Zounkova 1 Compatibility Mode

REFLEX LOCOMOTION

ACCORDING TO PROF. VOJTA

REFLEX LOCOMOTION

ACCORDING TO PROF. VOJTA

Zounková I.Zounková I.Zounková I.Clinic of Rehabilitation and Sport Medicine

2 nd Medical Faculty, Charles University PragueUH Motol

Czech Republic

irena.zounkova@lfmotol.cuni.cz

Zounková I.Clinic of Rehabilitation and Sport Medicine

2 nd Medical Faculty, Charles University PragueUH Motol

Czech Republic

irena.zounkova@lfmotol.cuni.cz

REFLEX LOCOMOTION (RL)REFLEX LOCOMOTION (RL)

• Prof. Vaclav Vojta (1917 – 2000) - Czech neurologist

• Worked with babies, CP

• Prof. Vaclav Vojta (1917 – 2000) - Czech neurologist

• Worked with babies, CP• Experiential and empirical method of RL, postural

reactions, primitive reflexes, spontaneous motor activity

• after 1968 – Munich, Germany

• Experiential and empirical method of RL, postural reactions, primitive reflexes, spontaneous motor activity

• after 1968 – Munich, Germany

HISTORYHISTORY

• While working with children affected by CP he discovered the principle of “reflex locomotion“

• While working with children affected by CP he discovered the principle of “reflex locomotion“

• 1950 –1970, he developed a new neuro-rehabilitation concept, called Vojta‘s principle

• 1950 –1970, he developed a new neuro-rehabilitation concept, called Vojta‘s principle

• Through specific defined stimuli in various body positions - evoked motor reactions of the trunk and extremities

• Through specific defined stimuli in various body positions - evoked motor reactions of the trunk and extremities

HISTORYHISTORY

• He noticed that these motor reactions caused the body to move forward

• He noticed that these motor reactions caused the body to move forward

• Vojta’s hypothesis: the motor activity evoked by stimulation are inborn motor patterns

• Vojta’s hypothesis: the motor activity evoked by stimulation are inborn motor patterns

HISTORYHISTORY

• He tested his hypothesis on healthy newborns and the same motor patterns were evoked

• He tested his hypothesis on healthy newborns and the same motor patterns were evoked

REFLEX LOCOMOTION (CONT)REFLEX LOCOMOTION (CONT)

• Two reflex complexes identified by Vojta-Reflex creeping-Reflex turning

• Global patterns in which the entire muscular system is involved in a well-defined

• Two reflex complexes identified by Vojta-Reflex creeping-Reflex turning

• Global patterns in which the entire muscular system is involved in a well-defined system is involved in a well-defined coordinated way

-All levels of CNS take part in controlling their activation

• These global patterns can be evoked in man as constant reproducible partial patterns

system is involved in a well-defined coordinated way

-All levels of CNS take part in controlling their activation

• These global patterns can be evoked in man as constant reproducible partial patterns

Their partial patterns are included in motoricdevelopment of human locomotionTheir partial patterns are included in motoricdevelopment of human locomotion

REFLEX LOCOMOTIONREFLEX LOCOMOTION

Tabelle nach V.Vojta, Das 1. Lebensjahr des Kindes,Hansisches Verlagskontor H. Scheffler

„GLOBAL PATTERNS“ (Vojta, 1954)„GLOBAL PATTERNS“ (Vojta, 1954)

• Authentic motor responses, which are reproducible at any time

• Coordinated activity of skeletal musculature

• Authentic motor responses, which are reproducible at any time

• Coordinated activity of skeletal musculature

• The activity of facial muscles, eye movements, swallowing process, bladder and bowel function, breathing

• The activity of facial muscles, eye movements, swallowing process, bladder and bowel function, breathing

„GLOBAL PATTERNS“„GLOBAL PATTERNS“

• The part of human movement: grasping, rolling, creeping, crawling, walking

• The basis of motor rehabilitation of babies, children, adolescents, adults

• The part of human movement: grasping, rolling, creeping, crawling, walking

• The basis of motor rehabilitation of babies, children, adolescents, adults

MODELSMODELS

• Reflex turning• Reflex creeping• 1st position

• Reflex turning• Reflex creeping• 1st position

….and their modification

Vojta V., Peters A.: Das Vojta princip, Springer Verlag, 2001

THE CHARACTERISTIC OF MODELSTHE CHARACTERISTIC OF MODELS

• Artificial• Contain partial models of ontogenesis, the basic

motor program

• Artificial• Contain partial models of ontogenesis, the basic

motor program motor program • The fundamental pattern for bipedal locomotion

motor program • The fundamental pattern for bipedal locomotion

3 inseparable components of move forward :

• The automatic control/regulation of body position

3 inseparable components of move forward :

• The automatic control/regulation of body position

THE CHARACTERISTIC OF MODELSTHE CHARACTERISTIC OF MODELS

• A corresponding up-rihting mechanism• A concurrent phasic mobility• A corresponding up-rihting mechanism• A concurrent phasic mobility

REFLEX CREEPING-CONTRALATERAL PATTERNREFLEX CREEPING-CONTRALATERAL PATTERN

Vojta V., Peters A.: Das Vojta princip, Springer Verlag, 2001

REFLEX TURNING-IPSILATERAL PATTERNREFLEX TURNING-IPSILATERAL PATTERN

Vojta V., Peters A.: Das Vojta princip, Springer Verlag, 2001

HOW EVOKE THESE MODELS ?HOW EVOKE THESE MODELS ?

• Involuntary

• In the specific initial body position

• Involuntary

• In the specific initial body position

• By pressure on certain body parts – „zones“

• By pressure on certain body parts – „zones“

Vojta V., Peters A.: Das Vojta princip, Springer Verlag, 2001

STIMULATIONSTIMULATION

• Not nociceptive• Mainly proprioceptive• Not nociceptive• Mainly proprioceptive

THE PROCESS DURING STIMULATIONTHE PROCESS DURING STIMULATION

• By stimulation of reflex zones in a given position involuntery muscle activity is evoked

• By evoked muscle activity the point of gravity is transferred

• By stimulation of reflex zones in a given position involuntery muscle activity is evoked

• By evoked muscle activity the point of gravity is transferredis transferred

• The body is supported automatically at given points

is transferred

• The body is supported automatically at given points

Are evoked partial motor function maturing inthe course of postural development-Postural stabilization in sagitall plane-The swinging (stepping forward, grasping)-The support function of extremities

Are evoked partial motor function maturing inthe course of postural development-Postural stabilization in sagitall plane-The swinging (stepping forward, grasping)-The support function of extremities

Vojta V., Peters A.: Das Vojta princip, Springer Verlag, 2001

• By repeated stimulation will be partial and global ideal motor patterns fixed as parts of spontaneous motor behavior

• By repeated stimulation will be partial and global ideal motor patterns fixed as parts of spontaneous motor behavior

• Spontaneous motor behavior will be more physiological

• Spontaneous motor behavior will be more physiological

Video as the part of DVD in book: Creig Liebenson, Rehabilitation of the Spine, Lippincott Williams&Wilkins, Second Edition, 2007

• Good proof and feedback of a right treatmentare changes of the posture or spontaneous movement immediately after the session

• Good proof and feedback of a right treatmentare changes of the posture or spontaneous movement immediately after the session movement immediately after the session movement immediately after the session

THE THERAPEUTIC GOALS OF RLTHE THERAPEUTIC GOALS OF RL

• The finding the new way to address CNS• To facilitate the automatic regulation and

control of the body`s position• The prevention , the remodeling of substitute

• The finding the new way to address CNS• To facilitate the automatic regulation and

control of the body`s position• The prevention , the remodeling of substitute • The prevention , the remodeling of substitute

patterns of movement• Reduction of motor disturbance

• The prevention , the remodeling of substitute patterns of movement

• Reduction of motor disturbance

Internationale Vojta Gesellschaft e. V., Vojtova terapie v dětském věku, 5. vydání. www.vojta.com; info@vojta.com

PREREQUISITES OF EFFECTIVE RL TREATMENTPREREQUISITES OF EFFECTIVE RL TREATMENT

• The parents or family members are important part of the treatment

• The parents are thoroughly instructed to carry out Reflex locomotion

• The parents or family members are important part of the treatment

• The parents are thoroughly instructed to carry out Reflex locomotion

• PT should supervise the treatment (regular appointments are convenient)

• PT should supervise the treatment (regular appointments are convenient)

INDICATIONSINDICATIONS• Cerebral palsy (CP) • Central coordination

disorder (CCD)• Peripheral paresis • Spina bifida (MMC) • Myopathies• Congenital malformations

• Cerebral palsy (CP) • Central coordination

disorder (CCD)• Peripheral paresis • Spina bifida (MMC) • Myopathies• Congenital malformations

• Stroke• Brain injuries • Traumatic cross sections• Multiple sclerosis• Neuromuscular

dysfunctions etc. • Back pain, nerve root

• Stroke• Brain injuries • Traumatic cross sections• Multiple sclerosis• Neuromuscular

dysfunctions etc. • Back pain, nerve root • Congenital malformations

(pes equinovarus)• Orthopedic problems

(skoliosis, hip dysplasia, congenital hip dislocation)

• Congenital malformations (pes equinovarus)

• Orthopedic problems (skoliosis, hip dysplasia, congenital hip dislocation)

• Back pain, nerve root involvement

• Function problems of breathing, swallowing, chewing

• Back pain, nerve root involvement

• Function problems of breathing, swallowing, chewing

CONTRAINDICATIONSCONTRAINDICATIONS

• Febrile stage• Acute stage/ systemic inflammatory process • Cancer – advanced stages with metastases or

acute stage, exhausted patient under oncology (ongoing chemo and radiotherapy)

• Febrile stage• Acute stage/ systemic inflammatory process • Cancer – advanced stages with metastases or

acute stage, exhausted patient under oncology (ongoing chemo and radiotherapy)(ongoing chemo and radiotherapy)

• Pregnancy• Babies/infants – 3-4 days after vaccination• Patients on very high doses of steroids (Risk

of excessive exhaustion)• Hard mental disturbance – autistic behavior• Diarrhoea, vomiting, regurgitation

(ongoing chemo and radiotherapy)• Pregnancy• Babies/infants – 3-4 days after vaccination• Patients on very high doses of steroids (Risk

of excessive exhaustion)• Hard mental disturbance – autistic behavior• Diarrhoea, vomiting, regurgitation

Vojta said: „Crucialcontraindication isVojta said: „Crucialcontraindication iscontraindication isbad physiotherapist!“contraindication isbad physiotherapist!“

THERAPY SHOULD BE CARRIED OUTTHERAPY SHOULD BE CARRIED OUT

• 4 times a day• The treatment should not last more than 20

minutes

• 4 times a day• The treatment should not last more than 20

minutesminutes• The therapy should always fit to actual health

state of the patient

minutes• The therapy should always fit to actual health

state of the patient

Internationale Vojta Gesellschaft e. V., Vojtova terapie v dětském věku, 5. vydání. www.vojta.com; info@vojta.com

HOW WENT THE TIME…HOW WENT THE TIME…

• 50th years of the last century-The discovery (foundation) of method

• 60. – 70. years-The development of diagnostic and therapy

• 50th years of the last century-The discovery (foundation) of method

• 60. – 70. years-The development of diagnostic and therapy -The development of diagnostic and therapy system

-Special courses - Germany, Italy, Japan

-The development of diagnostic and therapy system

-Special courses - Germany, Italy, Japan

• 80. – 90. years-The extensive of the indications for this type of kinesiologic facilitation

• 80. – 90. years-The extensive of the indications for this type of kinesiologic facilitation

HOW WENT THE TIME…HOW WENT THE TIME…

-The using not only in childhood but in adultshood

-The using not only in childhood but in adultshood

• The comparison of the effects Vojta`s therapy and Bobath – not statistically significant

• The verification of effects of therapy – EMG

• The comparison of the effects Vojta`s therapy and Bobath – not statistically significant

• The verification of effects of therapy – EMG

HOW WENT THE TIME…HOW WENT THE TIME…

• The verification of effects of therapy – EMGdetections – have shown the effect of the therapy in peripheral and central damage

• The verification of effects of therapy – EMGdetections – have shown the effect of the therapy in peripheral and central damage

• Internationalle Vojta Gesellschaft e.V. - Germany

• Czech Republic: RL- Corpus s.r.o

• Československá rehabilitační společnost dr. Vojty

• Internationalle Vojta Gesellschaft e.V. - Germany

• Czech Republic: RL- Corpus s.r.o

• Československá rehabilitační společnost dr. Vojty

HOW WENT THE TIME…HOW WENT THE TIME…

http://www.vojta.com/

• 21th century-RL is scientifically proofed and well-tested, but…..

-Principles of reflexlocomotion are incorporated in

• 21th century-RL is scientifically proofed and well-tested, but…..

-Principles of reflexlocomotion are incorporated in

HOW WENT THE TIME…HOW WENT THE TIME…

-Principles of reflexlocomotion are incorporated inexisting physiotherapy concepts the same way asin the new one

-Principles of reflexlocomotion are incorporated inexisting physiotherapy concepts the same way asin the new one

Vojta′s principle - Contact Stimulating Physiotherapy in Respiratory Handling

Vojta′s principle - incorporated in Klapp Crawling (according to Čápová)

Vojta′s principle - the exercise by Therapi Master

Vojta′s principle - the voluntery exercise

Vojta′s principle - Dynamic neumuscular stabilization according to Kolář (DNS)

CONSLUSIONSCONSLUSIONS

Inborn movement patterns

• The early diagnostic • The early therapy

The therapy can be apllied:

Inborn movement patterns

• The early diagnostic • The early therapy

The therapy can be apllied:The therapy can be apllied:-Generally - the all of motoric disturbances (inneurology, orthopaedics, traumatology, etc.)

-In the every age (newborn, babies, children,adolescents, adults)

The therapy can be apllied:-Generally - the all of motoric disturbances (inneurology, orthopaedics, traumatology, etc.)

-In the every age (newborn, babies, children,adolescents, adults)

Internationale Vojta Gesellschaft e. V., Vojtova terapie v dětském věku, 5. vydání. www.vojta.com; info@vojta.com

• VT is universal neurophysiological principle• VT is based on „natural movement“• VT fits for children• VT is basic of other therapies

• VT is universal neurophysiological principle• VT is based on „natural movement“• VT fits for children• VT is basic of other therapies

CONSLUSIONSCONSLUSIONS

• VT is basic of other therapies• VT effec t of the treatment is long lasting• VT is economically favourable

• VT is basic of other therapies• VT effec t of the treatment is long lasting• VT is economically favourable

Internationale Vojta Gesellschaft e. V., Vojtova terapie v dětském věku, 5. vydání. www.vojta.com; info@vojta.com

www. rl-corpus.cz

www. Vojta.com

www. Rehabps.com