2009

Cerebra 2011

Vojta (Reflex Locomotion)Therapy/Dynamic Neuromuscular

Stabilisation
Anthea Wright
Introduction
Vojta therapy or Reflex Locomotion, (RL), was developed by Professor
Hellbruegge (University of Munich), and based on the research conducted by
the Czech Paediatric Neurologist, Professor Vojta at the beginning of the 1950s.
Professor Vojta closely studied the natural mobility and innate muscle control
progression in babies, and observed that movement caused motor reactions
throughout the body as a result of specific stimulation via the central nervous
system.

Babies have an innate ability to develop movements to grasp, reach, roll, sit
up, crawl, and eventually stand up and walk; these abilities are not taught
but appear to be stored movement patterns, which control the muscles of
the body in a co-ordinated sequence. Vojta established that components
of these movements provoked global dynamic muscle activity and central
nervous system regulation, which is found in all forms of human movement or
locomotion.1,2,3

Global patterns form the basis of Reflex Locomotion, a term that refers to the
motor responses resulting from the application of Vojta therapy, or pressure
applied to specific areas of the body which cause the reflexes.1,2,3

To illustrate stored movement muscle activity, one can imagine standing on one
leg and concentrating on the muscles in the leg; however, innate sequences of
involuntary movements of muscles in the back, neck, head, arms, the other leg
and all around the body, make fine adjustments to maintain this balance. This
shows that it is not just the muscles in the leg that are required to maintain this
posture. Vojta therapy involves pressure or massage on one part of the body,
which stimulates related motor patterns, of stored movement muscle activity, as
in creeping, crawling or walking, giving the global patterns described.4

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Vojta therapy Whilst studying the inborn programmes of locomotion, kinesiology,

(movement, posture and balance), and natural development of
requires an movements, Vojta observed that there were trigger points, which provoked
evaluation of the complimentary movements to co-ordinate the body in the natural way.
medical aspects
Professor Vojtas research
of the childs
development, It was found that gentle pressure on certain points of the muscles used
by babies during locomotion, reproduced the reflex locomotion, in the
before designing form of stabilising dynamic muscle activity, which are the fine involuntary
the appropriate muscle movements or reflexes, discussed earlier. The research was divided
treatment. into two main streams:

The medical a) Neurological evaluation, leading to the development of a methodology

evaluation of evaluating child development, its dynamics and major disorders.
considers three b) The concept of the nervous system as an open system endowed
areas, covering with a basic, phylogenetic make-up, yet capable of receiving various
the automatic stimulations, which may affect the functioning of the nervous system,
and have an effect on its anatomical maturation. The reflex locomotion
postural is the physical representation of the meeting of these two
reactivity; the complimentary aspects.3 Vojta suggests that his therapy exercises,
which induce the primitive reflexes of a baby, may be imprinted or re-
kinesiological learned by the central nervous system later in life.
analysis of the
spontaneous A clinical assessment of the childs development
motor function; Vojta therapy requires an evaluation of the medical aspects of the childs
and reflexology. development, before designing the appropriate treatment. The medical
evaluation considers three areas, covering the automatic postural
reactivity; the kinesiological analysis of the spontaneous motor function;
and reflexology.

Automatic postural reactivity - seven to eleven tests are carried out

to identify any abnormalities in reaction to sudden postural change,
which would also highlight any problems associated with the automatic
responses from the central nervous system, (CNS). The sequential CNS
changes in these reactions are well established by the end of the first

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year of life, therefore, any central or peripheral anomalies, and the stage of Where a
development may be identified at this examination. child has
Kinesiological analysis during normal development, spontaneous motor brain lesions,
function accompanies specific movements, such as adjustments to orientation, developmental
balance during locomotion, or posture whilst sitting or standing. The
components of locomotion become synchronised during the first year of
delay, or
growth and therefore, comparisons can be made to identify any possible other cerebral
pathological conditions. dysfunctions
Reflexology pressure or taps on specific areas of the body elicit reflexes, and causing
an evaluation of such responses will give an indication of any anomaly within disturbances
the central nervous system.3
in movement
The physiotherapeutic approach or posture,
the therapy is
Where a child has brain lesions, developmental delay, or other cerebral
dysfunctions causing disturbances in movement or posture, the therapy is designed to
designed to enhance the development of movement sequences and treat the enhance the
motor developments. 4
development
Vojta therapy aims to4: of movement
sequences and
modify the reflex activity by introducing a different neurological
activity to give a new physical awareness, or muscular proprioception treat the motor
(balance) developments.
modify spinal reflexes involved in co-ordinating a movement
improve breathing to increase efficiency of functions
promote growth of innate anatomical locomotor systems
encourage development of movement-associated neural pathways
prevent orthopaedic degradation in severe pathological conditions
delay degenerative neurological function.

In the practical application, there are two basic co-ordination complexes:

reflex creeping
reflex rolling.

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The therapeutic
goals of Reflex
Locomotion
are: to facilitate
the automatic
regulation or
control of the Figure 1: Reflex creeping/crawling Figure 2: Second phase reflex rolling
bodys position, to
facilitate the active Reproducing global patterns forms the basis of motor rehabilitation in
babies, children, adolescents, and adults, and it is possible to stimulate these
maintenance important patterns from early movement, like the building blocks of the normal
of the support development in children, for those with movement disorders. In babyhood,
Reflex Locomotion is utilised within the framework of early intervention, and
function of the
the best results are gained at this time. At this age, the central nervous systems
extremities, and malleability or plasticity is at its greatest.1 Plasticity, or neuroplasticity, is
to stimulate co- the lifelong ability of the brain to reorganise neural pathways based on new
experiences and sensory stimulation.
ordinated muscle
activity. Musculature throughout the body is activated in a co-ordinated manner
and the nervous system is addressed at all regulatory levels. Besides the
skeletal musculature, muscles involved in facial expression, eye movements,
the swallowing process, bladder and bowel function, and breathing are also
activated. This flow of automatic motor reactions is provoked by graded pressure
applied on certain body parts, with the patient placed in specific positions,
(lying on the back, side-lying, and lying on the tummy). They are part of human
movement processes such as grasping, rolling, creeping, crawling, and walking.1

The therapeutic goals of Reflex Locomotion are: to facilitate the automatic

regulation or control of the bodys position, to facilitate the active maintenance
of the support function of the extremities, and to stimulate co-ordinated muscle
activity.

Reflex Locomotion can play an important role in the domain of rehabilitation to

improve the quality of life in children and adults with motor disorders. A Vojta-
trained physiotherapist should be responsible for the implementation of the
therapy. The developed therapy programme should be regularly supervised and

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matched to the patients movement development.1 Motor
development
Vojta therapy has a positive influence on the entire co-ordination of a child during infancy
in his/her spontaneous movement, resulting in improved up-righting against
gravity, balance, gait,grasp, speech and other functions. The improved co- is automatic,
ordination of movements as a result of the therapeutic activation can often be but also
sustained over the duration of the whole day, and will slowly build to become
automatic.5
requires correct
development
Movement-impaired patients also appeared to gain a better ability to of vision and
initiate contact and communicate, therefore, a child has better ways to
meet the confrontations within his/her environment. Vojta therapy can be hearing, which
used as the basis for other therapies and help a child meet the tasks set contribute to
by the psychologist, early educationalist, speech and language therapist,
occupational therapist, and teacher.
balance and
orientation, for
For Vojta therapy to be successful, it must be carried out several times a day. A stability. Skeletal
treatment lasts between 5-20 minutes, and parents/carers are required to carry
out the treatment daily; they play a very important role in the implementation and muscular
of Vojta therapy. development are
For the entire duration of the therapy which can last for weeks to months,
genetic, but joint
or years the Vojta therapist educates the parents in how to implement the positions, posture
therapy and is a support person for the parents. The Vojta therapist should and muscle
monitor and review the progress of the patient and make adjustments, where
necessary, throughout the duration of the treatment.5 development
depend on motor
Advances on Vojtas Reflex Locomotion (RL) to Dynamic programmes
Neuromuscular Stabilisation (DNS)
received from the
Kolar was a student, under the supervision of Vojta whilst he studied patients CNS.
with cerebral palsy, and he noticed that predicted movement patterns
were sometimes compromised, not only in patients with musculoskeletal
pathologies, but also in healthy volunteers. This may have indicated that the
guiding role of CNS in motor development ceases its control later in life, after
the motor patterns become fully learned and automatic,6 (by the age of about
4 years, when gross motor function is fully formed).

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Kolars approach Kolar further developed Vojtas pressure point therapy to enable older patients
is to optimise muscle systems to re-learn the processes which occur during the development of
babies. He addressed the problems of balance and stability by looking at all the
distribution of muscles involved, including the deeper, internal muscles within the abdomen.
internal forces of His therapy is called Dynamic Neuromuscular Stabilisation, (DNS).
the muscles acting
Motor development during infancy is automatic, but also requires correct
on each segment development of vision and hearing, which contribute to balance and orientation,
of the spine and for stability. Skeletal and muscular development are genetic, but joint positions,
posture and muscle development depend on motor programmes received from
other joints. This the CNS. Disturbances to the equilibrium of the CNS, due to lesions, trauma,
enables a good genetic factors, habitual patterns or overuse will result in musculoskeletal
posture for balance dysfunction.6

and stability, as The inborn motor programmes can be evoked automatically through stimulation
well as dynamic of global reflex postural-locomotion zones, (fine motor adjustments throughout
the body, to maintain balance and posture), which correspond to those observed
movement. DNS in babies. The brain must be stimulated and conditioned to automatically
therapy also activate optimal movement patterns that are necessary for stable activity. To re-
enhances the learn the motor programmes from the CNS, the patients are placed in the primal
positions that a baby would adopt. This feeds forward simultaneous activation
performance of all of the diaphragm, pelvic floor, deep neck flexors, and all the sections of the
the organs in the abdominal wall. For example, the position of the pelvis will affect the quality of
breathing, because the muscles of the spine are involved in chest movements.
body.
Kolars approach is to optimise distribution of internal forces of the muscles acting
on each segment of the spine and other joints. This enables a good posture for
balance and stability, as well as dynamic movement. DNS therapy also enhances
the performance of all the organs in the body.6 This therapy aims to correct a
wrong pattern and re-establish good neuro-musculoskeletal function.

Examples of studies on Vojtas Reflex Locomotion (RL)

Dvorak and Valouchova employed Vojta therapy for peripheral facial palsy in
seven patients. Reflex Locomotion assists where it is difficult for patients to
exercise voluntary control of muscles. Palsy areas involved were, eye brow/lid and
mouth movements, as well as swallowing and articulation. The treatment lasted
for 15-20 minutes and the results were recorded by electromyograph, (EMG)7.

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 The aim of the
All seven patients reported improvements in swallowing and six had
improved articulation; five out of the seven confirmed better control of study was to
volutary movements, such as closing eye lids, puckering and smiling. The examine the
EMG recordings confirmed these results, but also showed less than 50%
improvement, possibly due to muscle fatigue after approximately 15 minutes. long-term effect
Further treatments could resolve facial symmetry, to enable patients to of DNS in the
perform voluntary exercises for strengthening and mobility7. treatment of
Bokarius AV and Bokarius V employed DNS to treat patients with chronic chronic pain, and
pain due to musculoskeletal disorders, caused by neuromuscular diseases, they, therefore,
neurological lesions, genetic factors, congenital anomalies, muscle atrophy,
post polio syndrome, spasticity, and some bone conditions. Their study looked
looked at their
at the number of patients who returned after DNS treatment, as an indication records for 820
of success, because they had noticed that there was a decline in the numbers patients, who
experiencing recurring pain.
received 4 to 12
The aim of the study was to examine the long-term effect of DNS in the treatments of
treatment of chronic pain, and they, therefore, looked at their records for 820
patients, who received 4 to 12 treatments of this therapy. The results showed
this therapy. The
that in the age group 18 to 35, only an average of 6% returned for further results showed
treatment, and in the age group 36 to 65 an average of 21% required further that in the age
attention. The results were significant for the efficacy of DNS.
group 18 to 35,
Pavlu et al., analysed the principles of Vojta therapy by SEMG (surface only an average
electromyography) monitoring the responses in healthy young adults whilst
receiving two to five 30 minute sessions. The results demonstrated the
of 6% returned for
following responses: further treatment,
and in the age
responses recorded after 3 to 5 sessions, and more quickly in subsequent
sessions group 36 to 65 an
responses preceded by changes in respiration and deeper breaths before average of 21%
activation of trunk muscles, with a tendancy towards rotation
required further
legs tended to bend at hips and knees
arms had a tendancy to lift with elbows slightly bent and wrists dorsally attention.
flexed
levels of resposes varied in each individual, but the characteristic of tending
to turn was the same.

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The trials confirmed that the pressure point method achieved adjustments in the muscles
responsible for innate motor control.9

Husrov studied the Vojta approach as a treatment for the rehabilitation of 30 subjects, post
stroke. The patients had partial paralysis which affected speech and walking, and the stroke
caused spasticity and an inability to co-operate in their given psychological state. They were
given Reflex Locomotion therapy two to three times a day for a period of 15 days. The results
showed 83% had improved speech, 87% improved gait, 90% decrease in spasticity and 90%
improvement in feeling of wellbeing or psychological state. This shows that the therapy
evoked the global pattern of movement for walking, reaching, grasping and other physical
daily activities, which returned. The results also demonstrate the plasticity of the brain and the
return of 3-D and deep sensation.1

Vojta/Reflex Locomotion/Dynamic Neuromuscular Stabilisation may benefit the following

conditions:

Cerebral Palsy (CP)

Central Co-ordination Disorder (CCD)
Peripheral paresis
Spina Bifida (MMC)
Myopathies
Congenital malformations (pes equinovarus)
Orthopaedic problems (scoliosis, hip dysplasia, congenital hip dislocation)
Stroke
Brain injuries
Traumatic cross sections
Multiple sclerosis
Neuromuscular dysfunctions
Back pain from nerve root involvement
Function problems of breathing, swallowing and digestive tract.

Vojta therapy is not recognised by the National Health Service, nor are there any guidelines for
the treatment from the National Institute of Clinical Excellence, (2010).

Vojta therapy has been available in many countries across Europe for some time, (Germany,
Spain, Italy, Slovenia, Czech Republic, Poland, Norway, Austria, Romania), as well as, more
recently, Syria, Japan, Chile, Argentina, Mexico, India and Korea.

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Vojta therapy/Reflex Locomotion therapy came to London this year, (2010), and is available at the
Kikis Childrens Clinic, 124 Thurleigh Road, London, SW12 8TU.
Tel: 020-7207-4234.

This paper has been written to provide an overview of a particular intervention/therapy and any
associated research findings, not as a recommendation for the use of any therapy.

This information is not meant to replace the advice of any physician or qualified health professional.
The information provided by Cerebra is for information purposes only and is not a substitute for
medical advice or treatment for any medical condition. You should promptly seek professional
medical assistance if you have concerns regarding any health issue.

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Glossary (A-Z)

Automatic postural reactivity timed response to stimulation

Electromyograph a system for recording musculoskeletal activity

Global - throughout the whole body

Kinesiology study of movement, posture and balance

Neuro-musculoskeletal nerve, muscle and skeleton relationship

Orthopaedic degradation worsening of a childs condition

Pathological conditions those having abnormal body structures or functions

Plasticity of the brain the brains ability to change or make new connections

Phylogenetic genetic origin

Proprioception orientation and balance

Reflex locomotion all the bodys muscles involved in moving an arm or leg

SEMG surface electromyography - measures electrical activity in contracting muscles

Stored movement patterns innate sequence of muscle movements to complete a

physical task

Stabilising dynamic muscle activity energy stored in the muscles corrects balance.

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References

1
Kikis Childrens Clinic (2010) Vojtas Reflexlocomotion Therapy in children with motor difficulties, [Online].
Available at: www.kikisclinic.com/physio/vojta [Accessed 17 August 2010]

2
Dynamic Neuromuscular Rehabilitation Center, Vojta Therapy,(2010) [online]. Available at: DNR, www.
nydnrehab.com/vojta.php [Accessed 18 August 2010]

3
Times (2005), Vojta Therapy: Clinic brings therapy used in Europe to area, [online]. Available at: http://www.
cerebral-palsy-injury.com/vojta-therapy.html [Accessed 6 August 2010]

4
Paediatric Physiotherapy (2010), Vojta Therapy: A different physiotherapeutic approach, [online]. Available
at: www.paediatricphysio.com.au [Accessed 18 August 2010]

5
Nation Institute for Developmental Delay, (2010), Vojta Therapy, [online]. Available at: www.nidd.org/
therapy_vojta_obj.htm. [Accessed 6 August 2010]

6
Kolar, P & Kobesove, A (2010), Postural locomotion function in the diagnosis and treatment of movement
disorders, Clinical Chiropractic, 13:1, pages 58-68

7
Dvorak, P.T. & Valouchova, P.T., 2008. The benefits and limitations of Vojtas approach of reflex locomotion. In:
Neurorehabilitation Principles Conference, Charles University, Prague, Czech Republic 14-15 November 2008

8
Bokarius AV & Bokarius V (2010) Long-Term Efficacy of Dynamic Neuromuscular Stabilization in Treatment of
Chronic Musculoskeletal Pain. Pain Practice, 10:5, pages 451-458

9
Pavlu D, Vele F & Havlickova L (2000), Electromyography and kinesiological analysis of Vojtas therapeutical
princip. Czech Journal of Rehabilitation and Physical Therapy, 7:2

10
Husrov R (2005) Rehabilitacia, Slovak Journal of Rehabilitation, 42:3

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The Cerebra In-house Research Team carries out desk-based research

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Cerebra 2009
2011