Vojta Therapy in children &

Current Practice
Jurairat Buaphiban, M.D.
Sirindhorn National Medical Rehabilitation Institute,
Thailand
26 March, 2018 1
Professor Vaclav Vojta

“1950 – 1970” 2
 Vojta therapy in
Thailand

• Vojta therapy for children course was started by SNMRI, Zy’s

movement foundation & Vojta society in 2011
• At present we have 61 vojta therapists for children in thailand
• Vojta therapy for children course: QSNICH
• Vojta therapy for adult course: SNMRI

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1 คน 1 คน
3 คน 2 คน

2 คน
2 คน
2 คน
1 คน
2 คน
1 คน
10 คน
1 คน
7 คน
1 คน
15 คน
1 คน
6 คน
2 คน
1 คน
1 คน

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The Important of Vojta principle

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 Important factor to
develop the movement Vojta assessment
1. Postural reaction 1. Spontaneous movement
2. Uprighting and uprighting
mechanism mechanism compared
3. Differentiation vs with normal postural
Holokinetic development
2. Postural reaction by
4. Motivation to take
Postural reflex test
contact
3. Primitive reflex
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Normal Postural development

 Postural reactions
-Traction reaction*

- Landau reaction*
โดย Landau ,1923
- Axillary hanging reaction
โดย Vojta 1967/1969
- Side tilting reaction
- Horizontal side hanging reaction*
โดย Collis, 1954
- Vertical side hanging reaction*
โดย Peiper และ Isbert ,1927
- Vertical side hanging reaction*
โดย Collis, 1954

*ดัดแปลงและกำหนดมำตรฐำนกำรตรวจ โดย Vojta 10

Primitive reflex
Pediatric Neurology 2004,31(1)

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 Summary
Total number of
Abnormal postural Normal result
reactions Mildest C.C.D.
(1 – 3 abn.post.reaction)
Predominantly mild C.C.D.
abnormal side (4 – 5 abn.post.reaction)
Moderatrly severe
(6 – 7 abn.post.reaction)
Postural developmental age
Min Max Severe C.C.D. (7 abn.post.reaction and
additional obvious disturbance in tone)

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 central coordination disturbance
2308 patients displayed as percentage
80 69.74
70
60
50
40
30
18.77
20
7.22 3.86
10 0.41
0
Normal Leichteste ZKS Leichte ZKS Mittelschwere Schwere ZKS
ZKS

Costi, G.C. et al.: Vojta's seven postural reactions for screening of neuromotorial
diseases in infant, research of 2308 case. La PediatrMedica e Chirurgica, Vol. 5,Nr 1-2
(1983), pp 59-65
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 Prognosis of Symptomatic risk Children
Or children with abnormal postural reaction
Postural reaction Prevalence of all Developed into Suggestion
population (study in normal without
~ 8000 children) treatment
(Imamura et al)
all postural reaction normal 70 % 100 % No need to follow up
Mildest Central coordination disturbance: > 90 % Follow up at 6 – 8
1 - 3 abnomal postural reaction weeks
Mild Central coordination disturbance: Follow up at 4 – 6
~ 25 % ~ 75 %
4 - 5 abnomal postural reaction weeks

Moderately severe
Start treatment with
central coordination disturbance 3-5% ~45 %
Vojta Therapy
6 - 7 abnormal postural reaction
Severe Central coordination disturbance
7 abnomal postural reaction and Start treatment with
0,5 % ~10 %
additional abnormal tone Vojta Therapy

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 Abnormal development in central coordination disturbance
Without treatment 211 patients (Imamura et al.)
Number Group Turn to CP (ร้อยละของ n)
107 Very mildly (LLB) 2.6
67 Mild (LB) 4.5
13 Mod severe (MB) 30.7
24 Severe (SB) 37.5
With treatment 713 patients (Vojta et al.)
number Group Turn to CP (ร้อยละของ n)

57 Very mildly (LLB) -

258 Mild (LB) -
328 Mod severe (MB) 3.35 15
70 Severe (SB) 51.42
 Vojta Therapy Principle
• Reflex locomotion
= motor reactions occurring throughout the entire
body as a result of specific peripheral stimulation given
to specific body parts (Zone) with the patient placed in
specific position.

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 Therapy goal
• Therapy goal is to facilitate
- the automatic regulation of the body position
- the active maintenance of the support function of the
extremities
- the coordination of muscle activity

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Reflex creeping

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 Reflex locomotion
• Reflex rolling
first phase • Reflex creeping
6 variations

second phase

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 Reflex Rolling 1st phase
Abdominal contraction

Posterior pelvic tilt

• Hip ext. rotation and hip flexion presented  Posterior pelvic tilt

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 Vojta treatment effect
• Depend on frequency of discharge, summation by duration,
summation of zones
• After discharge: 45 minutes
• Twice a day, 20 mins each session
=40 minute treatment time + 2x45 minutes “after discharge”
=130 min. activated status
• four times a day, 10 mins each session
=40 mins treatment time + 4x45 minutes “after discharge”
=220 mins activated status 24
the vojta therapy may not be delivered in case of :
• febile patient
• acute inflammatory illness
• malignant tumor
• 10days after immunization
• pregnant patient

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 Indication for Vojta therapy
• Moderately and severe Central coordination disturbance
• Asymmetrical presented: Scoliosis, Torticollis
• Cerebral palsy
• Delayed motor development
• Spinal cord syndrome
• Muscular disease
• Weakness due to Peripheral nerve injury
• Congenital anomaly: limb deficiency
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 Research: SNMRI
• Effect of postural control and activites of daily living in
children with spastic diplegia: A comparison between
conventional PT and vojta therapy
• 64 children
– Conventional PT: individual – PROME, strengthening exercise, trunk
control in sitting position 3 days/week, 120 min/ session x 8 weeks
– Vojta: Therapy 3 days/week, 30 min/ session x 8 weeks
• Compared 2 groups: RCT
– Postural control: Trunk control measurement scale
– ADL: PEDI
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 Vojta therapy in cerebral palsy: CRC SNMRI
• Spastic diplegia: 60%, spastic tetraplegia 30%, spastic
hemiplegia 10%
• Improved 1 level of GMFCS: 20%
• 80% remaining:
– No improvement of GMFCS
– Improved quality of movement
• Head and neck control in prone: child canextend his neck higher and in
longer duration
• Standing with/ without support,

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We are Team Dr. Jakkapong Dr. Jurairat

PT Assistance

OT

Napat Nongnuch
Sasithorn
Sawitree
Nitchakan

Suleewan Mod

Wimwipa
Ratwaree Jay
Somporn
Thank You