive rollover movements described above.
In conclusion, the basic principle of the Vojta method is to achieve treatment by inducing reflexive movement, promoting normal reflex pathways and movement patterns, and inhibiting abnormal reflex pathways and movement patterns. The earlier the treatment, the better the results. In the early stage of the disease, especially within 3 months, the abnormal posture is not yet fixed, and the result of brain injury only causes impaired motor coordination. 6 months later, the brain injury will produce secondary degeneration, making the organic damage more obvious. If treatment is given before the secondary lesions appear, the dysfunction can be reversed and function can be improved. This improvement in function in turn prevents secondary degeneration of the brain, thus providing a good therapeutic outcome.