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Sánchez-González JL, Sanz-Esteban I, Menéndez-Pardiñas M, Navarro-López V, Sanz-Mengíbar JM. Critical review of the evidence for Vojta Therapy: a systematic review and meta-analysis. Front Neurol 2024; 15:1391448. [PMID: 38711552 PMCID: PMC11070493 DOI: 10.3389/fneur.2024.1391448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/29/2024] [Indexed: 05/08/2024] Open
Abstract
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.
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Affiliation(s)
- Juan Luis Sánchez-González
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Ismael Sanz-Esteban
- Department of Physiotherapy, Physical Therapy and Health Sciences Research Group, Universidad Europea de Madrid, Madrid, Spain
| | - Mónica Menéndez-Pardiñas
- Early Intervention and Child Rehabilitation Department, Women & Children’s “Teresa Herrera Hospital”, A Coruña University Hospital (CHUAC), A Coruña, Spain
- Physiotherapy, Medicine and Biomedical Sciences Department, University of A Coruña, A Coruña, Spain
| | - Víctor Navarro-López
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain
| | - José Manuel Sanz-Mengíbar
- Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, University College London Queen Square, London, United Kingdom
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Sánchez-González JL, Díez-Villoria E, Pérez-Robledo F, Sanz-Esteban I, Llamas-Ramos I, Llamas-Ramos R, de la Fuente A, Bermejo-Gil BM, Canal-Bedia R, Martín-Nogueras AM. Synergy of Muscle and Cortical Activation through Vojta Reflex Locomotion Therapy in Young Healthy Adults: A Pilot Randomized Controlled Trial. Biomedicines 2023; 11:3203. [PMID: 38137425 PMCID: PMC10740470 DOI: 10.3390/biomedicines11123203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/20/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
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.
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Affiliation(s)
- Juan Luis Sánchez-González
- Department of Nursing and Physiotherapy, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, 37008 Salamanca, Spain; (J.L.S.-G.); (I.L.-R.); (R.L.-R.); (B.M.B.-G.); (A.M.M.-N.)
| | - Emiliano Díez-Villoria
- Centro de Atención Integral al Autismo-InFoAutismo, INICO-Instituto Universitario de Integración en la Comunidad and Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, 37008 Salamanca, Spain; (E.D.-V.); (R.C.-B.)
| | - Fátima Pérez-Robledo
- Department of Nursing and Physiotherapy, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, 37008 Salamanca, Spain; (J.L.S.-G.); (I.L.-R.); (R.L.-R.); (B.M.B.-G.); (A.M.M.-N.)
| | - Ismael Sanz-Esteban
- Physical Therapy and Health Research Group, Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain;
| | - Inés Llamas-Ramos
- Department of Nursing and Physiotherapy, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, 37008 Salamanca, Spain; (J.L.S.-G.); (I.L.-R.); (R.L.-R.); (B.M.B.-G.); (A.M.M.-N.)
- University Hospital of Salamanca, 37007 Salamanca, Spain
| | - Rocío Llamas-Ramos
- Department of Nursing and Physiotherapy, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, 37008 Salamanca, Spain; (J.L.S.-G.); (I.L.-R.); (R.L.-R.); (B.M.B.-G.); (A.M.M.-N.)
| | - Antonio de la Fuente
- Department of Physiology and Pharmacology, Institute of Neurosciences of Castilla and León (INCyL), University of Salamanca, Avenida Alfonso X El Sabio s/n, 37007 Salamanca, Spain;
| | - Beatriz María Bermejo-Gil
- Department of Nursing and Physiotherapy, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, 37008 Salamanca, Spain; (J.L.S.-G.); (I.L.-R.); (R.L.-R.); (B.M.B.-G.); (A.M.M.-N.)
| | - Ricardo Canal-Bedia
- Centro de Atención Integral al Autismo-InFoAutismo, INICO-Instituto Universitario de Integración en la Comunidad and Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, 37008 Salamanca, Spain; (E.D.-V.); (R.C.-B.)
| | - Ana María Martín-Nogueras
- Department of Nursing and Physiotherapy, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, 37008 Salamanca, Spain; (J.L.S.-G.); (I.L.-R.); (R.L.-R.); (B.M.B.-G.); (A.M.M.-N.)
- Department of Nursing and Physiotherapy, Institute of Neurosciences of Castilla and León (INCyL), University of Salamanca, 37008 Salamanca, Spain
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Pleskova J, Koucky V, Medunova K, Vlckova B, Smolikova L, Pohunek P. Reflex zone stimulation reduces ventilation inhomogeneity in cystic fibrosis: A randomised controlled cross-over study. Pediatr Pulmonol 2021; 56:1558-1565. [PMID: 33656249 DOI: 10.1002/ppul.25350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 02/02/2021] [Accepted: 02/25/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The reflex zone stimulation technique (RST) activates complex motor responses and has a positive impact on the locomotor system. This technique may also indirectly affect breathing; however, the use of this technique as adjunct of the treatment of cystic fibrosis (CF) has not yet been characterised. METHODS We performed a randomised controlled single-centre interventional trial to evaluate the short-term effects of RST on lung function in 21 paediatric CF patients with normal baseline spirometry. The effect of 30 min of RST was compared to that of sham therapy in a crossover design. The interventions were performed in random order and planned 6 months apart. The primary outcome was a change in global ventilation inhomogeneity after intervention, assessed by lung clearance index (LCI2.5 ) derived from a nitrogen multiple breath washout test. Secondary outcomes included changes in regional ventilation inhomogeneity (indices of acinar [Sacin*Vt] and conductive airway [Scond*Vt] inhomogeneity) and spirometry parameters (inspiratory capacity, forced vital capacity, and forced expiratory volume in 1 s). Trunk deformity was assessed by physiotherapists at study entry. RESULTS After the RST intervention, the LCI2.5 (p = .004) and Scond*Vt (p = .009) decreased significantly, while inspiratory capacity increased (p = .012). In the sham-therapy group, none of the parameters changed significantly. Trunk deformity was seen in 76.5% of all patients, and 92.9% of those with trunk deformity showed a decrease in LCI2.5 after RST. CONCLUSION RST has multiple positive short-term effects on lung function, especially in CF patients with trunk deformities.
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Affiliation(s)
- Jana Pleskova
- Department of Paediatrics, 2nd Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic.,Department of Rehabilitation and Sports Medicine, 2nd Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Vaclav Koucky
- Department of Paediatrics, 2nd Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Katerina Medunova
- Department of Rehabilitation and Sports Medicine, 2nd Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Blanka Vlckova
- Department of Rehabilitation and Sports Medicine, 2nd Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Libuse Smolikova
- Department of Rehabilitation and Sports Medicine, 2nd Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Petr Pohunek
- Department of Paediatrics, 2nd Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
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Hok P, Hlustik P. Modulation of the human sensorimotor system by afferent somatosensory input: evidence from experimental pressure stimulation and physiotherapy. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 164:371-379. [PMID: 33205755 DOI: 10.5507/bp.2020.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 10/27/2020] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Pavel Hok
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University Olomouc, and University Hospital Olomouc, Czech Republic
| | - Petr Hlustik
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University Olomouc, and University Hospital Olomouc, Czech Republic
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Hok P, Opavský J, Labounek R, Kutín M, Šlachtová M, Tüdös Z, Kaňovský P, Hluštík P. Differential Effects of Sustained Manual Pressure Stimulation According to Site of Action. Front Neurosci 2019; 13:722. [PMID: 31379481 PMCID: PMC6650750 DOI: 10.3389/fnins.2019.00722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/27/2019] [Indexed: 11/19/2022] Open
Abstract
Sustained pressure stimulation of the body surface has been used in several physiotherapeutic techniques, such as reflex locomotion therapy. Clinical observations of global motor responses and subsequent motor behavioral changes after stimulation in certain sites suggest modulation of central sensorimotor control, however, the neuroanatomical correlates remain undescribed. We hypothesized that different body sites would specifically influence the sensorimotor system during the stimulation. We tested the hypothesis using functional magnetic resonance imaging (fMRI) in thirty healthy volunteers (mean age 24.2) scanned twice during intermittent manual pressure stimulation, once at the right lateral heel according to reflex locomotion therapy, and once at the right lateral ankle (control site). A flexible modeling approach with finite impulse response basis functions was employed since non-canonical hemodynamic response was expected. Subsequently, a clustering algorithm was used to separate areas with differential timecourses. Stimulation at both sites induced responses throughout the sensorimotor system that could be mostly separated into two anti-correlated subsystems with transient positive or negative signal change and rapid adaptation, although in heel stimulation, insulo-opercular cortices and pons showed sustained activation. In direct voxel-wise comparison, heel stimulation was associated with significantly higher activation levels in the contralateral primary motor cortex and decreased activation in the posterior parietal cortex. Thus, we demonstrate that the manual pressure stimulation affects multiple brain structures involved in motor control and the choice of stimulation site impacts the shape and amplitude of the blood oxygenation level-dependent response. We further discuss the relationship between the affected structures and behavioral changes after reflex locomotion therapy.
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Affiliation(s)
- Pavel Hok
- Department of Neurology, University Hospital Olomouc, Olomouc, Czechia.,Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czechia
| | - Jaroslav Opavský
- Department of Physiotherapy, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czechia
| | - René Labounek
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czechia.,Department of Biomedical Engineering, University Hospital Olomouc, Olomouc, Czechia
| | | | - Martina Šlachtová
- Department of Physiotherapy, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czechia
| | - Zbyněk Tüdös
- Department of Radiology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czechia.,Department of Radiology, University Hospital Olomouc, Olomouc, Czechia
| | - Petr Kaňovský
- Department of Neurology, University Hospital Olomouc, Olomouc, Czechia.,Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czechia
| | - Petr Hluštík
- Department of Neurology, University Hospital Olomouc, Olomouc, Czechia.,Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czechia
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