Body Scheme Perception
So far, most agree that the perception of the body scheme is a matter of continuous learning. The idea of one’s body should be based on experience and the associated perception with the body. This should lead to saving the sensorimotor information at different levels of the CNS. The possibility to be aware of one’s body and its position within the environment is facilitated this way.
To reach the normal and maximal possible sensorimotor development of the child, it is necessary for the arrangement within the CNS to create one single integrated self-image. The question is whether the information that forms this body scheme is created by external and intrinsic stimuli in the form of gradual learning.
I think that it is only gradual “unzipping and saving” of the inborn programs of sensorimotor creation of the body scheme. The program for sensorimotor perception is only a part of the basic operating program for motor skills. It is a part that provides feedback for regulation of the musculoskeletal apparatus. Feedback is a component of every regulation. Thus, the regulation of motor skills also depends on the permanent multifunctional sensorimotor feedback. Its flawless function is necessary for permanent correction of movement deviations. We certainly cannot talk about a learning process that is not a suitable tool for the complex and mostly automated motor skills.
As the other even more primitive regulatory programs contain a regulation feedback component, the extremely complicated programs of the musculoskeletal apparatus possess the biofeedback component as well, i.e. the sensorimotor skills. The evidence of the properly launched and working feedback of sensory function is the ability of correct body scheme perception. We can talk about this truly conscious perception only in children, whose mental level of individualisation and separation has begun to mature. Many years ago, Jean Piaget described this phenomenon within the development of mental functions in children1. The creation of the body scheme is significantly delayed in children who haven’t undergone physiological development of the musculoskeletal apparatus. Its impairment is in direct proportion to the damage of the regulation of motion. The typical example could be the impairment of stereognosis, i.e. the ability to recognise the shape of objects by touch.
The function of therapeutic models that don’t respect the developmental rules of kinesiology must resort to utilising reflex gait automatism.
It can be evoked early after birth and, as a primitive reflex, it fades away early. Its extinction is necessary in order to “make space” for developmentally higher levels of regulation. Gait automatism can be launched under specific conditions. The child is being held in a vertical axis against gravity, and the support of one limb initiates walking. Holding the child excludes the necessary regulation of antigravity supporting mechanisms and autonomic regulation of the body.
Gait training in patients with motor disorders imitates the similar situation (mostly walking in Lokomats or other hanging devices). Passive hanging of the patient excludes the necessity of regulation of antigravity supporting mechanisms. Hence, patients don’t have to control their autonomic regulation of the posture in the space. Their gait is dominantly regulated at the spinal level, similarly to new-borns and their gait automatism.
If the basic “cornerstones” of regulation of motor skills were missing (antigravity and supporting mechanisms and the autonomic regulation of the posture of the body), it would be practically impossible to “train” the bipedal gait.
“Bipedal gait is the universal basic pattern of human locomotion.” (Vojta, 2009)2 Its “cornerstones” are supporting and antigravity mechanisms, autonomic regulation of the posture of the body in the gravitational field and the stereotypical gait.
These three pieces are mutually interconnected. They have been created during the development of the first year within the developmental ontogenesis. They have been described in detail by developmental kinesiology. Therapeutic thinking must be based on them during the treatment of disorders of bipedal locomotion in children and adult patients. The therapy must be focused on restitution of all three of the above-mentioned cornerstones.
Stimulation of Reflex Zones and Reflex Points within VM2G
Stimulation of reflex zones and reflex points, the way it was introduced by Vojta, still hasn’t changed within the classical implementation of the Vojta method. Activation of these reflex points is performed by applying pressure with the fingers, thumb or the outer edge of the hand. Stimulation by pulling these zones is also performed with fingers, thumb or the whole hand. This kind of stimulation is not comfortable for the patient, infants in particular. As the longer effect of pressure or pulling leads to slow retreat of the soft tissues at the point of contact, the pressure/pulling starts to irritate the periosteum with increasing intensity. Innervation of the periosteum is not physiologically adapted to increasing stimulation by pressure or pulling on a small surface. This increasing mechanical irritation induces a defensive reaction – pain that is supposed to protect the organism from possible damage. On the other hand, long-term mechanical stimulation that is adequate in terms of force and area of stimulation is tolerated very well and ultimately leads to the activation of osteoblasts and increase in bone tissue.
If the soft tissues, mostly muscles, were subjected to pressure stimulation with fingers, their reaction would be also perceived as uncomfortable or painful in a short time. Physiological stimulation of the muscle by mechanical pressure on small area causes gradual ischemia of affected muscle fibres. But when the stimulation is performed on a larger surface over a sufficiently elastic separator that has the ability to “dull” the margins of the stimulation, the muscle adapts quite easily because no ischemia and subsequent pain occur.
The implementation of classical stimulation with fingers reduces the time, in which it is possible to perform the therapeutic stimulation. It is possible within the order of tens of seconds up to one or two minutes most.
Hands of the therapists and parent, who exercise with their children at home, represent a considerable limiting factor of classical performance of the Vojta method. Long-term isometric pressure or pulling with fingers is inadequate in terms of biomechanical construction of the fingers and the hand. It often leads to overload and subsequent discomfort, mostly inflammations of tendons of the hand and the forearm.
The use of elastic separators within VM2G has proved to be suitable for the following reasons: it removes the pain from stimulation by pressure or pulling; it enables longer implementation of the stimulation; it limits the overload of the hands of the therapists and the parents; it allows gradual temporal and spatial intensification of the stimulation, and it allows maintaining the correct vectors of stimulation pressures and pulling easily.
The existing method of retaining the exact direction of the stimulation by means of the classical Vojta method wouldn’t be probably necessary. The problem was well presented by the results of the thesis “Stimulation of zones used in reflex locomotion with TENS” by Markéta Vodňanská.3 The goal of the thesis was to demonstrate whether the stimulation of the trigger zones with transcutaneous electric neurostimulation during Vojta’s reflex locomotion in the form of reflex belly-crawling would lead to activation of the respective locomotion pattern as with manual stimulation of the trigger zones of reflex belly-crawling. The results demonstrated that the locomotion pattern of reflex crawling induced by manual stimulation of trigger zones can also be induced with TENS by stimulation of the same trigger zones. It implies that the vector of the direction of the stimulation and the pressure during manual stimulation of the zones is not necessary for induction of the locomotion pattern of the reflex crawling. Further, it was found that during stimulation of the torso zone either manually or with TENS, the same order of activation of selected muscles appears in each person. The order of activation during the stimulation of the heel zone is completely individual.
1 PIAGET, Jean. Psychologie dítěte, Praha: Portál, 2010. ISBN 978-80-7367-798-5
2 VOJTA, Václav. Vojtův princip, Praha: Grada, 1995. ISBN 80_7169-004-X
3 VODŇANSKÁ, Markéta. Stimulace zón používaných při reflexní lokomoci pomocí proudu TENS. Praha, 2011. Thesis. Charles University, FTVS. Head of the thesis: PhDr. Jitka Čemusová, Ph.D. Also available at : https://is.cuni.cz/webapps/zzp/detail/108129/