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Vojta Approach
Evidence reviewed as of before
01-01-2021 Author(s): Ogourtsova, T. (PhD OT); Steven, E. (MSc App OT); Iliopoulos, G. (MSc App OT); & Majnemer, A. (PhD, OT, FCAHS)Share this
intervention:
Vojta
Introduction
The Vojta approach was developed by Václav Vojta, a neurologist active during the 20th century concerned with motor rehabilitation for children with cerebral palsy, developmental disorders and musculoskeletal diseases. The Vojta approach is based on the principle of reflex locomotion, which he developed.
Dr. Vojta discovered that even clients with damage to their central nervous system (CNS) had consistent motor reactions to specific stimuli on different parts of the body when positioned in a certain way (supine, prone and side lying). Because he was able to help activate recurring movements that his clients were not able to do spontaneously, Dr. Vojta concluded that there may be functional blockages that can be overcome.
Reflex locomotion has 2 main phases to treat motor disfunction that involve complex activities where motor patterns can be practiced and reintegrated by the CNS. Phase 1, reflex creeping, is a movement sequence that includes the most fundamental components of locomotion. It requires the client to be positioned on their stomach and promotes movements such as postural control, extension against gravity, and goal-directed stepping movements of the arms and legs. Phase 2, reflex rolling, includes transitions from lying on the back to the side. It includes mechanisms necessary for walking, deep breathing, activation of abdominal muscles, swallowing and mastication, eye movements and control of urinary and rectal sphincters.
The Vojta approach can be used for any age and clientele with movement disturbances. It is most commonly used for newborn and young children with CP or adults with stroke. While it has been used since the mid 20th century, it is not a widely practiced technique in North America. It is most commonly used in European countries.
Dr. Vojta treating a premature infant. Accessed on July 4, 2022 from https://www.vojta.com/en/the-vojta-principle/profvvojta
The Vojta approach is used with adult and pediatric clienteles with a variety of neurodevelopmental and musculoskeletal issues. It was developed by a pediatric neurologist, Václav Vojta, in the mid-20th century for treating movement disturbances in children with CP.
Dr. Vojta discovered the principle of reflex locomotion when treating children with CP. He found that by stimulating certain zones of the body when positioned in front, back or side lying positions, children with CP had reflexive movements (reflex creeping and reflex rolling) that they couldn’t do spontaneously.
Reflex locomotion has two phases: 1) reflex creeping (begins in front lying position) and 2) reflex rolling (begins in back lying position and transitions to side lying position). These two phases refer to movement complexes. Reflex creeping leads to a type of creeping movement, while reflex rolling begins from back lying to side lying to a crawling movement. In reflex locomotion, there is a coordinated, rhythmic activation of the total skeletal musculature and a CNS response at multiple levels. Muscles, joints, ligaments and tendons are stimulated which promotes postural maintenance through isometric contraction.
Through the use of reflex locomotion Vojta believed he was able to help a client access “reflex-like” muscle functions necessary for spontaneous movement in everyday life. He saw his treatment as a way to create new networks between the brain and spinal cord through repeated practice.
Vojta therapy can be used for any age and for almost every movement disturbance and for numerous illnesses (e.g. CP, stroke, spina bifida, congenital myopathies, etc.). It can also be incorporated into physiotherapy sessions with similar approaches (e.g. NDT, manual therapy and sensory integration techniques)
It is used for improving patterns of movement that can effect numerous areas of the body, decreasing pain, gaining strength and improving the ability of the person to function independently in daily activities. Vojta therapy is also believed to help activate higher cortical functions (motivation, concentration, patience, speech acquisition, multitasking, perception, etc.).
The Vojta approach is a very versatile therapy approach and is also said to have positive effects on the following:
Skeletal musculature (e.g. the arms and legs become more functional for targeted support and grasp
Face and mouth (e.g. sucking, swallowing, and chewing)
Respiration (e.g. rib cage expansion)
Autonomous nervous system (e.g. the regulatory function of the urinary bladder and intestines are activated)
Balance and Perception (e.g. body awareness improves)
Vojta therapy has been extensively used for over fifty years in Europe and Asia, yet the research does not draw any definitive conclusions about its effectiveness. Only one fair quality study met the criteria of this project. It examined the effects of the Vojta approach vs. general physiotherapy on diaphragm movement (inspiration and expiration). It found that the Vojta approach was more effective than general physiotherapy in improving the inspiration of children with spastic CP while there were no significant differences for expiration. More research is required as there are many applications of the Vojta approach for CP.
Vojta therapy takes place in a specialized medical or physiotherapy clinic. A Vojta trained therapist will work one-to-one with your child to first assess movement pattern dysfunction and any compensatory behaviors and set therapy goals.
Treatment sessions will be conducted on a padded table. The therapist will position your child in 3 main positions (lying on his/her stomach, back and side). While in these positions, the therapist will position your child’s limbs and apply goal directed pressure to defined zones of the body. This type of stimulation will lead to two types of movements: reflex creeping in front lying position and reflex rolling in back lying and side lying position. This is what Vojta referred to as reflex locomotion.
You will likely see new motor reactions, resulting from the positioning and stimulation the therapist provides. For example, you might see toes that were once contracted releasing and straightening. These new movements are what Vojta described as “new networking” within functionally blocked networks of nerves between the patient’s brain and spinal cord. With continued repetition during treatments, it is believed that the central nervous system can reorganize and these patterns of movement can become more available to the child.
The Vojta approach is not painful, but some parents report that their child cries during a session. A therapist can use toys and other techniques to help your child be more comfortable when possible. It is also possible to have parent coaching to conduct treatments at home.
Vojta therapy is provided by either physiotherapists or doctors who have successfully completed a professional qualification course in Vojta Therapy. This training course must comply with the guidelines of the International Vojta Society (IVS). Training for these professionals lasts eight weeks for the treatment of infants and children and six weeks for adults. There is additional training required to be able to conduct neurological examinations. Please note: Vojta therapy is more available in European countries.
The therapist determines the frequency and duration of treatments on a case-by-case basis. The more severe the condition, the higher the frequency of sessions recommended.
The success of Vojta therapy may also depend on the expertise of the therapist and the proper dosage of therapy.
More research is required to determine if the Vojta approach is able to improve the functioning (patterns of movement) for children with CP and developmental disorders. Only the effects of the Vojta approach on diaphragm movements (respiration and expiration) were examined in the study reviewed for this module. This fair quality study showed that the Vojta approach was more effective in improving inspiration when compared to general physiotherapy; however, there was no significant difference for expiration in children with spastic CP and GMFCS level I-III.
Information on this website is provided for informational purposes only and is not a substitute for professional medical advice.
One fair quality RCT (Ha and Sung., 2018) investigated the effects of the Vojta approach on diaphragm movement in children with spastic CP (diplegia/hemiplegia). This fair quality RCT randomized participants to receive either the Vojta approach or general physiotherapy. Diaphragm movement (inspiration and expiration) was assessed using ultrasound imaging at post-treatment (6 weeks). A significant between-group difference was found for inspiration, favoring Vojta vs. traditional physiotherapy.
Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that the Vojta approach is more effective than a comparison intervention (traditional physiotherapy) in improving diaphragm movement (inspiration) for children with spastic CP (diplegia/hemiplegia).
References
Ha, S. Y., & Sung, Y. H. (2018). Effects of Vojta approach on diaphragm movement in children with spastic cerebral palsy. Journal of exercise rehabilitation, 14(6), 1005–1009. https://doi.org/10.12965/jer.1836498.249
A group of lifelong disorders affecting a person’s movement, coordination, and muscle tone and which are the result of damage to the brain before, during, or shortly after birth.
Gross Motor Functional Classification System. It is a tool used to categorize the gross motor skills of children with cerebral palsy into 5 different levels across 5 age bands. It evaluates the child’s abilities in sitting, walking and wheeled mobility as well as the type of assistive devices needed for mobility. The levels are assigned based on the severity of the limitations, ranging from mild (level I) to severe (level V).
