Vojta therapy

from Wikipedia, the free encyclopedia

The Vojta therapy is a physiotherapeutic treatment for disorders of the central nervous system and the musculoskeletal system . It was developed by the Czech neurologist and child neurologist Václav Vojta in the 1960s.

Principles

While healthy people can automatically and unconsciously access all the building blocks of human erection and locomotion in their everyday orientation , the innate movement patterns for grasping and handling, turning and standing up, walking and running are only available to a limited extent in the event of damage to the central nervous system and the postural and musculoskeletal system Available.

With the so-called reflex locomotion (or reflex locomotion ) Vojta has developed a method that fundamental movement patterns makes in people with damaged central nervous system and musculoskeletal system, at least in some areas reopened.

The term “reflex locomotion” already summarizes the main features of Vojta therapy: Science understands reflex to be a constant response to a certain stimulus that cannot be consciously controlled. Locomotion generally refers to the ability to move.

application areas

Vojta therapy can be used as a basic therapy in the field of physiotherapy for practically every movement disorder and numerous diseases. It is often wrongly assumed that Vojta therapy alone achieves the desired therapeutic success in infants and toddlers. The central nervous system is much more malleable in infancy and childhood than in adulthood. But even in later years of life, healthy movement patterns can still be “ paved ” in the central nervous system .

Vojta therapy only requires a neuromuscular connection, i.e. an existing "conduction" between nerve tracts and muscles. For diseases that cannot be treated causally, such as B. Multiple sclerosis, with the so-called reflex locomotion within the framework of Vojta therapy, the respective existing neurological potential can be exploited.

Indications for Vojta therapy are:

Contraindications

Vojta therapy must not be used in:

  • acute febrile or inflammatory diseases
  • special diseases such as B. Vitreous Bone Disease
  • certain heart and muscle diseases
  • pregnancy

execution

The reflex locomotion is triggered mainly from the three basic positions of the prone, back and side lying position and from ten trigger zones on the body described by Vojta. In healthy newborns, the complete activation of the “reflex crawling” movement pattern is possible from a single zone. In older children and adults, several zones must be stimulated in order to trigger reflex locomotion.

In precisely defined starting positions, the Vojta therapist exerts targeted pressure on certain areas of the patient's body. Irrespective of the patient's will, this stimulus leads to two movement complexes in people of all ages, which contain all the essential “building blocks” of human locomotion and straightening: “reflex crawling” and “reflex turning”.

The movements of the reflex locomotion, scientifically precisely described in detail, can be called up at any time. By combining and varying the trigger zones as well as the smallest changes in the pressure directions and joint angles in the starting position and with resistance to the movements of the extremities, the therapy is adapted to the patient's individual clinical picture and treatment goal.

Mode of action

The movement complexes of reflex locomotion contain the elementary components for every locomotion:

By repeatedly triggering these automatic body controls and movements, the patient is “unlocked” or new pathways within those nervous networks between the brain and spinal cord that are functionally blocked. Access to the muscle functions required and unconsciously used for spontaneous actions in everyday life is "unlocked" and the innate movement patterns are activated.

Depending on the underlying disease, the therapeutically induced " facilitation " of posture and movement functions in the central nervous system can often maintain the improved level of movement throughout the day with only a few, relatively short exercises. This results in a positive change in spontaneous posture and movement. In this way, the movement-impaired patient also gains better contact skills, and communication and the development of independence are promoted.

The Vojta method acts on the existing nerve pathways on the most varied of body levels from the skeletal muscles to the internal organs to higher brain functions and on the patient's psyche. Thus, in addition to posture and locomotion, Vojta therapy can also activate and influence vegetative functions ( breathing , blood circulation , bladder and bowel function , sleep-wake rhythm ), sensitivity and the face and mouth area (swallowing, eye movements, language).

Individual therapy program

Vojta therapy is prescribed by the attending physician . The treatment is carried out by a physiotherapist trained and certified in Vojta therapy. Each patient is treated individually with a focus on their main motor problem, according to their underlying disease and the resulting possibilities and limits. In addition to the underlying disease, exercise intensity, frequency and accuracy determine the effectiveness and thus the success of the treatment. After the appropriate prescription by the attending physician, the Vojta therapist creates an individual program and defines the therapy goals together with the patient or their relatives. The therapy program, the dosage and any breaks in therapy are adjusted by the Vojta therapist at regular intervals to the development of the patient.

The infant in Vojta therapy

The central nervous system is much more malleable in infancy and childhood than in adulthood. In order to adequately exploit the opportunities and possibilities of early treatment within the first year of life, Vojta therapy usually has to be carried out several times a day. In order to enable the necessary intensity of the treatment, the treatment technique is passed on to the parents or caregivers, who can then also carry out the therapy at home. During the therapy, which can take weeks to months - in special cases even years - the Vojta therapist should always be at the parents' side.

Vojta therapy is a complex form of treatment and places high demands on the performing Vojta therapist. If used incorrectly, it loses its dialogical character and thus completely or partially its effect. Therefore, the possibilities and limits of therapeutic action of the relatives must be assessed before Vojta therapy. Constant accompaniment of the treating caregiver is an integral part of Vojta therapy. In this way, a permanent adjustment of the therapy takes place both with regard to the mentioned movement patterns as well as the dosage. The behavior of the child before, during and after the treatment proves to be a sensitive regulator for the application of Vojta therapy. To be in constant dialogue with the parents about these perceptions is an essential part of the therapeutic process according to Vojta.

The reflex movement is extremely effective, but also unusual and very strenuous for babies and toddlers. The therapeutically desired activation state is usually expressed in infants during treatment by crying . At this age, screaming is an important and appropriate means of expression to react to the unusual activation of the reflex movement. As a rule, after a short period of acclimatization, the screaming is no longer as intense, and the infants stop screaming during breaks in exercise and after therapy. With older children who can express themselves verbally, the screaming usually no longer occurs.

Controversial discussion and criticism

The most common criticism of Vojta Therapy is based on screaming in infancy patients. In one study, many parents stated that they had reached their physical and psychological limits because they had to suppress their "intuitive behavioral readiness to calm down and remove the cause of the cry". Many mothers also worried that the child might resent the treatment and suffer permanent emotional damage.

Other critics suggest that “at a time when physical closeness and love were intended to cement trust and a symbiotic relationship between parents and their babies, parents would become aggressors. They have to bring their children into forced positions several times a day in a way that a baby soul cannot understand and can only perceive as abuse. "

This discussion is very controversial.

A comparative study (Vojta-treated infants / age-matched healthy infants) showed that the additional maternal involvement in Vojta therapy does not come at the expense of the duration of relaxed play together. In the subgroup of infants with central coordination disorder (ZKS), it was found that the treated infants were significantly less restless than the untreated infants outside of the treatment period.

A comprehensive psychological investigation came to the result, among other things, that in contrast to the most diverse emotional arguments about traumatization of the children by Vojta's neurophysiotherapy, the early treated symptomatic children at risk between the ages of four and seven years would not differ from previously inconspicuous preschool children.

In the analysis of the parent-child relationship , the group treated with Vojta showed a strong partnership attitude between the parents and the child. Aggression or rejection of the parents towards the child could not be determined in this investigation, on the contrary, the parents were sometimes rather too much into their child.

Ludewig and Mähler are also studying how early physiotherapy therapy according to Vojta and Bobath influences the mother-child relationship. It was found that, especially at the beginning of the treatment, physiotherapy according to Vojta posed a considerable burden for the mothers, but with increasing duration of therapy there was no difference between the Vojta and Bobath methods , either in terms of mental or physical stress . Overall, the results suggested providing or intensifying psychological education and support for mothers with children undergoing physiotherapy.

The scientifically responsible Society for Neuropediatrics and the German Society for Social Pediatrics and Adolescent Medicine are of the opinion that in the last few decades the knowledge about motor control and psychomotor development in children with cerebral movement disorders has changed so much that the theoretical basis of physiotherapy has changed on a neurophysiological basis according to Vojta and Bobath are no longer tenable.

The critical attitude towards the special therapy procedures such as that according to the concepts of Bobath and Vojta would not mean that no important impulses for motor development could be given and that consequential damage could be reduced. As part of the qualified further training in these treatment techniques, the necessary knowledge regarding the neurological symptoms including their effects on the functional and ability disorders as well as the psychomotor development of children, which are indispensable for the treatment of patients with infantile cerebral palsy, would be imparted.

If triggering the reflex locomotion to Vojta several times a day leads to refusal and protests from the children, a change in the procedure is usually recommended.

recognition

Vojta therapy is a treatment method recognized by health insurance companies . Vojta therapists have successfully completed recognized professional training according to the standards and guidelines of the International Vojta Society for Vojta therapy. The doctor in charge will refer you to a Vojta therapist.

Qualified Vojta therapists and doctors as well as treatment centers, clinics and physiotherapy practices that offer Vojta therapy are available throughout Germany.

Studies

The reflex movements observed by Václav Vojta, their effects and their therapeutic successes have been scientifically examined many times and empirically confirmed. In addition, there are isolated evidence-based studies .

author n examination Result Level of evidence
Vojta, 1974 (1969–1971) 394 Symptomatic children at risk versus anamnestic children at risk Early treatment is possible and effective C.
Vojta, 1978 (1971–1973) 582 Children with central coordination disorder (ZKS) who showed worsening on follow-up examination (higher-grade ZKS, asymmetry) The spectrum of unsuccessfully treated children is different from that of untreated children C.
Vojta, 1982 713 Significance of subjective influences in the assessment of findings; Treatment versus spontaneous response , duration of treatment Effective early treatment begins before the 5th month of life; Partial results of the study (1974) deepened and expanded C.
Imamura et al., 1983 472 Symptomatic children at risk, untreated, examined according to Vojta criteria About 50% of untreated children “normalize”; Fixed cerebral palsy are recruited from all degrees of severity of the central coordination disorder (ZKS) in the absence of treatment D.
Kanda et al., 1984 029 Comparison of children with spastic diparesis and relevant CT findings with early treatment according to Vojta versus late treatment Children treated early start running an average of 8 months earlier than children treated late B.
Niethard, 1987 067 Children with hip dislocations were treated prior to surgical therapy according to Vojta The rate of postoperative femoral head necrosis was significantly reduced, optimizing postoperative treatment C.
Laufens et al., 1995 046 Changes in motor skills in patients with multiple sclerosis due to Vojta therapy Significant improvement in motor skills. Depending on the starting position (see implementation ), differences can be demonstrated in the result B.
Böhme and Futschik, 1995 011 Highly immature premature babies with bronchopulmonary dysplasia (BPD) are stimulated in the Vojta chest zone Use of the chest zone stimulus improves lung function and reduces the work of breathing in BPD B.
Banaszek and Norska-Borowka, 1997 031 31 premature babies were treated within the first 12 months after Vojta, their development compared with 70 children of the same age during the first year of life A treatment prognosis can be made using a risk score (necessity, duration, success) C.
Jirout, 1998 100 The degree of blockage in the upper head joint (atlanto-occipital joint) was tested under different starting positions before and after the trunk and chest zones were released according to Vojta By stimulating the trigger zones according to Vojta, blockages in the atlanto-occipital joint can be released without manipulating the spine CD
Laufens et al., 1999 015th Investigation of the combinatorial therapy effects of treadmill therapy / Vojtatherapy in patients with multiple sclerosis Therapy effects are best when combined: treadmill therapy and subsequent Vojta therapy. The combination is more effective than Vojta therapy alone B.
Yamori and Hirota, 2004 (1988-2000) 322 Investigates in motor disabled children over the age of 6 months whether and how the Vojta therapy has an influence on the criterion "free walking" The therapeutic prospects are more favorable with an early start (before the 6th month of life) and the absence of structural lesions D.
Kanda et al., 2004 10 Long-term courses (62 months, see publication 1984) in premature infants with spastic diplegia treated according to Vojta: effectiveness of early treatment Statistically proven motor advantages for children at risk of CP with consistent Vojta therapy B.
Bittrich et al., 2008 035 Premature babies are examined according to Prechtl and Vojta, the results are related to the results of the early Vojta therapy Vojta therapy is effective, but not required in every case. The indication can be specified by combining postural reactions and general movement patterns . B / C
Zukunft-Huber, 2008/1; 2008/2 002 Embedding the long-term treatment according to Vojta for two premature babies in a complex treatment concept Carefully documented long-term progress under therapy D.
Jung, 2011 037 In infants with postural asymmetry, a video-based assessment was used to document the restricted rotation of the head and the convexity of the spine in the supine and prone position before and after an 8-week therapy block Vojta therapy corrects postural asymmetry significantly better than control therapy A.
  1. The period in which the data was collected in brackets
  2. n: number of subjects in the sample
  3. Evidence level:
    A = controlled, randomized “blind” study; RCT
    B = study with parallelized, randomized control group, not "blind" controlled;
    C = like B, but without a randomized control group, but with standardized examination instruments;
    D = carefully documented case presentation without comparison group and without standardized examination instruments.

Historical

Between 1950 and 1970 Václav Vojta developed a treatment principle for cerebral palsy children. Vojta had observed innate movement patterns in these movement-impaired children, which could be activated from certain body positions by applying pressure to specific areas on the body. These activated movements were unconsciously carried out by the respective child, could be reliably repeated and contained the basic features of locomotion. The effects of these activations were considerable: the cerebral palsy children were able to speak more clearly at first and after a short time they could get up or walk more confidently. In further investigations, Vojta was able to prove that the movements could be activated more extensively and completely even in healthy newborns and also in healthy adults after repeated, repeated activation. Vojta saw his theory of innate movement patterns that are firmly “programmed” in the brain confirmed. Based on this theory and the clinical experience that there are program disorders in the central nervous system in neurological movement disorders, as well as further experience that orthopedic poor posture are often associated with impairments of the central nervous system, Vojta developed the basis of his therapy.

Vojta Therapy has proven itself as a systematic, holistic treatment for infants, children and adults with cerebral palsy since the 1960s. In addition, Vojta Therapy also proved to be a versatile treatment for patients of all ages from the fields of neurology , orthopedics , surgery , traumatology and internal medicine .

Today the team of teaching physiotherapists and doctors, some of which Vojta has trained itself, is run by the Internationale Vojta-Gesellschaft e. V. (IVG), which is internationally involved in basic, advanced and advanced training, research, diagnostics and quality assurance of Vojta therapy.

distribution

The Vojta principle is used in Germany and in various nations around the world. Vojta courses have been held regularly for many years in the following countries: Chile, Japan, Korea, Mexico, Norway, Austria, Poland, Romania, Spain, the Czech Republic, Croatia, Thailand, Taiwan.

There are also national Vojta companies in Italy, Japan, Romania, the Czech Republic, Spain and Switzerland.

See also

Individual evidence

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literature

  • Václav Vojta: Cerebral movement disorders in infancy - early diagnosis and early therapy. 8th edition, Georg Thieme-Verlag 2004, ISBN 978-3-13-140768-9
  • Václav Vojta, Annegret Peters: The Vojta principle. 3rd edition, Springer Heidelberg 2007, ISBN 978-3-540-46509-6
  • Václav Vojta, Edith Schweitzer: The discovery of the ideal motor skills Richard Pflaum Verlag Munich 2009, ISBN 978-3-7905-0966-3
  • Heidi Orth: The child in Vojta therapy - an accompanying book for practice. 2nd edition 2011 (Urban & Fischer), ISBN 978-3-437-46941-1
  • Maren Thiesen-Hutter: Psychology and Neurophysiotherapy Vojtas: e. Group comparison between early treated u. previously inconspicuous preschoolers. Stuttgart: Enke 1982, ISBN 3-432-93061-5
  • Barbara Ernst: Principles of neuromotor and psychological development diagnostics , Ferdinand Enke Verlag 1983, ISBN 3-432-93301-0
  • Teaching, advanced and advanced training: Vojta therapy. pt - magazine for physiotherapists. 62 (2010) 2: p. 29ff
  • Huang-Tsung Kuo, Mechthild Papousek: Early communication between mother and child under the demands of Vojta therapy. Childhood and Development 1, 97-106 (1992), Behavioral Medicine
  • Jan Jirout: Blockage of the head joints and their sideways movement - stimulation of the trigger zones according to Vojta to correct them. Physiotherapy 50th year (1998) No. 8

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