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

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.

Synergy of Muscle and Cortical Activation through Vojta Reflex Locomotion Therapy in Young Healthy Adults: A Pilot Randomized Controlled Trial

BACKGROUND

Vojta Therapy is a neurorehabilitation therapy that allows to activate reflex movement patterns. The scientific literature has shown its ability to generate muscle contractions. The activation of brain neural networks has also been proven. However, the relationship between these processes has not yet been demonstrated. For this reason, the aim of this study is to verify brain activation produced by recording with near-infrared spectroscopy and its relationship with muscle activation produced in the abdominal muscles recorded with surface electromyography.

METHODS

A total sample of 27 healthy subjects over 18 years of age was recruited. An experimental study on a cohort was conducted. Two experimental conditions were considered: stimuli according to the Vojta protocol, and a control non-stimuli condition. Abdominal muscle activation was measured using surface electromyography, and the activation of the motor cortex was assessed with near-infrared spectroscopy.

RESULTS

In relation to the oxygenated hemoglobin concentration (HbO), an interaction between the stimulation phase and group was observed. Specifically, the Vojta stimulation group exhibited an increase in concentration from the baseline phase to the first resting period in the right hemisphere, contralateral to the stimulation area. This rise coincided with an enhanced wavelet coherence between the HbO concentration and the electromyography (EMG) signal within a gamma frequency band (very low frequency) during the first resting period.

CONCLUSIONS

The results underscore the neurophysiological effects on the brain following tactile stimulation via Vojta Therapy, highlighting increased activity in pivotal areas essential for sensory processing, motor planning, and control. This activation, particularly evident in the Vojta stimulation group, aligns with previous findings, suggesting that tactile stimuli can not only evoke the intention to move but can also initiate actual muscle contractions, emphasizing the therapy's potential in enhancing innate locomotion and rolling movements in patients with neurological disorders.

Impact of reflex locomotion and the Bobath concept on clinical and biomolecular parameters in people with multiple sclerosis: study protocol for a randomized controlled trial

Introduction

Multiple sclerosis (MS) is a progressive disease with a fluctuating and unpredictable course that has no curative treatment at present. One of its main characteristics is the variety of signs and symptoms that produce a high percentage of patients who present alterations in balance and gait during the development of the disease, decreased muscle strength, spasticity, or decreased pimax. Rehabilitative therapy, especially physiotherapy, is the main course of the treatment of these alterations using reflex locomotion and the Bobath concept as a form of kinesitherapy that activates the preorganized circuits of the central nervous system.

Objective

The objective of this study is to evaluate the reflex locomotion and Bobath concept effects on balance, spasticity, reaction time, respiratory parameters, and lacrimal biomolecular markers.

Methods and analysis

This is a randomized controlled trial on the effectiveness of two neurorehabilitation techniques in patients with multiple sclerosis conducted at the University of Salamanca. The research will take place at the Faculty of Nursing and Physiotherapy, University of Salamanca. The study will be conducted from June 2023 to June 2024. The reflex locomotion group will receive individual sessions of therapy (n = 27), and the Bobath concept group (n = 27) will receive the same number of sessions. Both groups will receive two sessions per week for 12 months. The measurement variables will be the Berg Balance Scale, the Tardieu Scale, the Cognitfit Program, Maximum Inspiratory Pressure, and Lacrimal Biomarkers.

Ethics and dissemination

This study has been approved by the Ethics Committee of the University of Salamanca on March 2023 (ref: 896).

Limitations

The main limitations of this study are the selection and number of patients, the delay in implementing the therapy within the initially scheduled period, inadequate sample collection, and inadequate sample processing.

Trial registration number

ClinicalTrials.gov; identifier: NCT05558683.

Cerebral Projection of Mirrored Touch via sLORETA Imaging

Touch is one of the primary communication tools. Interestingly, the sensation of touch can also be experienced when observed in another person. Due to the system of mirror neurons, it is, in fact, being mapped on the somatosensory cortex of the observer. This phenomenon can be triggered not only by observing touch in another individual, but also by a mirror reflection of the contralateral limb. Our study aims to evaluate and localize changes in the intracerebral source activity via sLORETA imaging during the haptic stimulation of hands, while modifying this contact by a mirror illusion. A total of 10 healthy volunteers aged 23-42 years attended the experiment. The electrical brain activity was detected via scalp EEG. First, we registered the brain activity during resting state with open and with closed eyes, each for 5 min. Afterwards, the subjects were seated at a table with a mirror reflecting their left hand and occluding their right hand. The EEG was then recorded in 2 min sequencies during four modifications of the experiment (haptic contact on both hands, stimulation of the left hand only, right hand only and without any tactile stimuli). We randomized the order of the modifications for each participant. The obtained EEG data were converted into the sLORETA program and evaluated statistically at the significance level of p ≤ 0.05. The subjective experience of all the participants was registered using a survey. A statistically significant difference in source brain activity occurred during all four modifications of our experiment in the beta-2, beta-3 and delta frequency bands, resulting in the activation of 10 different Brodmann areas varying by modification. The results suggest that the summation of stimuli secured by interpersonal haptic contact modified by mirror illusion can activate the brain areas integrating motor, sensory and cognitive functions and further areas related to communication and understanding processes, including the mirror neuron system. We believe these findings may have potential for therapy.

Assessment of the Emotional State of Parents of Children Starting the Vojta Therapy in the Context of the Physical Activity-A Pilot Study

The aim of the study was to assess the emotional state of parents at the moment of starting therapy for their children using the Vojta method in the context of the physical activity undertaken by the parents. The study involved 68 parents (37 mothers and 31 fathers) of children with central coordination disorders (CCD) presenting for consultation and therapy using the Vojta method. The authors' questionnaires, the Perceived Stress Scale (PSS-10), the State-Trait Anxiety Inventory (STAI), the Patient Health Questionnaire (PHQ-9), the Satisfaction With Life Scale (SWLS), and the Inventory to Measure Coping Strategies with Stress (Mini-COPE) were used. As many as 84% of mothers and 77% of fathers presented high level of perceived stress. Comparative analysis showed a statistically significant difference in anxiety and life satisfaction between the groups of mothers and fathers studied. Taking declared physical activity into account, there was a statistically significant difference in stress and anxiety in the mothers' group and a statistically significant difference in mood and life satisfaction in the fathers' group. Promoting physical activity among parents of children with CCD can be helpful in maintaining better psycho-physical conditions and can also be a good tool in combating stress in difficult situations, such as the illness and therapy of a child.

A Bibliometric and Visualization Analysis of Motor Learning in Preschoolers and Children over the Last 15 Years

Motor learning enables preschoolers and children to acquire fundamental skills that are critical to their development. The current study sought to conduct a bibliometric and visualization analysis to provide a comprehensive overview of motor-learning progress in preschoolers and children over the previous 15 years. The number of studies is constantly growing, with the United States and Australia, as well as other productive institutions and authors, at the leading edge. The dominant disciplines were Neurosciences and Neurology, Psychology, Rehabilitation, and Sport Sciences. The journals Developmental Medicine & Child Neurology, Human Movement Science, Physical Therapy, Neuropsychology, Journal of Motor Behavior, and Journal of Experimental Child Psychology have been the most productive and influential in this regard. The most common co-citations for clinical symptoms were for cerebral palsy, developmental coordination disorder, and autism. Research has focused on language impairment (speech disorders, explicit learning, and instructor-control feedback), as well as effective intervention strategies. Advances in brain mechanisms and diagnostic indicators, as well as new intervention and rehabilitation technologies (virtual reality, transcranial magnetic stimulation, and transcranial direct current stimulation), have shifted research frontiers and progress. The cognitive process is critical in intervention, rehabilitation, and new technology implementation and should not be overlooked. Overall, our broad overview identifies three major areas: brain mechanism research, clinical practice (intervention and rehabilitation), and new technology application.

Electromyographic Response of the Abdominal Muscles and Stabilizers of the Trunk to Reflex Locomotion Therapy (RLT). A Preliminary Study

Reflex locomotion therapy (RLT) was developed by Vaclav Vojta in 1954 as a diagnostic and treatment tool. This therapy is mainly used to rehabilitate children with motor disorders and risk of cerebral palsy. It is also used for adults with neurological and motor impairment. RLT is based on specific postures and regular stimulation points through which a series of reflex responses are triggered. The neurophysiological mechanisms of this therapy have recently been discovered. This study aims to objectively evaluate muscular responses at the abdominal level after stimulation in the first phase of reflex rolling by showing, with surface electromyography analysis (sEMG), the muscular activity in trunk stabilizing muscles (rectus abdominis, external oblique, internal oblique, and serratus anterior) before, during, and after the application of RLT. A total sample of 27 healthy subjects over 18 years of age was recruited. An experimental study on a cohort was conducted. Two experimental conditions were considered: stimuli according to the Vojta protocol, and a control non-STI condition. Regarding muscular electrical activity, statistically significant differences were determined in all muscles during right-sided stimulation in the VSTI condition (p < 0.001), but not in the non-STI condition. The mean increase in muscle activity in the VSTI condition during the first stimulation ranged from 7% to 20% in the different abdominal muscles. In conclusion, an sEMG response was observed in the abdominal muscles during stimulation of the pectoral area as described in RLT, compared to stimulation of non-described areas.