Vojta Therapy versus transcutaneous electrical nerve stimulation for lumbosciatica syndrome: A quasi-experimental pilot study

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.

Characterising the Features of 381 Clinical Studies Evaluating Transcutaneous Electrical Nerve Stimulation (TENS) for Pain Relief: A Secondary Analysis of the Meta-TENS Study to Improve Future Research

Background and Objectives: Characterising the features of methodologies, clinical attributes and intervention protocols, of studies is valuable to advise directions for research and practice. This article reports the findings of a secondary analysis of the features from studies screened as part of a large systematic review of TENS (the meta-TENS study). Materials and Methods: A descriptive analysis was performed on information associated with methodology, sample populations and intervention protocols from 381 randomised controlled trials (24,532 participants) evaluating TENS delivered at a strong comfortable intensity at the painful site in adults with pain, irrespective of diagnosis. Results: Studies were conducted in 43 countries commonly using parallel group design (n = 334) and one comparator group (n = 231). Mean ± standard deviation (SD) study sample size (64.05 ± 58.29 participants) and TENS group size (27.67 ± 21.90 participants) were small, with only 13 of 381 studies having 100 participants or more in the TENS group. Most TENS interventions were ‘high frequency’ (>10 pps, n = 276) and using 100 Hz (109/353 reports that stated a pulse frequency value). Of 476 comparator groups, 54.2% were active treatments (i.e., analgesic medication(s), exercise, manual therapies and electrophysical agents). Of 202 placebo comparator groups, 155 used a TENS device that did not deliver currents. At least 216 of 383 study groups were able to access other treatments whilst receiving TENS. Only 136 out of 381 reports included a statement about adverse events. Conclusions: Clinical studies on TENS are dominated by small parallel group evaluations of high frequency TENS that are often contaminated by concurrent treatment(s). Study reports tended focus on physiological and clinical implications rather than the veracity of methodology and findings. Previously published criteria for designing and reporting TENS studies were neglected and this should be corrected in future research using insights gleaned from this analysis.

Analysis of Intracerebral Activity during Reflex Locomotion Stimulation According to Vojta’s Principle

Vojta’s therapy is a widely used approach in both the prevention and therapy of musculoskeletal disorders. Changes in the musculoskeletal system have been described repeatedly, but the principles of the approach have not yet been clarified. The objective of our study was to evaluate changes of intracerebral activity using electromagnetic tomography (sLORETA) that arise during reflex locomotion stimulation of the breast trigger zone according to Vojta’s therapy. Seventeen healthy women took part in the experiment (aged 20–30 years old). EEG activity was recorded 5 min prior to the reflex locomotion stimulation, during stimulation, and 5 min after the stimulation. The obtained data were subsequently processed in the sLORETA program and statistically evaluated at the significance level p ≤ 0.05. The analysis found statistically significant differences in the frequency bands alpha-2, beta-1, and beta-2 between the condition prior to stimulation and the actual stimulation in BAs 6, 7, 23, 24, and 31 and between the resting condition prior to stimulation, and the condition after the stimulation was terminated in the frequency bands alpha-1, alpha-2, beta-1, and beta-2 in BAs 3, 4, 6, and 24. The results showed that reflex locomotion stimulation according to Vojta’s therapy modulates electrical activity in the brain areas responsible for movement planning and regulating and performing the movement.

Innate Muscle Patterns Reproduction During Afferent Somatosensory Input With Vojta Therapy in Healthy Adults. A Randomized Controlled Trial

OBJECTIVE

Vojta therapy describes stereotypic widespread motor responses as a pattern of tonic muscle contractions during a peripherical pressure stimulation. The present work proposes to characterize the responses at muscles level to a specific tactile input based on Vojta therapy, assessed by sEMG, compared to a sham stimulation in healthy subjects.

METHODS

Surface electromyography (sEMG) signal was acquired with dipolar electrodes placed at wrist extensors of both forearms, right tibialis anterior, and top part of rectus abdominus, ground channel placed over the right olecranon. It was amplified and digitized by a 4-channel hub Biosignalsplux device (Plux Wireless Biosignals S.A., Lisboa, Portugal), sampled at 1000 Hz with 16-bit per channel. A continuous 10-minute record of the sEMG signal from the four electrodes were registered. Resting EEG during the first minute before the stimulation period was recorded by 64 active electrodes.

RESULTS

Statistically significant differences were showed between sham and experimental group. Experimental group participants were subjected to cluster analysis based on their muscle activation patterns, generating three different models of activation. Differences in the previous resting cortical activity in left superior frontal area were found between clusters that activated limb muscles and the cluster that did not.

CONCLUSIONS

Vojta specific stimulation area activates innate muscle responses assessed by sEMG in healthy subjects, compared to a sham stimulation.

SIGNIFICANCE

This characterization might be helpful to the prescription and application of Vojta therapy in an individual-basis for non-neurophysiologically damaged adult subjects.

Feasibility and efficacy of the Vojta therapy in subacromial impingement syndrome: a randomized controlled trial

Subacromial impingement syndrome (IS) is a common disorder associated with functional impairment and disability of the shoulder. The aim of this study was to evaluate the efficacy of Vojta therapy (VT) techniques compared with standard therapy (ST) in patients with subacromial IS. A randomized controlled trial was performed, with 60 patients with IS (mean age, 61±12 years) randomized into two groups: ST (n=30) and ST plus Vojta therapy (SVT, n=30). Both received 15 treatment sessions over 4 weeks. Outcome measures included pain intensity, functionality, joint range of motion (RoM), strength, and quality of life measurements. The efficacy of both treatments was analysed, both comparatively and separately, immediately after completion of treatment and after 3 months. After the intervention, both groups showed statistically significant differences in visual analogue scale (P=0.001), RoM (P<0.01), and strength (P<0.001), which were also seen 3 months after the intervention. SVT is more efficient in both the short and medium term in reducing pain, improving functionality, increasing articular RoM and strength, and offering a better quality of life in IS patients.

Cortical activity during sensorial tactile stimulation in healthy adults through Vojta therapy. A randomized pilot controlled trial

Background

Brain’s is stimulated by Vojta Therapy through selected body areas activating stored innate motor programs which are exported as coordinate movement and muscle contractions to trunk and limbs. The aim of this pilot study is to know the responses at cortical level to a specific tactile input, assessed by electroencephalography (EEG), compared to a sham stimulation, in healthy subjects.

Methods

A randomized-controlled trial was conducted. Participants were randomly distributed into two groups: a non-specific tactile input-group (non-STI-group) (n = 20) and a Vojta specific tactile input-group (V-STI-group) (n = 20). The non-STI-group was stimulated in a non specific area (quadriceps distal area) and V-STI-group was stimulated in a specific area (intercostal space, at the mammillary line between the 7th and 8th ribs) according to the Vojta therapy. Recording was performed with EEG for 10 min considering a first minute of rest, 8 min during the stimulus and 1 min after the stimulus. EEG activity was recorded from 32 positions with active Ag/AgCl scalp electrodes following the 10–20 system. The continuous EEG signal was split into consecutive segments of one minute.

Results

The V-STI-group showed statistically significant differences in the theta, low alpha and high alpha bands, bilaterally in the supplementary motor (SMA) and premotor (PMA) areas (BA6 and BA8), superior parietal cortex (BA5, BA7) and the posterior cingulate cortex (BA23, BA31). For the V-STI-group, all frequency bands presented an initial bilateral activation of the superior and medial SMA (BA6) during the first minute. This activation was maintained until the fourth minute. During the fourth minute, the activation decreased in the three frequency bands. From the fifth minute, the activation in the superior and medial SMA rose again in the three frequency bands

Conclusions

Our findings highlight that the specific stimulation area at intercostal space, on the mammillary line between 7 and 8th ribs according to Vojta therapy differentially increased bilateral activation in SMA (BA6) and Pre-SMA (BA8), BA5, BA7, BA23 and BA31 in the theta, low and high alpha bands in healthy subjects. These results could indicate the activation of innate locomotor circuits during stimulation of the pectoral area according to the Vojta therapy.

Trial registration Retrospectively registered. This randomized controlled trial has been registered at ClinicalTrials.gov Identifier: NCT04317950 (March 23, 2020).

Modulation of the human sensorimotor system by afferent somatosensory input: evidence from experimental pressure stimulation and physiotherapy

Peripheral afferent input is critical for human motor control and motor learning. Both skin and deep muscle mechanoreceptors can affect motor behaviour when stimulated. Whereas some modalities such as vibration have been employed for decades to alter cutaneous and proprioceptive input, both experimentally and therapeutically, the central effects of mechanical pressure stimulation have been studied less frequently. This discrepancy is especially striking when considering the limited knowledge of the neurobiological principles of frequently used physiotherapeutic techniques that utilise peripheral stimulation, such as reflex locomotion therapy. Our review of the available literature pertaining to pressure stimulation focused on transcranial magnetic stimulation (TMS) and neuroimaging studies, including both experimental studies in healthy subjects and clinical trials. Our search revealed a limited number of neuroimaging papers related to peripheral pressure stimulation and no evidence of effects on cortical excitability. In general, the majority of imaging studies agreed on the significant involvement of cortical motor areas during the processing of pressure stimulation. Recent data also point to the specific role of subcortical structures, such as putamen or brainstem reticular formation. A thorough comparison of the published results often demonstrated, however, major inconsistencies which are thought to be due to variable stimulation protocols and statistical power. In conclusion, localised peripheral sustained pressure is a potent stimulus inducing changes in cortical activation within sensory and motor areas. Despite historical evidence for modulation of motor behaviour, no direct link can be established based on available fMRI and electrophysiological data. We highlight the limited amount of research devoted to this stimulus modality, emphasise current knowledge gaps, present recent developments in the field and accentuate evidence awaiting replication or confirmation in future neuroimaging and electrophysiological studies.