Therapeutic approach of VM2G to implementation of reflex stimulation has achieved a significant progress. Thanks to the technical instruments used within VM2G therapy, the “technology of reflex stimulation” has acquired new attributes and revealed several new characteristics of the Vojta method. The newly discovered therapeutic possibilities of VM2G have been proven to be extremely efficient in children and adult patients.
The fundamental progress has been manifested in induction of the therapeutic reflex locomotion itself. Within VM2G, the reflex runs in an on-off mode. VM2G launches only the program of physiological locomotion without risk of induction of the substitute pathological program. Thanks to these features, VM2G is safe. Under supervision, it could be safely delegated to parents, other family members, close friends or “home therapists”.
VM2G induces the therapeutic reflex without risk of causing painful impulses in practically all patients. It is excellently tolerated in the long term. VM2G allows regulation of the therapeutic intensity of the stimulation and thus a significant increase in the efficacy of the therapy. The possibility of regulation consists in the overall increase or decrease in stimulation and in targeted focusing of the therapy. The therapeutic effect itself is long-lasting, even in patients who started the therapy in a chronic stage of difficulties.
Correctly implemented VM2G prevents the recurrences and allows the patients to return to long-term physical exercise.
VM2G therapy could be initiated immediately after cessation of the acute state, including the postoperative conditions.
Vm2G therapy significantly increases the comfort of the patients and the therapists as well.
New Therapeutic Utilisation of VM2G
The practice of the therapy is possible in infant patients with central coordination disorder, who are at risk of impairment of motor development, in a way that allows the regulation of the therapeutic intensity without risk of pathological development emerging.
It’s possible to safely conduct the therapy in preschool children.
VM2G can be conducted in children with attention disorders, hyperactivity or mild cerebral dysfunctions. Experience shows that the therapy could be performed even in children suffering from disorder of an autistic type. Long-lasting therapeutic practice indicates that there’s been beneficial utilisation of VM2G in patients with gynaecological problems, in pregnant patients and in patients with urogynaecological problems.
VM2G has delivered good results and excellent therapeutic tolerance in psychiatric patients after cessation of acute problems.
Another group that has tolerated VM2G therapy safely includes elderly patients, even after the ninetieth year of life.
VM2G has been proved to be beneficial in sports medicine, not only as an instrument for posttraumatic physiotherapy, but as an instrument for physical regeneration and for improvement in specific sport abilities.
VM2G has been also beneficial in patients with neurodegenerative disorders, like multiple sclerosis. The therapy has been beneficial in patients with developmental disorders of skeleton, e.g. scoliosis, chest deformities, etc.
VM2G therapy has served patients in various stages of immobility, including comatose states, very well. It improves ventilation functions, including normal evacuation of bronchial mucus; it improves food intake, digestion and defecation. It prevents the initiation and development of immobilisation syndrome.
Video – Strong response to exercise
Video – Strong response to exercise
New Psychological Approach within VM2G Therapy
The therapy of infants utilises the psychological approach that respects the specifics of communication in this period and the findings of developmental psychology. Use of technical aids significantly reduces the positional insecurity of infants that alone can induce psychic discomfort in the child.
Technical aids increase the inducement of a reflex, but the stimulation pressure on the zones only needs to be small. This eliminates the risk of the child perceiving the experience as painful.
Therapeutic guidance of mothers of the infants is targeted on good communication with the child during the exercise. It prevents the development of negative perception and subsequent aversive reaction to the therapy itself.
A carefully planned and non-aggressive psychological approach to the therapy in preschool children and children with autistic disorders has been beneficial. Slow habituation of the children to the stimulation with stimulation balls, which takes place at home, brings good results. Children gradually get used to the whole situation, they can perceive the freedom of own choice and they can stop the therapeutic stimulation any time. Thanks to this experience, they get used to the therapy and stop fighting back because they know nothing is going to happen against their will.
Another remarkable benefit of this approach is that the child gets full, intensive and focused attention from its parents. This experience leads to gradual habituation. The children consent to the therapy easily and sometimes they even ask for the therapy themselves.
For an adult patient, there is an important possibility of active attendance of the close family members during the VM2G therapy. They are not in a passive role of recipients of expert care. They participate in their healing with their own activity or alternatively with the activity of their relatives. At the same time, they realise the possibility of building sufficient physical endurance to future stress and that is very motivating for the VM2G therapy, too.
Application of VM2G in Newborns and Infants
Psychological Specifics within VM2G in Newborns and Infants
In the therapeutic relationship developed within the Vojta method, the stimulation is a very strong incision into the mental state of the child because the therapist touches the child physically. Consequently, the child experiences a myriad of feelings it hasn’t come across before. These feelings are closely related to induction of the global reflex through stimulation of reflex zones. Consequently, tonic and locomotive muscle activity is induced in the whole body. As the activity is a reflex in origin and independent on the child’s will, it must initially cause mental confusion.
According to observed initial reactions, we think it’s confusion and anxiety. In every moment of uncertainty, any child, be they new-born, infant or older, looks for explanation and help from their parents. In this situation, positive cooperation between the therapist and the parents may play a key role because well-informed parents can stand close to their child, calm it down and reassure it that nothing wrong is going on and everything is going to be fine again.
Dyadic interactions, nonverbal and verbal communication between parents and the stimulated children should lead to gradual habituation. The child should learn to ignore the stimulus that has become known and that hasn’t had serious consequences. The goal is to make a ritual and not a necessary evil of the time spent together during therapy.
Video – Care of the mental comfort of the child and the mother during the therapy
If the therapy could become a ritual for the child and the parents, through which they can pay undivided attention and enjoy physical closeness to each other, the stress and imposition would be perceived less by all family members involved.
What can contribute to making the therapy a positive ritual? The preconditions consist in correct understanding of the meaning, purpose and goal of the therapy; properly learnt technique; the ability to implement it confidently and to control the physical expressions induced by the stimulation; good time management and schedule of the activities throughout the day to prevent the time stress. It is important to keep in mind that therapy of infants must be performed 4 times daily.
The highly efficient method of prevention from burnout syndrome and physical exhaustion of the mother, who is the parent most often exercising with the child, is to regularly engage a close person, i.e. father, grandmother, etc., into the therapeutic process. It’s necessary to consider that successful therapy often requires several months of stimulation, which may cause not only mental and physical exhaustion of the mother that has no alternation, but also disorders from overload, i.e. inflammations of insertions of extensor muscles of the hand, e.g., tennis elbow.
Initially, the therapy is practiced briefly, during breaks. The child should be taken into a care-giver’s arms and assured that everything is alright and that nothing uncomfortable is going on.
During therapy, eye contact should be made and maintained within the adequate distance the child can focus on to see our face. Throughout the stimulation time, it’s very important to catch the attention of the child by talking. Nursery rhymes, poems and songs are very popular. Children taken by the melody of the voice get used to and consent to the stimulation sooner.
In terms of therapeutic approach within VM2G therapy for infants, it’s necessary to consider the findings of developmental psychology of early childhood. The therapist must actively and sensitively lead the parents to recognising the child’s reactions and not to hurry with the “commencement” of the therapeutic stimulation until he/she is sure the parents have understood the approach that should be practiced with their child. A reckless approach to therapeutic intervention, which is still practiced sometimes, is inappropriate in terms of results of the therapy and the cooperation of the parents.
From the very first weeks of life, the child has been creating the image of its surroundings and searching for “adequate and useful” reactions to them. The time invested in the establishment of the contact among the therapist, the parents and the child in the beginning of the therapy is going to pay off in the future. Because of the slight anxiety of the parents in the early phases of the therapy, we have found it to be beneficial to establish email communication, so parents can ask about uncertainties in implementation of the stimulation or responses to it. Prompt answering of the questions guides them smoothly out of helplessness and reduces their anxiety.
Video – Eye contact between the mother and the child
Learning And Long-Term Memory In Infants
For long time, there was prevailing opinion that children younger than 8 or 9 months cannot keep the information in the memory for no longer than a few seconds; refer to Jerome Kagan, 19891. The recent research indicated that this idea has been wrong. Based on observations of David C. Rubina,2 we can assume that the circumstances create the first entry towards the recognition of the target indicator.
Collected data indicate that small infants can quite precisely remember what they have learnt and they keep the knowledge in the memory for days or weeks and not seconds or minutes, as was presumed. Although the indicators of revoking the memories in infants are extremely specific, the amount of information within the context that slowly integrates into their memories, increases during the first six months of life. It has been found that infants of 3 months of age are sensitive to information from context. This is the opposite view of the common opinion that says the hippocampus, which most probably processes the information concerning the space and disposition of the place of the respective event, is not active before the end of the first year of life (see also Diamond A.)3
The infant is not only a pupil that automatically creates connections. He/she is also an active pupil who can remember for a long time, what he/she has learnt. He/she can also benefit from the learnt knowledge and perform more difficult tasks that would require recognition processes of foreseeing and anticipation. Moreover, although very dependent on its surrounding, the infant is not only a passive pupil, but a very active one, as evidenced by their facial expressions and the sounds they make, when they’re content with accomplished task or dissatisfied with failure. The first instances of learning take place within a context of mutual interaction with the environment.
These findings indicate an important fact for VM2G. If the saving of a “therapy ritual” into the child’s memory is to be facilitated, it is necessary to create adequate and consistent conditions for this. The place of training should not change. It is also very useful to create a time schedule of therapeutic exercises; it must be integrated within the child’s biological rhythm.
Case Study of a Patient with Severe Central Coordination Disorder with Muscular Hypertonicity
Illustration of the Possibilities of a Solution of a Very Hard “Start in Life”
The mother of the patient remembers in her reflection: “Matyášek was born in the 35th week of pregnancy, and he had been our “prayed for” child, who arrived after many problems. He had undeveloped lungs and severe jaundice. Nevertheless, after 3 weeks at ICU and to our great pleasure, we took him home. Like every other child from ICU, he had undergone many examinations, including several examinations by a neurologist. Everything seemed to be alright. Approximately after the postpartum period, I began to notice that he didn’t lie flat, but he turned to the side and tilted his head back. It was most apparent in the baby stroller. Within a few days, it seemed to me, he did it more and more but I didn’t know what that could mean. When I read the book Tender Parents’ Arms several times, I came across a figure of a child bent into a “C-shape”. It was written there that these children were exercising with the Vojta method.”
The patient, brought to our office by his mother, was among those, who had a very uncertain future at first sight. Neurological reports from the maternity hospital and outpatient visits proved this initial impression. The patient was prematurely born in the 35th week of pregnancy. After changing the diaper, it was apparent how difficult it was for him to only lay on his back. He tilted his head back and expressed his dissatisfaction with loud cries. His mother had taken careful notes, pictures and videos throughout the whole course of development. Among other observations, she noted: “As late as the end of the second month, I noticed, he had begun to turn to the side and it had tended to gradually worsen.” And also: “Sleeping always took place in a tight wrap; the less space, the better.” (4th month).
“He always lays on his back slightly curved. He doesn’t like the prone position and he doesn’t like to lift his head”. His head has noticeably grown.”
The next examination by the neurologist proved his mother’s fears. It revealed very severe central coordination disorder with muscular hypertonicity and excessive growth of the head. Exercises took place at home. They were very intensive – four to five times a day. After several months, the mother’s tendon in the forearm became inflamed, and she had to do the exercise with a brace on her hand.
Description of the Problem (clinical findings)
Based on previous medical history, it was apparent that a severe form of central coordination disorder might be present. The first examination we performed in the third month clearly proved that the central coordination disorder was present in a severe form accompanied by overall high muscular tension. The child spontaneously lay in a supine position in opisthotonus. He tried to find a support that had been lost to primitive reflexes. He had no support in the arms. He tilted his head backwards. Primitive reflexes could be induced with extreme vigour, particularly the reflex of Moro. All responses to positional tests were abnormal. The size of the child’s head was enlarged, which was confirmed by anthropological measurement. Conversely, the muscle volume of the limbs and torso were retarded in their trophic development.
1 KAGAN, Jerome. Unstable Ideals.
2 RUBIN, C. David Understanding Autobiographical Memory. Cambridge University Press, 1986. ISBN-13: 9780521189330
3 DIAMOND, A. Rate of maturation of the hippocampus and the developmental progression of children‘s performance on the delayed non-matching to sample and visual paired comparison tasks. Philadelphia: University of Pennsylvania Press, 1990.
Expert Explanation of the Problem
Prematurely born children are at multiple risks, particularly in terms of the impairment of future psychomotor development. Although the first neurological report from the maternity hospital and subsequent check-up described a normal condition, it could be detected from the mother’s observations, notes, photos and videos that the development of this child wasn’t heading in the right direction.
She wrote down: “Sleeping always took place in a tight wrap; the less space, the better.” This is typical of the children with great positional insecurity. It’s necessary to recreate a safe positional environment similar to intrauterine life. Positional instability is a source of unrest when falling asleep and sleeping. The children have difficulties falling asleep and wake up easily. These are the clear signs of extremely immature programs of motor skills. They wouldn’t let the child assume a resting position that would have been assumed automatically. The position is disturbed by easily induced primitive reflexes. The typical manifestation consists of an effort of the child to secure a stable position by tilting the head back into opisthotonus. To do so, the child uses primitive occipital reflexes.
In terms of developmental kinesiology, it is obvious that the development of the child didn’t progress from the new-born stage and the excessive inducibility of the primitive reflexes prevented the progress of development.
Impaired regulation of spontaneous motor skills could not provide a stable position in either the supine or prone position. This immaturity of postural autonomic regulation is the source of the child’s mental discomfort. It is shown in crying that could be hushed by creating conditions for the child to secure the position – optimally in the arms and when sleeping by reinforcement in a wrap.
Ongoing programs of primitive reflexology prevent the start of normal motor development. The child’s brain “ruled” by primitive reflexology soon starts using a substitute locomotion program for its development. This leads to substitute pathological movement interplays that result in pathological stereotypical movements. This means that basic stereotypical gait, grip, breathing and orofacial movements are impaired. Consequently, gross and fine motor skills of locomotion are impaired with all the subsequent impacts on the musculoskeletal apparatus.
Early and correctly established diagnosis of the state of the basic programs of motor skills based on the developmental kinesiology can show not only the actual condition of the child, but it also allows correct planning of the therapy. This kind of diagnosis becomes a continuous diagnostic tool in the course of the therapy as it can precisely monitor the development of the psychomotor functions and proves the correctness of the chosen therapeutic strategy.
The therapist of infant patients has to be an excellent diagnostician. The therapy within VM2G is targeted on normalisation of motor development in accordance with teachings of developmental kinesiology. Consequently, it should result in the deactivation of the substitute kinetic program without impairing the regulation of muscle coordination, as this would cause the utilisation of substitute pathological stereotypical movements.
Primarily, the therapy must “switch off” the substitute program of motor skills so that the “loading” of the physiological motor program would be enabled. Consequently, the normal development of the musculoskeletal apparatus could be started.
Illustration of the Solution
After 16.5 months of intensive exercises four times a day, they were changed to maintenance exercises of one item two times a day. There was a short-lived problem with sabre-shaped lower legs. The therapy has been completed after the following four months. Retrospectively, it’s been counted that almost two thousand exercises were done! What an extremely impressive feat! Motor development completely normalised in the 23rd month of the patient’s life. His mother has described all struggles in her reflection accompanied with many photos and videos. These materials represent a comprehensive view that reflects the course of motor development of the patient.
Explanation of the Solution
Despite the severe initial status confirmed by repeated neurological examinations, the patient has been guided out of the dangers of false motor development to the completely normal function of the musculoskeletal apparatus in all its components. We cannot conceal the fact that the therapy itself was extremely difficult for both the parents and the child. Twenty months of the therapeutic process and almost two thousand exercises speak for themselves. This all required a strong will, discipline and self-denial. It’s interesting that during this intensive therapy the child practically wasn’t ill in terms of common colds, respiratory inflammations or intestinal problems.
The implementation of VM2G started the reparative processes in the CNS. In this case, the stimulation activity was targeted on the processes within the CNS, neurogenesis in particular, and on prevention of apoptosis. Due to the utilisation of genetically determined motor programs, it is possible to perform the stimulation with maximal efficiency without the risk of overload. This plays the key role in children with severe central coordination disorder.
Notes of Patient’s Mother
Refer to report from the maternity hospital.
As late as at the end of the second month, I noticed that he began to bend and that the condition had worsened.
We have started to exercise. We attended the neurological department three weeks after the commencement of exercises. The condition was improved then, and he didn’t lie in such bent position. The photos of Matyášek lying naked have been taken on a day of the commencement of therapy to enable a comparison. Sleeping always took place in a tight wrap; the less space, the better…
He still lies slightly bent and doesn’t lift his head up. He doesn’t like the prone position. His head has noticeably grown .
Because of my acute gallbladder surgery, Matyášek was at home only with the father and on artificial nutrition. (He was fully breastfed before and afterwards.) For two weeks, he trained exclusively with his father, who knew the right method of exercise. Nevertheless, Matyášek wasn’t used to exercising with only his father. His condition worsened. Previously normalised reflexes reappeared. Because of suspected hydrocephalus, we had him examined by a neurologist. At the end of the month he began to elevate his legs when in the supine position.
In this month, Matyášek started to lift his head. He was lying on the side during play and started to put his feet into mouth.
At the beginning of this month he began to turn on his belly.
He lay totally straight in the supine position then. One hemisphere had subsided, so only one leg was bent.
In this month, he started to raise himself on his hands in the prone position more often, and he began to crawl. Detail of crooked toes. This month he gained much weight. Maybe that’s why his development has improved significantly.
Crawling got faster, see the picture of the feet.
Sometimes he got into the position on all fours, but his legs were too spread and his back too bent.
He wouldn’t sit; he wouldn’t crawl on all fours; he would just crawl on his belly. He started to climb up to slightly elevated surfaces.
He gained much weight this month. Maybe, that’s why he made such great progress. He stood up for the first time, but with a very bent back (Harrison’s groove). He began to sit and knee. He could get on all fours, but the back was still curved. Sometimes he held his feet together.
He still just crawled. We had found out accidentally that he could crawl on all fours well, but only on the mound. He could stand without a bent back and he started to walk along the furniture. He was really sure when sitting, kneeing and standing. He didn’t fall at all.
In the beginning of the month he began to crawl on all fours. He still crawled on his belly, only less. The feet were spread apart too much while crawling on all fours and the back was too bent. We tried to wear shoes, but he didn’t like them. Hence, he lay down on his belly from the sitting position.
At the beginning of the month he took three steps and later added more. Consequently, he could walk at the end of 16th month.
Training of gait. Fine motor skills are excellent – see the photo next to PC.
Improving the gait.
After 16.5 months of intensive exercise, we changed to maintenance exercises. Only 2 times a day, 1 exercise. There was momentary problem with sabre-shaped lower legs.
He could sit in the chair beautifully in the upright position. Taking photos got difficult. The subject was always running from the shot…
The sabre-shaped lower legs normalised, so we exercised 1 item once a day. Now there was a problem with crooked Achilles tendons and collapsed foot archest.
For soft motor skills, see the picture with the screwdriver when he hit a small screw. The gait was fine, sometimes he turned the tips inwards. Rough terrain made no problems. Compared to his coevals, he couldn’t manage to ride a pushbike. He couldn’t run so well, but otherwise, everything was comparable.
Reflexion of mother of small Matyášek
Matyášek was born in the 35th week of pregnancy and he had been our “prayed for” child, which came after many problems. He had undeveloped lungs and severe jaundice. Nevertheless, after 3 weeks at ICU and to our great pleasure, we took him home. Like every other child from ICU, he had undergone many examinations, including several examinations by a neurologist. Everything seemed to be alright. Approximately after the postpartum period, I began to notice, he didn’t lie flat, but he turned to the side and tilted his head back. It was most apparent in the baby stroller. Within a few days, it seemed to me, he did it more and more, but I didn’t know what that could mean. When I read the book Tender Parents’ Arms several times, I came across a figure of a child bent into a “C-shape”. It was written there that these children were exercising with the Vojta method.
Since I’ve always been ready to take action, I didn’t hesitate to find a solution. It was a weekend and Monday was far away. I consulted the problem with my friend, who’d used the Vojta method with her son. I got the contact of Mr. Krucký. I called him on Monday and booked a consultation appointment for us on Friday. On the same day, I visited our paediatrician to get the request form. She had been replaced by another physician that day. He acknowledged that our son was extremely physically impaired. He filled in the request form and we didn’t have any other problems to deal with together. It was “D” day, and we attended the consultation, which couldn’t get any worse. Our two-month old son was at the level of a new-born. That was a blow out of nowhere! I was crying the whole way back home and the whole weekend through. My husband tried to help me to cope with the news and to find new optimism. As I look back, we hadn’t even known what was at risk. We just wanted our Matyášek to be all right. Although I had unfortunately gone through quite a lot with my health conditions, this hurt me a lot – my child had to be healthy! So, we started to use the Vojta method. First, there was one exercise 4 times a day. Since the very beginning we’ve been very responsible, we’ve exercised regularly with no break. Initially, I thought to myself, there was nothing special about the Vojta method – it seemed very easy to do. Matyášek was very clever and coped with it bravely. He didn’t mind and didn’t cry. After three weeks of training, we saw the first signs of progress. He didn’t bend so much and lay straight sometimes. During one of our follow up visits, Mgr. Krucký pleased us with the findings. He said Matyášek could maintain eye contact for a very long time and that it was apparent that he was smart. I had thought to myself that if he were handicapped I would have coped with it somehow, but I still hope he wasn’t mentally challenged. Apparently, he wasn’t, which was great! The number of exercises grew and I discovered that the Vojta method wasn’t as simple as it first seemed. On the contrary, I had to plan beforehand, how each day would be scheduled so that we would manage to exercise 4 times a day. I had to keep in mind that Matyášek shouldn’t do the exercises soon after meal or when tired. I always had to manage the errands and the places where we had to be on time. Sometimes it was difficult, particularly with the visits to the physicians in another town. The paediatrician sent us to a neurologist when she found out that I had sought a physiotherapist and used the Vojta method. When I told her that at the age of 2 months he’d been at the level of a new-born, she replied that it wasn’t true, that the physiotherapist had only scared me and that “these” children looked different… The neurologist also determined that Matyášek was essentially healthy, although I mentioned that he’d improved remarkably since the beginning of the exercises. We still didn’t properly know what was at risk. When somebody asked us why we exercised and what would have happened to him, we used to answer that he might have had a deformed back or walked incorrectly, etc. A lot of people thought, we were exaggerating the problem because his condition hadn’t been so noticeable in the past; their children used to have similar problems, etc. Our family was supportive (although as time went on, nobody wanted to visit us at the time when we were exercising). And when it happened, for example, grandpa always left with absolute regularity because he couldn’t witness this “torment”. Sometimes, the exercises were pleasant, but as the time went on, they were always accompanied by powerful screams and cries. We live in a block of flats, and I often used to think that neighbours were going to inform the social department because the boy’s crying didn’t correspond with babies’ ordinary crying. Matyášek got better and his development had started well. He still liked to be wrapped tightly, the less space, the better. We attended the check-up visits every two months, and we looked forward to the next ones because each new visit meant the end of therapy was drawing closer. Initially, Mgr. Krucký had told us that children usually ended the therapy in about 8th or 9th month. So, my husband and I had set a goal to exercise until spring. We just needed an idea of an end. My husband and I both exercised with Matyášek. I have to say this was a great help for me personally because I knew that it all wasn’t up to just me. My husband had an extremely time-demanding job, but he exercised with our son at least once daily. Moreover, he got much closer to Matyášek during the exercises. Our son loved the singing and talking during the exercise. When I exercised with Matyášek, I didn’t mind the screaming. However, when my husband was exercising with him, I preferred to leave for another room. Following the first tearful weekend in the beginning, I was very positive and wouldn’t admit failure. Nevertheless, I couldn’t read about the development of the babies. I knew that Matyášek was behind, but I didn’t have to read that in this age he should have been able to do this and that. In the fourth month, he still didn’t lift his head and he didn’t like the prone position at all. Everything was going smoothly until I had to be taken for the surgery. For the first two days, I had Matýsek along with me in the hospital, but after the surgery, he stayed at home with his father. The fully breastfed four-month old son became a child on artificial nutrition. But they managed well. After 2.5 days, I could be at home again and we returned to breastfeeding. Moreover, at this time he started to lift his head and we were looking forward to another rehabilitation to show off our progress. Suddenly, it was all different and there came another blow – Matýsek’s development stopped and even worsened.
The new-born reflexes had reappeared. The prone position didn’t mean he lifted his head. He was bending his back, and the situation was severe. An immediate neurological examination was recommended and very severe neurological problem was suspected. Again, I was crying the whole way home and the whole following weekend. I was terrified, alarmed and totally wretched. Right on Monday, I ran to see the paediatrician to get the recommendation for a neurologist. After explaining our situation, she basically told me off. She questioned the place of our treatment and accused the specialist of being a charlatan! She wanted to see Matyášek in a prone position and examine him. She praised him for lifting his head and after the disagreement, she gave us the request form for the neurological examination. The neurologist wasn’t so enthusiastic about the condition of our son. She acknowledged that his prone position looked horrible and the assessment wasn’t based on how he lifted his head. She sent us for an ultrasound of the head, while other examinations could have been performed under general anaesthesia. To make a long story short, we went through a month of terrible stress, but luckily, the diagnosis wasn’t confirmed. In retrospect, we really think this it was caused by our detachment. Still, the neurologists didn’t want to tell us the prognosis. They said it was necessary to wait and see what was going to happen. Until then, the diagnosis shouldn’t be determined. All this time, we trained intensively and at the end of the 6th month, Matyášek really started to lift his head and even to like the prone position. What a joy! After about five months of intensive exercise, my first “training crises” appeared. We were still training in earnest, but for about a week I stopped to use balls and elastic nets. I felt an utter aversion to them as it always took too long to use them during the exercise. It was apparent that, following the deterioration, we couldn’t expect the therapy to end in spring. Thus, we moved the date to summer. By then we had six months ahead of us, and I was sure everything would be as it should be. There was no way we were exercising over the summer while on holiday… Matyášek started to raise his head in sixth month. One month later, he started to turn on to his belly and in the 8th month he started to belly-crawl. We were so happy about each advancement, which gave us the strength to keep on exercising with him. In the 8th month I asked Mgr. Krucký, if he could tell whether Matyášek would walk in the future. I expected a direct answer and was very surprised to hear that it couldn’t be predicted yet. I started to sense that it could be cerebral palsy we were trying to prevent by exercise. I had always thought that children with cerebral palsy were born with impaired limbs – after all, anyone could recognise cerebral palsy. After reading a certain article, I realised I’d been wrong. The limbs tend to bend in time, when the muscles couldn’t be used. Possibly from the 9th month, our exercise began to be physically demanding. Matyášek fought back and tried to get out of the positions. My hand started to hurt because of tendonitis. I had to tie them up and strengthen them during the nights to be able to exercise the next day at all. I used to exercise in pain and, sometimes, with tears in my eyes. But it had to be done. After the next month, my condition improved, but I had to protect my hands. Basically, they weren’t completely healthy until the end of the treatment. The summer was near and it was clear to us that we would have to move our target date. At one year of age, Matyášek couldn’t sit, he still only crawled. Two days before his first birthday, we visited the rehabilitation department again. And we got the best birthday present possible. Only at 10 months of rehabilitation were we told the truth: Matyášek really was at risk of developing cerebral palsy affecting both legs and one arm, the prognosis was severe and it seemed that Matyášek would have to remain handicapped. But at the age of one year, the risk of cerebral palsy was over! We were absolutely overwhelmed by euphoria for several days. I felt like I was walking on air. I was thinking, whether I would have wanted to know about the risk from the beginning. I like to know everything, and I minded the secrets, which the neurologists kept during their check-ups. Fortunately, we took the exercise seriously from the very beginning and trained as we should. So, we didn’t mind, we hadn’t known the truth. But I suppose, for many people, this might have been a stumbling-block, and they wouldn’t have exercised the way they should have. We continued with the exercise, although it was just a “cosmetic issue”. It was summer and we went to the cottage and on vacations and trips. We continued to train four times a week. Sometimes, it was difficult. But you do what you have to do. A specially manufactured tilted exercise mat travelled across the part of Europe along with us. Matýsek made great progress during the 13th and the 14th month. He sat and began to stand up, but his movement was limited to just crawling. In the beginning of the 15th month he surprised us by crawling on all fours! It was absolutely unbelievable as we’d waited for it for so long. In the beginning of the 16th month, he took three unaided steps. The following week, he took five steps, gradually taking more. Then, he stood without support and we expected the moment he would start to walk. The vision of the accomplishment of the therapy was so near.
At the beginning of the 17th month, Matyášek began to walk! We all were so thrilled, rejoicing that we could look forward to the end of exercise. But the end hadn’t come yet. The gait wasn’t perfect, so we had to improve it. After 13 months of intensive exercise, we got rid of the worst exercise – on the belly. Suddenly, the exercises were easy to do and completed quickly. I have to admit, that I had a minor “exercise crisis” again and for some time I trained without balls and elastic nets. Matyášek was 16 months old. During the exercise, he was pulling the balls. He didn’t like to wear them. He took them and threw them away. Throughout the whole course of the exercise, there were many unpleasant moments and moods. Sometimes we argued with my husband, who should have exercised that day. We would have rather do the least enjoyable activities to avoid exercising. Many times, I didn’t want to exercise, I postponed it and shifted it around during the day, which spoiled the mood. Several times, I wanted Matýsek to sleep as long as possible because the idea of exercise after getting up frustrated me. My husband also “blew up” during the exercise sometimes and said he was done with it. It was impossible to keep Matýsek in a position. He pulled on the balls. The elastic nets slid down.
The rehabilitation was extremely difficult, but thank God for it. What value would there be in a year of exercise, if Matýsek wasn’t able to walk and had instead stayed wheelchair-bound? We are so thankful for the method that could make life better for our littlest ones. Why wouldn’t we do this for them! In our case, there was an obvious maximal progress and improvement. The potentially handicapped little boy has become healthy. He can run around as he pleases. It takes a lot of strength, effort and patience, but it’s worth it for sure! We have to thank our physiotherapist Mgr. Krucký so much for his proper leadership in the exercises, great deal of useful advice and findings and excellent approach to our son. He had difficult times too – the very moment Matyášek saw him, he started to weep heartbreakingly, as he realised what he was up to. The doctor had to hide to stay unseen to let Matyášek act naturally. For a long time, we attended the visits with the video camera because Matýsek wouldn’t show anything at the office. Christmas was near, and we were looking forward to a special present – the successful completion of the rehabilitation. The joy didn’t come. We moved the deadline again. Maybe, it would come by the next visit next month. It had to come one day. And it almost did – at the next visit at 18.5 months of age, the exercises more or less ended. We didn’t have to exercise 4 times a day. One exercise 2 times a day was enough. Anyone who has ever trained will understand why we saw it as the end of therapy. Matyášek still had sabre-shaped lower legs – a condition that should improve with growth. Thus, there was the maintenance exercise. We had a party together because we got to this point after 16.5 months of intensive exercise. We could enjoy the whole day We didn’t have to plan. We managed to do everything on time. We were thrilled because the morning and evening exercises took just a little time. After a month, we didn’t feel like keeping up with the training, but we remained determined to follow through to a successful end. The progress was apparent. We hoped D-day was near. I have to say, I’m glad I didn’t know how long we would have to exercise for. Due to my profession, I couldn’t help to calculate how many times we exercised. And I arrived at a terrible number – 1,980 times! This is a decent sport performance! We haven’t finished yet, but this minor exercising is not worth counting any more.
Videos – Samples of therapy
New Approach to Management of VM2G Therapy
Due to new approach to management of therapeutic interventions, VM2G has become easily accessible. The model of exercise of the mothers with infants under supervision of the therapist implemented by Dr. V. Vojta in the 1950s wasn’t well understood at that time. The results showed that in practice it’s been the only functional model of care of the infants at risk of incorrect motor development.
This model delegating the practical therapeutic stimulation to relatives of the patients under regular physiotherapeutic supervision seems to be extremely beneficial within VM2G. Within this organisation of practical implementation of VM2G, it is possible to take care of significantly more patients than could be manageable within conventional physiotherapeutic practice. Concurrently, the implementation of the stimulation is secured on a daily basis for several months or years. Such physiotherapeutic care wouldn’t be possible in common healthcare facilities.
Care of home therapists represent a model of therapy that has been experienced in child patients with developed pathological findings of the musculoskeletal apparatus, cerebral palsy in particular. Often, it’s too difficult for the parents of the handicapped children to provide regular home rehabilitation. The basic home care of a handicapped child is so exhausting that the parents give up the home rehabilitation soon or later. This has unfavourable consequence for the development of these children. Often, it leads to restriction of their mobility.
Home therapists are well-trained. They take care of four to five patients at a time. Home therapists provide the care during office hours. The children obtain their care at home, at the kindergarten or at school they attend. In the summertime, the visits at the cottages of their grandparents can be possible. A home therapist attends the regular supervisions at the office with their patients. This secures continuous and gradually intensified physiotherapeutic care. This service is very beneficial for the family of handicapped children.
Home care service is also available for adult patients who haven’t had the possibility to undergo home care with close relatives or friends. We found the possibility of implementation of video streaming technologies and saving of the therapeutic sessions with the home therapist to a server to be extremely beneficial. This allows remote management of the quality, the method and the reflex response during therapy.
Home therapist during the supervision check-up at the office.
VM2G – Therapy in the Children at Risk of CCD (Central Coordination Disorder)
After 10 years of VM2G practice (since 2006) more than one hundred infants have attended my office. They were admitted due to suspected risk of incorrect motor development, i.e. CCD. The development of most of them has been documented on video.
The results of two cases concerning infants are extraordinary among others. One of them was diagnosed with a rare congenital metabolic disorder and entered a vegetative state. The other suffered asphyxiation during delivery, but was resuscitated after about 10 minutes of apnoea. The magnetic resonance imaging of the brain showed necrosis of practically all cortical areas. However, the implementation of VM2G prevented the development of any pathological changes of their musculoskeletal apparatus in terms of spastic transformation of the muscles, shortening of tendons and collapse of the chest of malfunction of the diaphragm. Due to these results, the care of these handicapped children is significantly easier.
A whole spectrum of degrees of CCD occurred in other children. As supposed by V. Vojta (1991)1, the children with very mild or a mild degree of CCD could be successfully guided towards normal psychomotor development. In moderate degrees of CCD, it could be expected that the development of the child bearing such risk could be accompanied by some motor problems. Beside these motor impairments, there are often associated disorders in terms of light brain dysfunction, concentration disorders and subsequent disorders of a wide spectrum of specific learning disorders (i.e. dyslexia, dysgraphia, dyscalculia, etc.). It is confirmed by long-term practice and often supposed in children at risk of a severe degree of CCD that their development would head towards some type of CP. The Vojta method has been mostly successful in alleviating the degree of affliction, i.e. the development stabilised at diparesis instead of quadruparesis.
The View of the Prognosis, Diagnosis and the Therapy if the Children at Risk of Motor Development Disorder due to Central Coordination Disorder (CCD) and Its Solution in Terms of VM2G
V. Vojta (1991) postulated that it could be presumed in most cases of children at risk of a severe degree of CCD that their development would head towards CP, as confirmed by long-term practice.
Therapy with the Vojta method has been mostly successful in alleviating the degree of affliction, i.e. the development stabilised at diparesis instead of quadruparesis. Our experience showed that children who underwent VM2G therapy regardless of the degree of risk of CCD were successfully led to completely normal motor development, i.e. normal bipedal gait.
Of course, therapy in children with the severest degree of CCD was most complicated and longest, but there are no doubts about its efficacy.
Children who had undergone VM2G therapy could be guided to normal motor development and normal bipedal gait, regardless of the degree of the risk of CCD, i.e. children who had demonstrably severe degree of CCD.
Of course, therapy in children with the severest degree of CCD was most complicated and longest, but there are no doubts about its efficacy.
VOJTA, Václav. Vojtův princip. Praha: Grada, 1995 ISBN 80-7169-004-X