THEORETICAL FOUNDATION, METHOD 1

A- MEDICAL POINT OF VIEW




V. Vojta proposes a methodology in three parts for clinic evaluation of the development :



1 - Study of the postural automatic reactivity:
The test of global reactions to sudden corporal position changes in the space (7 to 11 tested reactions), enables to highlight every perturbation in the automatic management of the postural mechanisms by the Central Nervous System (CNS). The progressive transformation of these reactions in the course of the first year of life, in the context of a normal development, is perfectly codified; their examination enables, not only to signal functional anomalies from central or peripheral origin, but also, to specify the level of development reached at the moment of the examination. 



Picture 1 - Evaluation of the postural reactivity: 
example of 3 main stages of the Vojta reaction . Tests consist of a sudden change of the corporal posture in the space (here a rapid lateral incline), that induces a reaction of the vertebral axis and of the limbs (here these of the upper side ). The normal reaction transforms in the course the first year according to precisely codified modes. It is therefore possible to discern a normal reaction for the age, a reaction indicating a delay, or an erroneous reaction indicating a central coordination deficiency.



2- Cinesiologic analysis of the spontaneous motor function:
Each stage of a normal development is characterized by behaviours answering to precise finalities (orientation, appropriation, locomotion, etc...); these fundamental needs induce the implementation of locomotor strategies, automatically adapted to the postural context of the moment. 
The originality of the Vojta methodology is to define clearly the cinesiologic content of these locomotor strategies; in other words, postures, support polygons, movements characterizing the main stages of an optimal development are precisely defined; the distinction between a multitude of individual variants and fundamental postural components is clearly made, in order to enable their systematic research at the patient and the comparison with possible pathological succedaneas.. 



Picture 2: Healthy child, 3 months old:
In the prone position, the baby releases automatically the upper limbs and builds a triangular support polygon, with symmetrical support on both elbows that enables the elevation of the shoulder belt and of the superior thorax to heave the head freely in the space, out of this polygon. 
This postural automatic mechanism, entirely enslaved to the visual need, contributes to the orientation in the space, it consists of a combination of very precise muscular synergisms in the vertebral axis and the shoulder belt insuring the alignment, the symmetry and the stabilization of these corporal regions, that will guarantee the coordinate rotation of the head. The artificial activation of these synergisms is possible from the birth during the reflex locomotion.



Picture 3: Healthy child, 4,5 months old:
In the prone position, the child has to liberate one upper limb for the prehension. That will be possible by releasing sideways the homolateral lower limb to constitute a new support point on the knee, this new support point will automatically substitute for the disappearing support point at the homolateral elbow . The support polygon is modified. This operation concretizes the appearance of a support diagonal line (from one elbow to the opposite knee); it announces ulterior forms of locomotion such as the dissociated quadrupedic locomotion, the dissociated walking. 
The automatic emergence of this global postural pattern is a preliminary condition to the good progress of the prehension in the prone position ; it's again an "enslaved pattern". This postural pattern includes very precisely coordinated muscular synergisms, of the vertebral musculature, of the trunk and of the limbs; these muscular games are also present in the reflex creeping, which can be activated from the birth under adequate stimulations. 



Picture 4: Child with a cerebral palsy: 
The global support pattern on one single elbow has never been accessible, the lower limb is not released to constitute a new support point on the knee because the necessary coordinated vertebral rotation for this movement is not realized. The prehension unfolds according to a postural substitution pattern, fundamentally different of the pattern illustrated by the picture 3. A functional rehabilitation soliciting frequently a such activity contributes to perpetuate the pathological postural procedure, by delivering to the central nervous system an erroneous afferent proprioceptive flow...



3 - Reflexology:
A series of reflexes selected in the medical literature, whose modes of provocation, answers and interpretation are precisely described, come to complete the diagram of examination to refine the immediate evaluation but also to specify the prognosis. 
The long term follow up of many children has shown that the presence or the absence of these reflexes, their quality, their validity period, could be corroborated with different paths of development (spastic, dyskinetic, etc...).



The severity of the " central coordination disorder " (CCD) is appreciated according to the number of abnormal postural reactions, and of the possible conjugation with aberrations of the reflexology (exceeding normal validity periods of reflexes, qualitatively abnormal answers etc...). 



The confrontation of these three types of data enables to classify the CCD in several categories, whose the most benign do not justify a physiotherapy, as it was proved by several a posteriori statistical studies, realized with important series of patients. 
Severe or medium CCD, correspond to a major risk of invalidating complaint ( cerebral palsy, or other illness), and justify therefore the early therapy. 
light C.C.D can be the expression of sensory or psychomotor various disorder, belonging or not to a definite syndrome , and justifying an attentive supervision of the ulterior evolution or further medical investigations . 



That shows the importance of this classification that helps the physician to prescribe the early physiotherapy in every necessary case, to avoid useless prescriptions, to anticipate complementary investigations. The CCD is a transitory situation, already pointing out the functional disorder of the CNS. The severity of this disorder has to be quantified to specify the therapeutic indication. More about C.C.D.


Source: Posmoved

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