When the child cries during the exercise, does it meant he/she’s
The crying of the child (during the exercise) has several causes:
- For new-borns under 6 weeks of age, the cause usually is insufficient thermoregulation. If such a small child was undressed for a longer time, it would get cold, and logically the discomfort would be manifested in crying. It’s better to keep the child lightly dressed and to ensure adequate warmth in the room where the exercises take place.
- Another quite common cause is the so-called “positional insecurity of the child’s body”. It means the child with motor immaturity couldn’t regulate the centre of gravity of its body. If this immature child was laid on the surface, it would present its instability and hand out to find the stable support. This condition is unpleasant for children, so they express their discomfort by crying. If we held them in our arms and created a stable support, they would be pacified. During the exercise, there reflex elevation of legs and the head or stepping. It also increases the perception of positional insecurity and leads to anxious reaction and crying.
- Perhaps the most common source of crying in children during Vojta therapy is incorrect communication with the child. Children under approximately one year of age have a so-called “omnipotent” way of communicating. They dictate “how and when the talk would take place”. The child really initiates, steers and concludes the communication. It’s an innate nonverbal pattern. If the child exercised with the Vojta method “strictly”, if there was no communication and “explanation” that nothing wrong was going on, it would start to feel insecure and anxious and start to cry. It’s necessary to communicate with the child permanently during the exercise even if it wasn’t in the mood for training. What really helps is to induce the positive atmosphere without nervousness. Also, the regularity of the exercise helps the child to get used to the stress mentally, physically and in terms of its biorhythms.
- If the source of crying was pain, it would always be a mistake! Pain induces a protective reaction that disturbs the reflex exercises. Moreover, the crying caused by pain persists even if the child was held in the arms. This crying is different and parents quickly recognise that it’s “serious crying” signalling the danger.
Couldn’t I hurt the child before I learn the exercises properly?
Even when the exercise is not performed completely correctly, it is very important because the child gets used to it gradually. However, exercises that are not always performed perfectly cannot be harmful.
Is the exercise difficult? Could a single person handle it?
In small children under one year of age, one person can handle it without any problems. If there was a helpful father or grandparent, it would be very practical to alternate between the exercises. Rarely, it is necessary that both parents perform the training.
Are there any special aids we could use?
VM2G uses several aids that significantly facilitate the training – balls, elastic bandings (could be obtained in shops with medical supplies), labilising discs, wedges or children’s medical lounge, which can create tilted training surfaces. Another aid would be training dress, which has contained stimulation balls already. The balls in the training dress can implement not only pressure stimulation but also stimulation with vibrations.
Is the Vojta method absolutely for everyone?
The Vojta method shows a great deal of promise. For small children, it mainly concerns disorders of motor development (central coordination disorders, tonic disorders – muscular tension), status post peripartal fracture of clavicle, underdeveloped cores of hip joints and predilection in the posture of the head (inability to turn the head to both sides). In older children, the potential benefits are in the treatment of common disorders of the posture of the body, scoliosis, etc. In adults, Vojta method is performed in the case of several disorders of the musculoskeletal apparatus. Caution would be needed in children with proven and unstable epilepsy.
Under which occasions it would be necessary to discontinue the exercises? (illness, vaccination…)
Exercise should be discontinued for 3-4 day because of vaccination, particularly if the negative reaction has appeared (fevers, sleepiness, fatigue). Common diseases (cold, viral diseases) require discontinuation of the training only during the period of fevers or fatigue of the child. Otherwise, there are no limitations.
What happens to the body during the exercise?
By stimulating the reflex zones, the body launches (i.e. the stimulation causes specific response) its “repair program”. See below. In 1950s MUDr. V Vojta discovered general rules of kinetic development of children from birth to the period of unaided locomotion. He studied these rules in order to find a rehabilitative methodology suitable for the children that were affected by disorders of musculoskeletal apparatus (mostly after cerebral palsies). He knew that the normal motor development had its order, through which every healthy child must go. However, because he was a brilliant observer and a great neurologist, he discovered that handicapped individuals also experience development that results in so called pathological stereotypical movements. We carry normal stereotypical movements in our genetic equipment into adulthood. Also, the pathological patterns of motion are “secretly carried” in traces of memory.
Disorders of musculoskeletal apparatus during the development and in adulthood can launch the pathological stereotype. We could say that physiological (i.e. healthy) stereotypical movements represent “operating programs” of the basics of locomotion for our brain (turning, righting, gait and grip). They can be compared to operating programs in a computer. If it didn’t work, no “special applications” of locomotion would work either. This developmentally younger and more fragile “operating program for physiological basic movements” could be impaired somehow, e.g., by stroke or joint surgery. In this case, the brain would use developmentally older operating programs. But they know only pathological stereotypical movements. This primitive operating program is not able to launch “extension applications of kinetic programs” at all (e.g. jumping, dancing, playing the piano and other learned motor skills), or it launches them in a crooked and faltered form, which becomes apparent during the locomotion.
The goal of every rehabilitation is basically to return to the developmentally younger operating program that can repeatedly launch complex kinetic applications in completely normal form.
The genius feature of the Dr. V. Vojta’s discovery has been the fact that from the moment of birth, the brain has stored a “backup repair program” we had been given by nature. This ability could generally be classified with other so-called “self-healing” mechanisms of the body, represented by, e.g., healing of the bone fracture or injured skin. For the normal and successful course of the healing process (e.g. bone fracture) it is necessary to provide adequate conditions – fusing of bony fragments, rest and no physical strain. Also, for the “commencement” and successful course of the treatment of the disorder of the musculoskeletal apparatus through this backup program, it is necessary to fulfil certain proven conditions – defined position of the body, stimulation of the “trigger reflex zones” on the body and reflex (unconscious) movement.
We can distinguish two types of these movements – reflex crawling and reflex turning. As time goes by, they have been modified. Practically, it is isometric movement, like if we really “froze” the movement in a certain phase. By temporal and spatial summation of the impulses that return to the brain, we can achieve much higher efficiency. Thanks to this feedback, the repair program is able to “fill in the missing impaired or damaged information and files”. This is how the basic physiological operating program for motion “gets back to work” to the greatest extent possible. This program is necessary for physiological stereotypical movements that subsequently enable the running of the extension and complex “application programs” of locomotion.
The treatment method has been called “the Vojta method” after its creator. First, it was used to great success only in small children at risk of impairment of motor development. Because of incredible brain plasticity, this repair program is able to cure even considerable motor impairment.
How long after meals can I begin to exercise with the child?
In small, exclusively breastfed children under 3 months of age, the exercise can start after about 15 – 20 minutes. In most of children, who take solid food, it’s better to wait at least 30 minutes. The Vojta method has a significant effect on the whole digestive apparatus as it normalises smooth muscle tone of the stomach and the intestines. It facilitates the mobility of the food in the digestive tract and secondarily, it improves defecation. In small children, vomiting during the start of the exercise subsides quite quickly because of the above-mentioned mechanism.
What is the best time for the last daily exercise so that the child wouldn’t be tired or wouldn’t in the end have problems with going to sleep because of stimulation?
The common practice has shown that it’s suitable to perform the last exercise before the evening bathing of the child. It induces general tranquillity and relaxation of the child before going to bed.
How can I recognise, that I should start to exercise with my child? Can I recognise it myself or should I visit the doctor?
Every mother has an innate sense for her child’s development. She subconsciously monitors its various manifestations, especially:
the strength, intensity and clarity of its vocalisations when crying, murmuring and screaming,
the muscular tension of the body, “how the child behaves in her arms”,
how a child lies on a mat or blanket and whether it bends its back,
how it lifts its head and whether it takes a step,
whether it relaxes its fist into an open hand, how it grips toys.
If the child’s physical manifestation doesn’t correspond to the mother’s natural expectations, it can arouse in her unease and anxiety, and she will start to seek help and explanations. Dr. Vojta had a great respect for this natural maternal instinct. He never underestimated it and never played down a mother’s fears. In fact, above his surgery door was the sign:
“THE MOTHER IS ALWAYS RIGHT!”
If a mother is dissatisfied with “something” in the development of her child, which she isn’t able to precisely describe, it is imperative to seek professional help. Real professional help is never reassuring words that the “child is lazy”, that “he/she will grow out of it” and that “each child is different.” These and similar reassurances prove that the paediatrician in question isn’t able to properly examine the child with regard to psychomotor development. He/she isn’t able to clearly delineate what developmental stage the child is in, why the child behaves in such a way and isn’t familiar with developmental screening, which would provide a reliable basis for distinguishing whether a child is developing completely normally or whether there is some deviation in the development.
These deviations can in principle be divided into:
mental development disorders (e.g., Down syndrome)
physical development disorders, the so-called central coordination and tonicity disorders.
mixed type disorders
It is also a matter of the degree of the disorder, i.e. very mild, mild, moderately severe and severe.
A mother who brings her child for an examination, suspecting that there is something amiss in her child’s development, should not in any circumstance receive a vague statement. She should assertively request a clear and expert answer.
This is precisely what they pay their paediatrician for. If she doesn’t receive such a clear answer, it is her duty to seek professional help from a different doctor.
When is it possible to begin to exercise with my child?
If necessary, the exercise could start soon after birth (on 2nd to 3rd day).
What is the latest time possible to begin to exercise with the child?
It can be said that if there is a disorder of any type in a child, postponing exercise is detrimental because it reduces the chance of normalising the disorder (or contributing to its significant reduction).
During the first year, the maturing brain is incredibly “plastic”. Dr. Vojta used to say that the brain is “pregnant” with possibilities. The developing brain matter is able to create many substitute connections, which allow it to compensate for and even completely eliminate a serious defect. A defect means an anatomical disorder, e.g., destruction of portions of the cerebral tissue from postpartum haemorrhaging or damage from new-born jaundice or functional disorders, e.g., the insufficient creation of functioning neural networks, which is essential for the function of an otherwise intact brain.
The sooner the exercises start, the better the outcome is.
Why does the child sometimes cry and sometimes have fun when performing the same exercise?
At the beginning of the training, the child perceives “positional insecurity”, which is unsettling. Repeated exercises create brain connections that allow the child to “control its centre of gravity” in the respective position. This leads to cessation of feeling of uncertainty that evokes anxiety and subsequent crying. Conversely, once the child is certain in the position, it “enjoys” the possibility to preform many new “funny” movements that used to cause anxiety. It could be compared to learning to ride a bike. In the beginning, the child is also very uncertain. It often has pupils dilated in anxiety. But as it gradually manages to balance and coordinate pedalling and driving concurrently, euphoria appears because of these new locomotion possibilities.
How long will I have to exercise with my child? When is it possible to end the training?
Exercises are worthwhile until the development of the child is normalised. This is individually specific. It depends on the type and the degree of the disorder. The quickness of normalising is also dependent on the time when the exercises began. The sooner the disorder is discovered and the exercises are initiated, the quicker the normalising of the motor development is. Unfortunately, the reverse also holds true: late diagnosis and treatments results in delayed normalisation.
What would be the consequences, if we didn’t exercise with our child?
The consequences of not paying attention are also individually specific. It depends on the type and the degree of the disorder. Central moderate and severe coordination a tonicity disorders may develop into some type of cerebral palsy. Cerebral palsy is a serious developmental disorder of the motor skills of the musculoskeletal apparatus, to which the child “grows into” without early diagnosis and subsequent intensive therapy.
Of cause, there are very severe, mostly combined disorders that have a serious prognosis despite good care. Fortunately, they occur very rarely. Very mild and mild disorders tend to impair the so-called “autonomic regulation of the body”. These children develop disorders apparent in standing and in walking as well. The stereotypical gait is impaired by inner rotation of hip joints with concurrent inward turning of the toes. The frequent cause is the impairment of the correct development of the longitudinal and transverse arch of the foot. The other serious developmental disorders appearing resulting from the lack of early care are represented by defects in the posture of the body:
Inward turning of the toes
Inward rotation of the knee joints and the valgus position
Anterior pulling of the pelvis
Increased bending in the lumbar region
Weakening and bulging of the abdominal wall, often combined with weakening of the tendinous midline connection of the straight abdominal muscles with the tendency to develop umbilical and abdominal hernias
Protrusion of scapulae and anterior inward rotation of the shoulders
Disorders of the configuration of the ribcage, most often its inner collapse and subsequent disorders of the coordination of the stereotypical breathing
Side deviation of the spine – i.e. scoliotic development
Anterior pulling of the head
Disorders of the posture of the mandible in terms of autonomic regulation of the closing of the mouth; concurrent development of an incorrect overbite because of the shift of the mandible, impaired dental occlusion and increased carious lesions. (Children tend to prefer the breathing with mouth.)
There are several developmental disorders that are manifested gradually during growth.
Beside these disorders, impairments of the development of coordination of fine motor skills subsequently appear. They consist of problems with writing, reading, wrong coordination of ocular and articulation muscles and manual clumsiness, e.g., when learning to play the musical instruments.
Developmental disorders of the gross and soft motor skills largely contribute to the development and subsequent maintenance of the so-called “mild brain dysfunctions”.
Who would teach me the exercises?
Therapy using the Vojta method and VM2G is conducted by experienced physiotherapists. Admission in the therapy is responsible decision and it has to be approached in this way.
Is it true that a child that has exercised with the Vojta method, becomes physically fit earlier? (crawls and walks earlier)
Yes, it’s been demonstrated that children diagnosed with very mild and mild developmental disorders have faster maturation of cerebral structures thanks to the Vojta method. They build richer neuronal networks, which are the essence of good performance and capacity of the brain. It’s not rare that these children can stand and begin to walk before their 10th month. Their motor coordination and handiness is highly matured.
The degree of maturation of gross motor skills also appears in the faster maturation of the fine motor skills (dexterity of the hand, matured manipulation with toys, drawing…), and in the overall psychomotor development (active use of language, musicality, better ability to build social contacts, etc.)
Does the training of the Vojta method help with increased salivation in small children? If it does, until what age?
The exercises normalise all stereotypical movements in every age.
Increased salivation is an impairment of the autonomic regulation of the swallowing of saliva. Physiologically, it occurs in small children under about 3 months of age, then the ability to continuously swallow the produced saliva appears to prevent its spontaneous leaking from the mouth.
In central coordination disorders in the first year of life, persistent spontaneous leaking of saliva often continues because of the disorder of the autonomic coordination of swallowing. Spontaneous leaking of saliva is a severe problem in mentally impaired people. With correctly guided exercise, correct autonomic swallowing of the saliva could be achieved in these patients. In adults, this problem may occur after a stroke, but quality exercise can regain the normal swallowing of saliva.
Could the exercise negatively influence the mental wellness of the child? (The child does something it doesn’t want to, something unpleasant and unnatural…)
Existing research proved the opposite. Children who exercised with the Vojta method had a better relation with their parent – therapist than with the parent who didn’t participate. It’s not easy to explain why it is this way. The child perceives unconsciously that the parent doesn’t want to hurt but help. Despite fighting back and resisting the exercises, a strong positive relationship is being built. From the view of the immature ego, the non-exercising parent seems be less interested in the child than the parent that exercises. Within the course and after the exercise, the child has to be soothed. Soothing is achieved by intensive physical contact, which is very important for the development of the future positive relationship.
What are the undesirable effects of the exercise?
The Vojta method has been used for more than 50 years, and the observed side effects of the exercise were essentially positive. Apart from focusing on the normalising of the disorders of the gross motor skills, it appears that there is demonstrable positive influence on the superior nervous functions, including cognitive functions, e.g., normalising the stereognosis (the ability to identify the object by touch), normalising the disorders of the fine motor skills (writing, drawing), normalising the disorders of reading, normalising the hyperactive manifestations in children with MBD. Normalising of the strabismus could often be encountered, which is caused by incorrect coordination of ocular muscles.
Is the regularity of the exercises important?
The regularity is very important. Creating daily schedule of exercises with the child is fundamental. The child adjusts to the regularity more easily. It creates a habit and biological stereotype, which helps him to tolerate the exercise better. Regularity is a very important factor of success.
How many times a day and for how long should we exercise?
The schedule of exercises is individually specific and depends on the age of the child and the type of disorder. Generally, we can say that small children under one year of age should exercise 4 times a day, the older children once or twice a day. The duration of the exercise to start with in small infants is 0.5 minute and the stimulation is increased to 1 minute, i.e. the duration of the effect of one exercise on one side. Of course, it’s necessary to exercise on both sides symmetrically. For older children, the duration of the stimulation could be individually increased to 2-3 minutes.
Can I overload the child with long exercise?
Long-term experience with implementation of VM2G has shown that the therapy implemented this way is absolutely safe. If the exercise took too long, the reflex stimulation would switch off automatically.
If I stopped exercising for some time, would it mean that I would impair the created stereotypes and return to the beginning?
This is a bit more difficult question. In small children under one year of age, when the basic stereotypical movements are being created very intensively (righting, autonomic regulation of standing, stereotypical gait and grip), it is absolutely necessary to secure continuous building of these cornerstones of the motor skills. Thus, it is recommended to interrupt the exercise only for the necessary period, i.e. after vaccination or fevers.
In the first year of life because of cerebral plasticity, there is a great chance of normalising of many disorders of the musculoskeletal apparatus. In older children that have accomplished the “cornerstones of the motor skills”, the break doesn’t have such shortcomings.
In older children, the created stereotype is recreated, improved, optimised and tuned by the exercise. If the “foundations and gross foundation work” has been built, they would remain standing, no matter if you halt the construction for some time. If the break was too long, gradual “erosion” of the created physiological stereotype could appear with subsequent replacement with the pathological stereotype.
Are the results of the exercise permanent?
Yes, the results of the exercise can be considered permanent because they have been created by the changes within the brain tissue (creation of a denser neural network with richer connections). This is manifested in normalising and tuning of the regulation of the stereotypical movements and in changes in the musculoskeletal apparatus – correct joint centration, correct setting of the autonomic regulation of the posture of the body (ideal curvature of the spine, posture of the pelvis, shoulder girdles, etc.).
How to make the exercise more pleasant for the child?
First, it’s important to create adequate external conditions that would be pleasant for the child. In infants, it is the thermal comfort since their thermoregulation is not adequate and they get cold quickly. The temperature at the place of treatment should be increased to 24 through 26 °C. Securing a calm and cosy atmosphere is necessary. It is unsuitable to let an older sibling disturb and demand attention. The tender-hearted laments of grandmothers over “the torment of their little darling”, the grand child, are unsettling and unnecessary. If your close relatives and friends can’t help, arrange it so that they can’t interfere. The place where the exercise takes place (table or changing table) must be stable, with a soft underlay (training mat) with hygienic antiskid mat over the surface. In older children, the comfort could be improved by playing a CD with favourite fairy tales or music.
Which muscles are influenced by the exercise? Could the exercise influence salivation, enuresis, bad suction technique of breastfeeding etc.?
The therapy with the Vojta method influence all muscles in the body including the muscles of the tongue, oculomotor muscles and sphincters. The exercise normalises all stereotypical movements in every age.
Increased salivation is an impairment of the autonomic regulation of the swallowing of saliva. Physiologically, it appears in small children under about 3 months of age, so the ability to continuously swallow the produced saliva appears to prevent its spontaneous leaking from the mouth. In central coordination disorders in the first year of life, persisting spontaneous draining of the saliva often continues because of a disorder of the autonomic coordination of swallowing. Spontaneous draining of the saliva is a severe problem in mentally impaired people. With correctly lead exercise, correct autonomic swallowing of the saliva can be achieved in these patients. In adults, this problem may occur after a stroke, but a quality exercise regime can regain normal swallowing.
Enuresis of older children is complicated psychosomatic problem. The causes are difficult to determine. In some children, it is suitable to use VM2G exercises. An incorrect suction technique in children is caused by impairment of the sucking and swallowing reflex. Most often, it is related to central coordination and tonicity disorder. The exercise can quite quickly improve these simple stereotypes and allow the child to be breastfed without problems and later to be fed with more solid food. If the impairment persisted, the feeding would become stressful. Hunger forces the child to drink, but it often chokes due to its impaired stereotype. Swallowing of the more solid food becomes an even more pronounced problem. The disturbed stereotype of oculomotor muscles leads to various forms of childhood strabismus. Even this disorder could be well influenced by the exercise that normalises the tone of oculomotor muscles and their mutual coordination.
Is it necessary that the child is naked? Is it a problem to wear a diaper?
It is not necessary that the child is naked. It’s no problem for him/her to wear a diaper.
Would it mean the exercise was incorrect, if the child didn’t react during the exercise (didn’t elevate the feet)? Eventually, the child doesn’t react during the exercise, but it does during the following dressing.
I guess you are talking about the reaction with elevated feet during the exercise in supine position (reflex turning 1). The reaction on the stimulation is individual and depends on the condition of the disorder as well as the actual developmental phase. Muscle tone could be trained and the motor response to stimulation would be minimal. Anyway, consultation with experienced therapist would be necessary. He leads the treatment and would recognise if some change was required (e.g. adjustment of the position to get the feet out of support).
If the child doesn’t mind the exercise at all (it doesn’t cry from it), would it be worthwhile to exercise several more times?
It is suitable that the child doesn’t cry during the therapy. If optimal conditions were created, the crying of the child would be minimal (refer to the answer to question no. 1). Repeating of the exercises should follow the chosen therapeutic approach, optimally 4 times a day in infants.
The child wriggles during the exercise – should it be straightened?
The exercises induce basic stereotypical movements – turning and crawling. They also contain a torsion component of motion. Thus, if it was induced, it would be physiological process. So that the torsion wouldn’t be too strong and couldn’t disturb the other motion components (bending, extension…), it is suitable to perform the exercise on a mat, that wouldn’t allow the child to twist. Thus, it is better to exercise without a cloth or blanket placed underneath but rather on the sleeping pad or antiskid mat.
Eye contact should be held during the exercise, but the child turns the head in various directions. Do I have to follow the eyes of should I just talk to him and not worry about it?
Eye contact is very important. Nonverbal communication significantly helps the child to comprehend the actual situation. The turning of the head happens both spontaneously and thanks to reflex stimulation. It’s not necessary to “follow” with the eyes. The child would “return” for the contact. And it is necessary to talk to the child throughout the whole time of stimulation, if possible.
One hand should be near the torso during the exercise. Should it be the whole limb or just the arm from shoulder to elbow?
I guess you mean the position of the upper limb during the reflex turning 1 (supine position). Basically, holding the arm lightly (from shoulder to elbow) near the body would be sufficient.
If we didn’t manage to repeat all the exercises in one day, should we add some more to the next day?
Four exercises every day is optimal. If you didn’t manage to meet the number of repetitions in one day for serious reasons, it better to continue normally in the following days. Excessive repetitions are not appropriate. It is important to optimise the time management so that the breaks in exercises would be as minimal as possible.
Is the sequence of the exercises important? Or it doesn’t matter which exercise would be first and which would be the last? Should we train the left side first before the right one?
With respect to expectations of the child it is suitable to put the exercise in some order – the order between the periods of the day and during the training itself. It’s necessary to follow the recommendations of the therapist that directs the exercise.
The fear of the Lord is the beginning of knowledge,
but fools despise wisdom and instruction. [Proverbs 1:7]